According to insurance factors, insurance companies are facing a storm of overcharges from private clinics, resulting in soaring compensations and, as a consequence, increases in premiums paid by the insured.
The “virus” of over-invoicing has affected the relations between insurance companies and hospitals, with the result that out-of-court cases have also started between the two sides.
An insurance company found that for a medium-sized operation that usually requires a hospital stay of up to three days, it exceeded six and as it was “detected” the patient was charged 80 needles per day, 20 serum devices per day instead of the usual three and 800 surgical gloves for one operation half an hour!
Another private hospital was “caught in the act” as it charged an insured patient 25 thermometers (!!!). In another case, 180 needles, 250 syringes, 410 gauzes, 432 gloves were billed for an operation that required a three-day hospital stay, which defies common sense.
Private clinics have something to do with gloves, as in another case 530 examination gloves were charged, that is 88 gloves per day, which means that the patient was examined 88 times a day by a doctor or nurse!
But syringes are not counted in private hospitals either, as in another case over 300 syringes were charged for a 6-day hospitalization, i.e. the patient received medicine or liquid by syringe more than 50 times a day.
The list is endless. In another case, a simple potassium test was charged 40 euros when it costs no more than two euros.
Premium increases
Unjustified charges, as insurers characterize them, lead to an increase in compensation (in 2022 they approached 610 million euros), but also in the companies’ technical indicators, such as the loss ratio. In order to prevent the health insurance industry from becoming unprofitable, insurance companies are obliged to continuously increase the premiums paid by the insured (increases of up to 25% were recorded for 2024!).
The whole situation is ultimately paid by the insured, who “cancels” the insurance policy when he needs it, that is, at an older age.
Agents of the insurance companies who follow the whole situation very closely note that if there is not a point of approach between private clinics, insurance companies and doctors, then increases in insurance premiums are a one-way street and in the end everyone will be the loser, primarily the consumer.
In fact, the warnings to the hospitals also come from forces “related” to the medical groups. The statements made at a recent press conference by Robert Gauci, CEO of National Insurance, a company controlled by the investment Fund CVC which also controls a group of private hospitals such as Hygeia, Metropolitan, etc., are indicative.
It is necessary to have a proper communication with the hospitals to find the right balance, said Mr. Gauci. If you (including the hospitals) win and I lose, it doesn’t go anywhere. It will last a year, two years, and then it will break. And this is a message I want to tell everyone, he underlined.
The solution
One of the answers to the “exorbitant” and “unjustified” charges would be the development and introduction into the Greek health system of a more modern system of budgeting and reimbursement of hospital services, a new system of Greek DRGs (Gr-DRG). The DRG system (Diagnostic Homogeneous Group System) is a patient categorization system that promotes transparency in the billing of their hospitalizations, since these are billed as a “package of services.”
In earlier statements, the president of the Health Committee of the Association of Insurance Companies of Greece and CEO of Interamerican, Yannis Kantoros, had emphasized that we are the only country in the European Union that does not apply the DRGs system, i.e. the medical protocols. Even Albania has DRGs, while Greece does not. I think, stressed Mr. Kantoros, we have to see it, because it is already slowly starting to be implemented in the public sector and we will arrive in 1-2 years from now to have a modern system of DRGs in the State, while in the private sector we will still have the outdated Fee-for-service.
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