The accession of Cyprus to the EU created the need for implementing a series of reforms in the health system, particularly in terms of policy, regulation and the provision of services. Major challenges included restraining the rising costs of health care, addressing inequalities in access to health care services, and improving the quality and financing of the health system. Reforms in these areas will help to maintain the progress achieved in controlling communicable diseases, to reduce the incidence of chronic diseases and to maintain the environment in a way that safeguards the quality of life.
It has to be noted that prior to EU accession, the parliament approved a law that called for a new health system based on the principles of solidarity, justice and universality. The General Health Insurance System (GHIS) was designed to provide universal coverage within a comprehensive health system. However, the starting date of the GHIS has been repeatedly postponed due to four main reasons:
- government concerns over costs,
- the negative impact of the financial crisis on the fiscal revenues,
- the time-consuming tender procedures associated with the introduction of the new system and
- the lack of sufficient consensus between the stakeholders involved.
Currently, the healthcare system in Cyprus is comprised of separate public and private systems of comparable size. Government expenditure on health care accounts for only around 40% of total health expenditure, which is a considerably lower percentage than in all other EU countries. The public health system, which is financed by the state budget, is highly centralised and tightly controlled by the Ministry of Health. Entitlement to free health services is based on citizenship and income level and, as a result, no more than 83% of the population has free access to health care. The public sector mainly provides outpatient and hospital care services and offers some specialist services that are otherwise not available from the private sector. All health professionals working in the public system have civil servant status and are remunerated on a salary basis. There are notable deficiencies in the public system, such as long waiting lists for some services, as well as a lack of computerization, performance payment incentives, monitoring systems and other tools for the improvement of efficiency and quality.
The private sector is almost completely separate from the public health system. As only about one-fifth of the population has coverage through Voluntary Healthcare Insurance. The majority of private expenditure is out of pocket at the point of service, with a significant share of private sector utilisation and expenditure by beneficiaries who have free access to the public system. Private sector physicians provide ambulatory care services and work mostly in solo practices, their own surgery centres or are shareholders in private hospitals and polyclinics; they are paid mostly on a fee-for-service basis.
Despite similarities in their sizes, there is disequilibrium between the public and private sectors. The public system suffers from long waiting lists for many services, which has been worsened by the recent economic crisis, while the private sector has an overcapacity of expensive medical technology that is underutilised. There is also an imbalance in nursing supply between the public and private sectors, as well as shortages in both sectors in some fields of care, particularly long-term care, rehabilitation care and palliative care. Public sector inefficiencies under the current system lead to high OOP payments in the private sector, and often there is a duplication of services between the public and private sectors. Ultimately, it is the vulnerable and low-income groups who suffer the most from inequalities in financing, access and outcomes.
On the other hand, it has to be noted that despite the limited National healthcare allocation of resources comparing to the percentage of gross domestic product (7,4%), the Cyprus health care statistics are performing better than the EU average and can be easily compared with the large and developed EU member-states. The physician’s qualifications and efforts made a significant contribution to these achievements. As Cyprus Medical Association we are determined to keep these good results and improve them.
One of Cyprus’ greatest assets of which it can be justifiably proud is its human capital. Most of the island’s physicians have trained at world recognised medical schools, with doctors boasting an outstanding reputation for their knowledge, experience and professionalism.
Currently, Cyprus is trying to move to a comprehensive system of universal coverage with better benefits, more effective financing mechanisms, cooperation between the public and private sectors, and reorganisation and computerization of all public hospitals. To this end, a new health insurance system has been planned, although it is uncertain as to when this system will ultimately be implemented.
To enable the success of the new system, a number of steps must be taken. For example, while computerization has begun in two public hospitals, IT should be improved and expanded where there is no comprehensive health data collection mechanism. The design of adequate payment mechanisms and associated incentives for doctors and hospitals will largely depend on the existence of quality data.
For the Cyprus Medical Association the reorganization and restructuring of the public health care sector and the Ministry of Health, along with the decentralization of health services and the participation on equal terms of the private sector and the suitable reimbursements of our members are key priorities in order to secure the efficiency and effectiveness of the Healthcare system.
As Cyprus Medical Association we believe that the general mission of a National Healthcare System is to provide high-quality health services to all of our patients, yet the current health system proposed has many deficiencies. Thus, we are trying to convince all the stake holders involved to focus and introduce best practices that will secure and elevate the health care quality provided to our patients.
Dr Petros Agathangelou
President of the Cyprus Medical Association