CNAS reacted on Friday to the investigations about imaging services and the use of radiologists’ initials between public and private, qualifying the situations as “serious practices”generated by structural deficiencies and the lack of coherent systemic reforms.
“Following the published journalistic investigations regarding the operation of some medical imaging services and the use of initials of radiologists in the relationship between the public and private sectors, the National Health Insurance Agency (CNAS) makes the following clarifications: The situations described represent serious practices, which, although isolated, have justified our recent concerns about the efficiency of the social health insurance system. The mentioned examples are part of a conglomeration of dysfunctions perpetuated in the health system in the last 10-15 years, as a cumulative effect of some structural deficiencies and the lack of coherent systemic reforms. We believe that the reported practices can be stopped by reforming the way the health system is organized, financed and controlled, and the steps taken so far are aligned in this direction”it is stated in a CNAS press release signed by the president Horatiu-Remus Moldovan, sent to AGERPRES.
What measures are the authorities taking?
According to him, it acts on five levels: intelligent, unitary control; digitization and transparency; reorganization of the contracting and financing of medical services; increasing the quality of the medical act and the regulation of telemedicine.
Currently, the control structures of the Health Insurance Companies are being reorganized, by merging them into a single national structure, with clear regional responsibilities. “This means the effective transition from formal, retrospective control to control based on data analysis, Business Intelligence and risk indicators”stated the head of CNAS.
The development of the new Health Insurance Informatics Platform (PIAS) integrates digital solutions that allow the analysis of overlapping work programs; analysis of medical service reports; integration of patient feedback; the implementation of a national online programming platform, which allows the real traceability of services; ensuring access to the attending physician to the raw images (DICOM), not just to the interpreted results, the release explains.
According to the cited source, regarding the contracting and financing of medical services, the Health Insurance Companies will request service strategies adapted to the real health needs of the population in each area, and the financing of hospitals will be progressively correlated with the types of skills, the complexity of the services and the real needs, not exclusively with the reporting history.
In order to increase the quality of the medical act, according to the president of the CNAS, the analysis of the imaging recommendations at the level of the prescribing doctor will be done, in order to identify over-investigation or the unjustified use of resources, and systematic feedback mechanisms from the patients will be introduced.
Also, the clear regulation of the reimbursement of telemedicine services, with differentiated tariffs, quality criteria, control mechanisms, feedback and business analysis, is also being considered, the release states.
Challenges in the health system
Horaţiu-Remus Moldovan mentions the following as “major” structural challenges that affect the sustainability and quality of services in the public health system in Romania, including radiology – medical imaging services:
– the constant exodus of medical personnel from the public sector to the private sector, determined by higher salaries, better working conditions and increased flexibility;
– the payment of the guards at a level unrelated to the responsibility and workload, incomparably lower compared to the income obtained in the private sector;
– the redirection of patients from the public sector to the private sector, in the absence of clear and predictable care paths;
– the perpetuation of the way of working in which the patient comes to be perceived as belonging to the doctor, and his route in the system – from the family doctor to the outpatient clinic, investigations and hospitalization – is not clearly defined, predictable or transparent;
– the absence of a functional mechanism for distributing and balancing the workload within public hospitals;
– managerial passivity in some public health units, including the lack of taking the necessary organizational decisions;
– the often formal or symbolic role of some hospital administration boards, without real involvement in their governance, efficiency and sustainability.
“The main objective remains the trust of each patient, who must benefit from a clear, safe and fair medical route, regardless of the form of ownership of the service provider”the CNAS president also sent.
Dozens of initials sold to private clinics
The reaction comes after a journalistic investigation carried out by G4Media.ro during six months revealed shocking situations in the medical system. It is about dozens of cases in which radiologists from state hospitals “sold” their initials to private clinics, so that they could obtain contracts with the County Health Insurance Houses (CJAS), without the doctors actually being present in the respective locations, sometimes hundreds of kilometers from the public hospital where they work.
Two sources stated that in these situations the interpretation of the analyzes is carried out by other doctors, with lower qualifications, but they are initialed by the doctor who was not even present at the clinic.
In a specific case, CJAS Alba representatives, informed by journalists about such a situation, carried out an unexpected check at a private clinic and did not find the doctor. As a result, the clinic was sanctioned by cutting 5% of the deductible amount from the state budget.
