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Which legislation governs the GHS?

The GHS legislation is composed of the General Healthcare System Laws of 2001 to 2017 (Law) and the Regulations, internal regulations and Decisions issued in virtue of these.

Regulations are drafted by the HIO, approved by the Council of Ministers and are subject to approval by the House of Representatives.

Internal regulations are drafted by the HIO, approved by the Minister and published in the Official Gazette of the Republic.

Decisions are the decisions made by the HIO and published in the Official Gazette of the Republic.

What is the Health Insurance Organisation (HIO)?

The HIO is a legal entity governed by public law responsible for the implementation, monitoring and management of the GHS.

Among other things, it is responsible for the management of the General Healthcare System Fund, for securing equal and non-discriminatory access and healthcare services to beneficiaries and for contracting with healthcare providers.

Who governs the HIO?

The HIO is governed and acts by a 13-member Board of Directors composed of:

The Chairman,
Two ex-officio members who are the Permanent Secretaries of the Ministries of Health and Finance respectively,
Two members representing the Government,
Three members representing the employers’ organisations,
Three members representing the trade unions,
One member representing the patients, and
One member representing the self-employed.

What is the labour status of the HIO employees?

HIO employees are appointed by and are under the supervision of the Board of Directors.

Their terms of employment and other labour relations issues are stipulated in the relevant secondary legislation and in particular in:

The Health Insurance Organisation (Staff Recruitment, Promotion and Service) Regulations of 2013,
The Health Insurance Organisation (Staff Recruitment, Promotion and Service) (Amending) Regulations of 2018, and
The Health Insurance Organisation (manner, preparation procedure, type of forms and submission of employees’ assessment reports) Decision of 2014.

Which healthcare services are provided by the GHS?

The healthcare services provided by the GHS include all services stated below as these are determined by Regulations and/or Protocols adopted by the HIO:

(a) Healthcare services provided by personal doctors (1st stage)

The healthcare services provided by a personal doctor, the fee, the minimum requirements for the provision of healthcare services, the GHS enrolment process, the conclusion of a contract with the HIO and the keeping of a record by a personal doctor are stipulated in The General Healthcare System (Personal Doctors) Regulations of 2018.

The HIO Board of Directors may in exceptional cases, as these are determined by a Decision, request from the Minister of Health to allow a specific doctors’ specialty who chose to contract with the HIO as personal doctors to provide inpatient healthcare services to beneficiaries registered in their list;

(b) Healthcare services provided by outpatient specialists (1st stage)

The healthcare services provided by outpatient specialists, excluding inpatient healthcare services, the specialties or specialties and specialisations of doctors with whom the HIO shall contract, the fee, the minimum requirements for the provision of healthcare services, the GHS enrolment process, the conclusion of a contract with the HIO and the keeping of a record by an outpatient specialist are stipulated in The General Healthcare System (Outpatient Specialists) Regulations of 2018.

(c) Laboratory Tests (1st stage)

The healthcare services provided by laboratories, the fee, the minimum requirements for the provision of healthcare services, the GHS enrolment process, the conclusion of a contract with the HIO and the keeping of a record by a laboratory are stipulated in The General Healthcare System (Laboratories/Laboratory Tests) Regulations of 2018.

(d) Pharmaceutical products, medical devices and medical supplies (1st stage)

These are the required pharmaceutical products, medical devices and medical supplies prescribed by a doctor or dentist and included in the catalogue of pharmaceutical products and the catalogue of medical devices and medical supplies (1st stage).

The provision of pharmaceutical products, medical devices and medical supplies that are not included in the relevant catalogues may be allowed subject to terms and conditions set out in internal regulations;

The required pharmaceutical products, medical devices and medical supplies covered by the GHS, the pharmacist’s fee, the minimum requirements for the provision of healthcare services by pharmacists, the GHS enrolment process, the conclusion of a contract with the HIO and the keeping of a record by pharmacists are stipulated in The General Healthcare System (Pharmaceutical Care) Regulations of 2018.

(e) Healthcare services by nurses and midwives (2nd stage)

(f) Palliative healthcare (2nd stage)

(g) Healthcare by allied health professionals (2nd stage)

(h) Inpatient healthcare (2nd stage)

(i) Preventive dental healthcare (2nd stage)

(j) Medical rehabilitation, including the supply, maintenance and renewal of orthopaedic devices, orthoses and prosthetics (2nd stage)

(k) Home visits by Nurses (2nd stage)

(l) Beneficiary transportation by ambulance (2nd stage)

(m) Healthcare as stipulated by Regulations, in case of accidents and emergencies (2nd stage)

The provided healthcare services do not include long-term psychiatric institutionalised or compulsory care that is provided by virtue of the provisions of the Psychiatric Hospitalisation Law.

What does the HIO require from healthcare providers?

The HIO may demand from all healthcare providers that they and/or their staff do the following:

Attend educational programs on the effective implementation and operation of the GHS,
Attend training seminars organised from time to time,
Implement the clinical guidelines and beneficiary safety and/or quality standards adopted by the GHS,
Keep records of beneficiaries,
Submit, with their claims for the payment of the healthcare services they have provided, data in the form set by the HIO,
Allow entrance to their facilities to people authorised by the HIO for control purposes,
Provide non-discriminatory healthcare services

Can I receive healthcare services abroad?

Healthcare services may be received abroad in accordance with procedures set by the HIO and after considering each request separately.

How will I receive inpatient healthcare services until June 2020 that this service will be included in the GHS?

