Our View: Doctors more than the patients are abusing Gesy

The Health Insurance Organisation (HIO) started a new campaign on Thursday aimed at tackling abuses of Gesy, which “constitute one of the major problems threatening the viability of the system”. It has created a road map for dealing with the abuse, the HIO said in an announcement, and the main thrust would be ‘enlightenment campaigns’ aimed at educating users about the system and the service providers – the doctors. The objective was “the cultivation of a culture of rational use of the Gesy health services”.

“Put yourself in his position, don’t take his position,” is the title of the campaign which aims at making users and providers understand that “taking advantage of and abusing health services does not only hurt the system, but everyone separately”. Too many people have been demanding medical tests, specialist treatment for no good reason, thus clogging the system and delaying people who urgently require care from receiving it. It is this mentality, which has existed ever since the introduction of Gesy that the HIO wants to fight, because it is threatening the system. 

This is the first of the three phases of the campaign said the HIO, which stressed that “the cultivation of a culture of correct use of the health services of Gesy, undoubtedly is the key to the country’s health system remaining strong and effective.” HIO bosses are deluding themselves if they think an advertising campaign will change the existing culture of entitlement among patients and the profit maximisation ethos of many Gesy doctors and clinics, which feed off each other and threaten to bankrupt the system.

They are right to want to tackle the patient culture, but doctors who exploit the system by carrying out unnecessary operations, because these maximise their earnings, as well as the revenue of the hospitals/clinics they work for because the daily rate per bed is higher for patients that have undergone surgery, are as big a threat to the system’s viability. It is no coincidence that patients with pathological ailments are not accepted by private hospitals, because the rate per bed-rate is low, and they all end up at public hospitals.

A day before the campaign commenced, we read a report about a lawsuit brought against surgeon who had carried out an operation on the left knee of a young man who had pains in the right knee. The doctor offered to operate on the right knee as well after the blunder was exposed, but the young man decided to visit another doctor of the same specialty, who told him his right knee, actually, did not need an operation. This was what the first doctor had also said, but he still put the patient under general anaesthetic to carry out an arthroscopic test.

This shows how the combination of the different cultures of patient and doctor led to an unnecessary operation at significant cost to Gesy. The patient insisted he should have the exploratory operation because it was free, while the doctor, although he thought it was unnecessary, went ahead with it, as he would be well-rewarded. Unnecessary operations are big income earner for doctors and private hospitals, but the HIO seems to pretend that they are not a problem.

In fact, the milking of the Gesy cash cow by doctors, private hospitals and clinics, medical testing labs and pharmacies should be the primary concern of the HIO, although it would take a lot more than some advertising campaigns to tackle the endemic, money-making culture that poses the biggest threat to the future of Gesy. Admittedly, the sense of entitlement of patients, who demand costly tests and referrals to specialists for the most innocuous ailment –because they do not have to pay for them – helps the providers generate more business. The ease with which some subject themselves to operations – because they do not have to pay – on the advice of some doctor, more concerned about his pocket than the patient, is also a problem.

The HIO must try to end the culture of Gesy over-use, but this will take many years to materialise. Perhaps it should consider imposing some charges to deter over-use, even if this would spark a public reaction. Paying a small amount would be much more effective than an advertising campaign in reducing abuses of the system because it is free. At the same time, the HIO must turn its attention to limiting the milking of the system by healthcare providers, because it is they, more than the patients, who are threat to the system’s viability.