Private hospitals falling victim to red tape snarl-ups

Private hospitals in Greece have seen a significant drop in revenues over the past year, on the one hand due to the debts accrued by social security funds to private healthcare institutes and, on the other, to the lack of clarity in the newly implemented KEN system, which determines the amount insurance funds are charged for treatment and hospitalization by private and public hospitals depending on the diagnosis.

Representatives of the administrations of the country?s private hospitals say that in September 2011, these institutions were owed a total of 850 million euros by social security funds, and that this debt has risen by an average of 60 million euros a month ever since.

Indeed, they add that they have not even received the down payments for treatment carried out on people insured with social security funds from November 2011 until the present.

In certain cases, meanwhile, private hospitals have had to send notifications to insurance funds whose contracts are near expiration, after which their debts can be expunged.

As far as the KEN system is concerned, professionals explain that it officially went into effect on January 1, 2012, though it was inexplicably retracted just under a fortnight later to be reintroduced in March, without the Health Ministry making it clear how treatments and hospitalization would be priced in the meantime.

The biggest victims of the debacle with the implementation of the KEN system, however, are patients insured with state social security funds who have received treatment at private hospitals and paid for it but will not be reimbursed the amount that they are due until the situation is cleared up, at which point they may even learn that they need not have paid in the first place.

The General Secretariat of Social Security recently published a decision stating that for February only, pricing would be conducted on the basis of a list published in the Government Gazette.

That, however, would temporarily bring back low-cost assessments on behalf of insurance funds, as well as other errors in the old system, such as ?special fees? for doctors being charged separately.

According to a recent study by the Civil Service Insurance Organization (OPAD), private clinics have a tendency to overcharge by an average of 12 to 18.5 percent.

Cases of indirect overpricing and overshooting prices set by the KEN system have also increased over recent months at public hospitals as well, according to the study. The main reason for this is that the system only foresees a specific number of days of hospitalization for every category of illness, so that once this period has been completed, all extra costs are charged directly to the patient or to insurance companies and funds, unless the extra days are justified as being due to a relapse, in which case the patient can be readmitted to hospital.

Needless to say, the number of readmissions has also risen significantly, as hospitals use this loophole to justify extending the period of patient care beyond that foreseen in the KEN system.

Insurers argue that hospitals have been presenting budget surpluses that have come at a cost for them, while at the same time denying that the pricing list in the KEN system was such as to overtax insurers.

In order to clarify these positions, state insurers have demanded that the Health Ministry publish data from all state hospitals in Greece concerning how they have priced their medications, treatments and hospitalizations over the past month, and how audits are made, in order to gauge the effects of the KEN system.