Until June 1st 2020, patients will receive inpatient healthcare services in the same manner that is currently in force, i.e. someone who is a public service beneficiary will receive services from public hospitals for free. If you are not a public service beneficiary you will receive the services that are not yet included in the GHS at your own cost or by private or group insurance coverage if this is applied by the private or the public sector.

How can I provide healthcare services to the GHS?

In order to provide healthcare services to the GHS you must comply with the following:

· Natural persons: all natural persons (doctors, pharmacists, laboratory managers) who wish to provide healthcare services to the GHS must first enrol in the GHS as healthcare professionals stating the service they wish to provide and following the procedure described in question 10. Next, if they wish to provide their services as self-employed persons they shall submit a request to conclude a contract for the service they wish to provide. If they are employed by a legal person or association of persons or the state services then the request to conclude a contract shall be submitted by the employer of the said natural person.

· Non-natural persons: all legal persons, associations of persons and state services (e.g. public service, hospitals, doctors companies, laboratories etc.) that wish to provide healthcare services to the GHS must first enrol with the GHS and state the service they wish to provide (separate request form for each service) following the procedure described in question 10 and then submit a request to conclude a contract for the specific service.

What is the GHS enrolment process for the provision of healthcare services?

The GHS enrolment process for the provision of healthcare services is described in the separate Regulations for each service (PDs, OSs, pharmaceutical products, and clinical laboratories).

All parties wishing to enrol in the GHS for the provision of healthcare services must do the following:

Fill in and submit via the Provider Portal a request to be enrolled with the GHS for a specific service (a separate request form must be submitted for each type of service).
Print, sign and send by post to the HIO the enrolment request they submitted online via the Provider Portal attaching original or certified copies of the supporting documents set out in the request form.

In case the request is approved the HIO shall inform the applicant and then it may ask the applicant to present themselves for identification and to complete the enrolment process.

In case the request is rejected the HIO shall inform the applicant duly justifying the reason/s for the rejection.

What is the HIO and Healthcare Providers Contracting Procedure?

A person wishing to conclude a contract for the provision of healthcare services must:

(a) First, enrol in the GHS as a person wishing to provide healthcare services within the GHS framework for a specific service,

(b) Fill in and submit via the information technology system – Provider Portal – the request to conclude a healthcare services provision contract for that specific service, and

(c) Print, sign and send by post to the HIO the request for concluding a contract that they submitted online and attach the original or certified copies of the supporting documents set out in the request from.

In case the request is approved the HIO shall inform the applicant and invite them to present themselves to sign the contract and complete the process.

In case the request is rejected the HIO shall inform the applicant duly justifying the reason/s for the rejection.

Please note that the request for enrolment with the GHS and the request to conclude a contract may be filled in and submitted at the same time.

Can a natural person provide more than one healthcare service within the GHS framework (e.g. as an OS and as a laboratory manager or as a PD and an OS)?

Natural persons who have enrolled as PDs may not provide any other service to the GHS. In addition, natural persons who have enrolled as OSs, laboratory managers and/or pharmacists may not be enrolled as PDs.

Can a legal person provide more than one healthcare service within the GHS framework?

A legal person may provide any, some and/or all healthcare services covered by the GHS provided that it complies with the provisions of the Laws and Regulations and have stated at least one natural person who shall provide on their behalf each of the services for which they have concluded a contract.

What is the GHS enrolment process for beneficiaries?

Beneficiaries wishing to receive GHS healthcare services must enrol in the GHS in accordance with the enrolment process set out in a Decision by the HIO.

See Knowledge Data Base for the GHS Beneficiary Enrolment Process.

Are healthcare providers obliged to have insurance coverage?

Healthcare providers must be covered by professional liability insurance (against negligence) for the provision of healthcare services by an independent insurance institution or organisation for the amount and content that is deemed adequate by the HIO Board of Directors from time to time.

What is the Medical Board?

The Medical Board is appointed by the HIO Board of Directors in order to give advice to the Board of Directors regarding the necessity of transferring beneficiaries abroad for the provision of healthcare, the securing of continuous provision of healthcare services and the monitoring of beneficiaries both prior and after their travel abroad, the expedience of costly healthcare services or healthcare services of limited or ambiguous effectiveness as well as any other task assigned to it by the Board of Directors.

What is the Secondary Medical Board?

The Secondary Medical Board is appointed by the Minister of Health and is responsible for consulting the HIO Board of Directors on objections against the decisions of the Board of Directors as well as exercising any other capacity that may be assigned to it by the Minister of Health.

What is the Medical Audit Committee?

The Medical Audit Committee is appointed by the Minister of Health and its purpose is to secure the provision of high quality healthcare services and take all appropriate measures as regards specific incidents where healthcare providers have not exercised reasonable skill or attention. Depending on the case under investigation, representatives of the relevant medical society and/or other relevant scientific and/or professional body also participate in the Medical Audit Committee as well as a patients’ representative with special education and training.

When will the GHS be put into force?

On June 1, 2019 the first stage of the GHS will be put into force and it includes the provision of healthcare services by personal doctors and outpatient specialists, pharmaceutical care and clinical laboratory tests.

On June 1, 2020 the GHS will be fully implemented and it will include inpatient care, healthcare services in cases of accidents and emergencies, ambulance services, nurses, midwives and allied health professional services, palliative healthcare, medical rehabilitation, home visits by nurses and preventive dental healthcare.

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