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Health systems in transition
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of patients on the list of a GP (i.e. the list of patients registered with a GP) from
1550 to up to 1900, and introduced a weekly reference number of hours (up to
18 hours) devoted to emergency service, which are included in the 40 weekly
hours. Additionally, a special pay scale was put in place, with monthly (gross)
salaries ranging from €2746.24 to €5063.38. This introduced flexibility in
the allocation of physicians’ working hours. The previous agreement (2009)
set the schedule at 40 hours/week, but there were additional dispositions for
specialized work in emergency care, intensive care units, which implied extra
and overtime payments. The new agreement allows the inclusion of some of
these extra hours (which are paid at a higher price), into the normal (average
price) payment system. Finally, the agreement added a new ruling, allowing
for supplementary pay by the NHS associated with seeing patients who are not
in a GP patient list.
5.4 Specialized ambulatory care/inpatient care
Secondary and tertiary care is mainly provided in hospitals, although, as mentioned
earlier, some primary care centres employ specialists who provide specialist
ambulatory services. These positions are gradually diminishing in number and
do not form a significant part of secondary and tertiary care provision.
The Ordinance No. 82/2014, of 10 April 2014, classided hospitals according
to the services they offer:
•
Group I: includes hospitals providing some internal medicine and surgery
services; further services may be provided (e.g. oncology, haematology,
nuclear medicine) depending on the population served and the established
national referral network. The national referral network is established by
the ACSS through a complex process, which makes its review difficult. It
defines where a patient goes by every specialty and region of the country.
•
Group II: includes hospitals providing internal medicine and surgery
services, including services that are not provided by Group I hospitals;
this group does not provide clinical pharmacology, genetics, paediatric
cardiology, cardiothoracic surgery and paediatric surgery services.
•
Group III: includes hospitals providing all internal medicine and surgery
services, including those highly specialized series not provided by
Group II hospitals.
•
Group IV: includes specialized hospitals in oncology, physical medicine
and rehabilitation, and psychiatry and mental health.