Visits and referral through Gesy, I'm confused, please explain
Dear Dr Makis
Gesy has been in the news a lot recently, there is talk of limiting visits to see GPs for free and having to pay if we exceed this number. My friends and I are really confused about this, especially when we are informed by Gesy that a visit has been opened by my GP when we haven’t even been to see them. Can you clarify exactly what is happening?
Up until several years ago, Cyprus was one of the few European Union countries that didn’t have a formal, structured system to provide modern healthcare to its citizens and legal residents. Gesy was devised to provide this. It is a publicly funded healthcare system; this means it is effectively paid for by the citizens and legal residents of Cyprus through taxes and specific contributions. It is therefore our collective responsibility to ensure that we use the system appropriately, and that it is not abused.
Gesy provides extensive and comprehensive modern healthcare from vaccinating babies and infants, to providing expensive and complex treatment for serious medical conditions such as cancer, and everything in between.
Gesy is based on a primary care model of healthcare, that means that each beneficiary of Gesy is allocated to a personal doctor (what we know to be a GP in the UK). The personal doctor’s responsibility is to provide the basic healthcare needs to their registered patients, to advise their patients and guide them through what additional care they may need, either in the form of medication; investigations such as blood tests and scans; or specialist referrals. The personal doctor is acting as a gatekeeper to the Gesy healthcare system.
When your personal doctor needs to record a medical consultation; a telephone conversation he or she may have had with you; prescribe you medication or a repeat prescription; order blood tests or x-rays; make a referral to a specialist; or record and claim that you have been given a vaccination, a visit needs to be opened on your Gesy medical records. Once a visit is created, this will remain open for about one month and can be used multiple times for subsequent activities before it is automatically closed and can no longer be used. Another visit will then need to be opened for any future activity on your medical record, you do not need to be physically present for a visit to be opened, for example when a repeat prescription is issued.
The number of visits you have allocated every twelve months depends on your age. Over 65 year olds are allocated 10 visits a year, 50 to 64 year olds are allocated 8 visits a year, 40 to 49 year olds are allocated 6 visits a year and under 39 year olds 4 visits a year. If a patient exceeds their allocated number of visits, then their personal doctor can charge them €15 for any subsequent visits. This €15 will be deducted from the payment the personal doctor receives from Gesy, i.e. it is not profit made by the personal doctor, they will be recouping the cost deficit for the additional visit directly from the patient.
As already mentioned, your personal doctor is your first point of contact with Gesy. It should be him or her that initially assess your medical condition and decide what further treatment you need. This may include a referral to a specialist doctor for further investigation or treatment of your specific condition. A referral is a professional communication between doctors about the patient, it is not just an administrative exercise performed by your personal doctor.
A referral by a personal doctor will enable the patient to consult with specialist doctor to through the Gesy system with a €6 cost to the patient, and is valid for 2 visits, the referral will expire after 6 months if not fully utilised.
If a patient attends a specialist doctor without a referral from their personal doctor, then they can be seen by making a payment of €25 directly to the specialist directly. We regularly have telephone requests asking for a referral because a patient is at the specialist without a referral, this is professionally inappropriate and puts the personal doctor in a difficult professional position. If a patient is under regular review by a specialist, then the specialist can request a long-term referral which enables the patient to be seen up to 12 times in the year depending on the patient specific condition and clinical need.
The purpose of all these limitations is to ensure the appropriate use of the public funds that provide these vital healthcare services, we all will need to access these at some point in our lives. These regulations are trying to ensure that these public funds are used to as efficiently as possible and inappropriate use is kept to a minimum, this is why we are seeing regular changes to the Gesy system made by the health insurance organisation (HIO).
Further information can be found on the Gesy website.
Dr Makis offers medical advice via his monthly article in the Paphos Post newspaper. If you require personal medical advice, contact your own GP in the first instance. For further information about Veramedica Medical Center, please contact us.