The Health Insurance Organisation (HIO) is set to introduce a new performance indicator aimed at reducing unnecessary specialist doctor visits through long-term referrals, primarily issued by general practitioners at specialists’ request.
Under the new measure, specialists who exceed HIO-set thresholds for long-term referrals will face a 5% reduction in their compensation.
The deducted funds will be redistributed to colleagues within the same speciality who remain within the prescribed limits.
The decision follows HIO’s analysis of the General Healthcare System’s (GHS) data, which revealed that while simple referrals decreased by an average of 10.5% annually after implementing performance metrics for GPs, long-term referrals doubled, showing a 53% average annual increase.
The aim is to ensure efficient healthcare delivery whilst preventing unnecessary visits resulting from specialists’ requests for long-term referrals, which waste resources and reduce the unit price used for doctor compensation, HIO stated in its announcement to physicians.
Data shows that patients often do not utilise all visits allowed under long-term referrals, which can include up to 12 visits annually.
For instance, patients typically use only 4 or 5 visits despite being approved for 8 to 10 or more.
The measure will operate as a pilot scheme until end-2024, with no impact on compensation during this period.
Full implementation begins January 2025, with different thresholds for each medical speciality.
HIO will consult with medical societies during the pilot phase to establish final thresholds and targets. Specialists will receive monthly updates on their performance against their speciality’s benchmark.
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