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How will healthcare providers be paid?
GHS healthcare providers will be paid as follows:
 
Phase 1: (outpatient services)
 
(a) Personal doctors[1]:
  • Capitation fee

  • Fee for Service for specific medical  activities and services based on:

  1. a fixed fee,

  2. a price per point

  • Performance Reimbursement on the basis of a price per point for the achievement of specific key performance indicators (KPI’s)

 
(b) Outpatient specialists:
  • Fee for Service on the basis of a price per point for medical  activities and services as defined in the services catalogue of each specialty

  • Performance Reimbursement on the basis of a price per point for the achievement of specific key performance indicators (KPI’s)

 
(C) Laboratories:
  • Fee per lab test or group of lab tests on the basis of a price per point.

 
(d)  Pharmacists
  • Fee per pack dispensed on the basis of a price per point.

 
(e) Pharmaceutical products, medical devices and consumables:
  • Reimbursement per item on the basis of a fixed price

 
 
Full GHS Implementation:
(f) Inpatient treatment:
  • Fee per inpatient case on the basis of a price per point – The Diagnosis Related Groups (DRG) codification system is applied.

 
(g) Allied health professionals (speech pathologists, clinical dieticians, clinical psychologists, nurses, midwives, occupational therapists, and physiotherapists):
  • Fee for Service on the basis of a price per point for services and activities as defined in the services catalogue of each category of allied health professionals.

 
(h)  Accident and Emergency Departments:
  • Fee for Service on the basis of a price per point.

 
(i) Ambulances:
  • Fee for Service on the basis of a price per point.

 
(j) Rehabilitation and palliative care centres
  • Fee per diem and/or Fee for Service (to be confirmed).

 
(k) Preventive dental care
  • Fee for Service.


[1] Including both PDs for Adults and PDs for Children  (Paediatricians)
How often will the healthcare providers be reimbursed?
Within the framework of the GHS, healthcare providers will be reimbursed by the HIO on a monthly basis both for the services for which they will submit claims (Fee for Service), as well as for the services for which they will not submit claims (Capitation Fee and Performance Reimbursement).
What is a Capitation Fee;
It is the amount received by personal doctors for every beneficiary that is registered on their List of Beneficiaries.  The amount is calculated based on the age group that each beneficiary belongs to: e.g. the capitation fee for older adults will be higher than the respective fee for younger adults.  The amount of the capitation fee will be independent of the number of visits of the beneficiary to his/her  personal doctor.
How is the Capitation Fee calculated in case a beneficiary changes his/her Personal Doctor?
In case a beneficiary changes his/her personal doctor within any month, the capitation fee will be calculated based on the number of days that the beneficiary is registered on the List of Beneficiaries of each personal doctor.
What is Fee for Service on the basis of a price per point?
Fee for Service based on a price per point is the fee received by healthcare providers for every service they provide in accordance with the services catalogue set for the specific category of providers in which they belong, which will be calculated on the basis of the price per point as follows:   A specific number of points (weighting) is assigned to each catalogue service, which is then multiplied by the price per point in order to calculate the fee for the specific service.  The price per point for a specific group of services is calculated monthly on the basis of:
 
The monthly budget for the specific group of services, and
The total number of points of the monthly claims submitted by healthcare providers and approved by the HIO for the specific group of services.
Why is the Point System Mechanism used?
The Point System Mechanism is necessary in order to apply the Global Budget and it ensures that during any financial year, the budget allocated to each category of healthcare providers will not be exceeded. More specifically, it is ensured that, irrespectively of the actual volume of services provided, the price per point is readjusted on a monthly basis so that the total actual expenditure does not exceed the predefined annual budget for each category of healthcare providers.
What is the Fee for Service based on a Fixed Fee?
Fee for Service based on a Fixed Price is the fixed fee received by healthcare providers for every service they provide as defined in the relevant services catalogue that is set for the providers’ category to which they belong.
What is Performance Reimbursement?
This method of reimbursement applies for personal doctors and outpatient specialists and its application is anticipated at a later stage when all the required actual data will be collected through the IT System after the implementation of the GHS.  Key Performance Indicators (KPI’s) will relate, among others, to the level of updating of the medical profiles of beneficiaries in the IT System and the number of referrals and prescriptions of pharmaceuticals, lab tests and other diagnostic tests.
What is the Global Budget?
The Global Budget is the annual budget defined by the HIO after consulting with the representatives of the healthcare providers and approved by the parliament, that will be made available for the provision of healthcare services to GHS beneficiaries during the following year.
Who will contribute to the GHS?
The categories of contributors to the GHS Fund are the following:
•    Employees
•    Employers
•    State
•    Self-employed
•    Pensioners
•    Income-earners
•    Officials
Will patients be charged in case they choose a pharmaceutical product that is more expensive than the one fully covered by the GHS?
Yes, in case a pharmaceutical product is interchangeable and the patient chooses to take a product that is more expensive than the one fully covered by the HIO, he/she must pay the pharmacist the amount of Contribution II which is an amount equal to the difference between the price of the pharmaceutical product fully covered by the GHS and the price of the pharmaceutical product that the patient chose.  Contributon II is paid in addition to the co-payment (€1 per pharmaceutical product).