Filenews 4 February 2022
Of interest are the data recorded in the Health Profile 2021 of Cyprus for the country's health system, through findings of 2020.
One of the most important findings of the Report is the fact that Cyprus spends less on health than most EU countries, with €1881 per capita allocated to health in 2019, which is about half the average for the EU as a whole, which is €3521. Moreover, expenditure on prevention services (€23 per capita) is well below the EU average, which is €102 per capita and only 1.2% of health spending (compared to 2.9% for the EU as a whole).
Long-term care also receives low levels of funding, accounting for 4.2% of current health expenditure, as opposed to the much higher average (16%) across the EU.
It is worth noting that the Report also refers to the implementation of the General Health System, noting that Cyprus has managed to implement reforms that ensure universal health coverage, despite the pandemic.
As mentioned, by implementing the first phase of the new General Health System in June 2019, a fragmented system was unified, facing serious problems, such as, among others, the disproportion of resources between public and private providers, high direct private payments, large inequalities in access, long waiting lists and inefficiency of the health system as a whole.
It should be noted that the new system is financed by state revenues and contributions on salaries, incomes and pensions. Under the new system, certain responsibilities of the Ministry of Health were transferred to the Health Insurance Organisation, which is the sole buyer of services from both public and private providers. Some other responsibilities of the Ministry were transferred to the new State Health Services Agency, which is responsible for the development, management, control and supervision of hospitals and public sector health centres.
The coordinated reform efforts have resulted in the full functioning of the new health system, despite the pandemic, as of June 1, 2020, while the Ministry of Health has also played a central role in coordinating the response to the COVID-19 pandemic in the country.
- Health funding is characterised by high direct private payments, but this should change
Cyprus spends less on health than most EU countries. In 2019, €1881 per capita was allocated to health (adjusted for differences in purchasing power), which is around half the EU average, which is €3,521.
-Despite gradual increases over the last decade, this represents 7% of GDP, which is significantly lower than the EU average of 9.9%.
-In addition, only 8% of the state budget was spent on health, compared to 14% which is the EU average.
-Spending on prevention in Cyprus is much lower than the EU average
Cyprus spends 24% less per capita on outpatient care, 39% less on inpatient care and 87% less on long-term care compared to the EU averages.
This is largely due to the smaller overall health budget available, so as a percentage of current health expenditure, the costs for more expensive aspects of care – such as inpatient care and medicines – are relatively high.
In 2019, 41% went to outpatient care, which is one of the highest in the EU, where the average is 30%. Around 18% went to medicines, which is equal to the EU average (18%), but in absolute terms translates to just under €332 per capita – around half the EU average.
Expenditure on prevention services (€23 per capita) is well below the EU average of €102 per capita. They account for only 1.2% of health expenditure (as against 2.9% for the EU as a whole). Long-term care also receives low levels of funding, accounting for 4.2 % of current health expenditure, as opposed to the much higher average (16 %) across the EU.
-There is a shortage of doctors and nurses in the public health system
In Cyprus, the density of doctors is 4 per 1000 inhabitants, i.e. it is slightly higher than the EU average, while the density of nurses of around 6 per 1000 inhabitants is well below the average.
These statistics do not reflect the wider imbalances between the public and private sectors, in terms of the workforce, since doctors work mostly in the private sector and nurses in the public sector. Prior to the implementation of the General Health System, a large number of doctors in the public system switched to the private sector. They then contracted with the new system, either as specialists or as personal doctors, who are active as primary care doctors.
Therefore, at the start of the pandemic, public hospitals tasked with ensuring mobilization in the event of a peak in the need to treat COVID-19 patients were already faced with a shortage of doctors. As a solution to address the needs created by the pandemic, it has been necessary to hire new doctors and other health professionals from other sectors of the public system.
In Cyprus there are now four medical schools, so it will be possible to train more doctors to fill the vacancies. The system is currently based on graduates of medical schools abroad who return to Cyprus to practice their profession.
Primary care plays an important role in the new health system
About a quarter of doctors in Cyprus report that they provide general practitioner services, although this may not be their specialty, and the mechanism of mandatory referral to specialists through the general-family doctor (gatekeeping) has been designed as the backbone of the General Health System.
There was concern that private doctors working outside hospitals would not contribute to the new system, as compensation charges were considered too low. However, the vast majority of doctors contracted, as it turned out that the salaries were satisfactory and even exceeded their expectations.
Since June 2019, the General Health System has begun to provide outpatient care services (family doctors and paediatricians, medical specialists, laboratory tests and medicines) and since June 2020, inpatient health care is also covered, as well as health care in cases of emergencies, transport by ambulance, preventive dental health care services and outpatient health care by other health professionals.
Prior to the introduction of the General Health System, utilisation levels and average length of hospitalization (5 days in 2019) were relatively low, but it is not yet known if they increased after the reforms, even without the pandemic, as expanded access may have released the accumulated demand for services.
Before the pandemic, Cyprus had 3.1 hospital beds per 1,000 people, which is well below the EU average of 5.3 beds in 2019.
As part of the pandemic response, the Ministry of Health has asked private hospitals to make beds and staff available in order to increase the available capacity to treat COVID-19 patients in public hospitals.
- The COVID-19 response was centrally organised and coordinated at the highest levels of government
According to the legislation, the Department of Medical and Public Health Services of the Ministry of Health is the body primarily responsible for the prevention and control of infectious diseases.
In January 2020, the department mobilized a special team in the Department of Epidemiological Surveillance and Control of Infectious Diseases of the Ministry. At the head of the effort to deal with the disease was the General Director and the Department of Medical and Public Health Services of the Ministry of Health, in coordination with the Scientific Advisory Committee, the Council of Ministers and the President of the Republic. The Scientific Advisory Committee consists of independent academics and members of the Unit of Epidemiological Surveillance and Control of Infectious Diseases.
The unit coordinates surveillance activities and is responsible for communicating with ECDC, WHO and THE EU. It also coordinates testing procedures for COVID-19. The analysis of data on COVID-19 falls under the responsibility of the Health Monitoring Unit of the Ministry of Health. At the highest level, the response to COVID-19 is coordinated by the Council of Ministers and the Ministry of Health, in cooperation with the State Health Services Organization and the Health Insurance Organisation as a mediator for cooperation with personal doctors.
-The first surpluses of the General Health System were used to cover the deficits associated with the pandemic
In the period 2020-21, the pandemic reduced the revenues of the General Health System, which come mainly from the health insurance contributions collected from the earnings of the beneficiaries and from the employers.
It is estimated that during the first months of the pandemic, this reduction amounted to more than 50% of the monthly revenues of the Health Insurance Organisation that came from the salaries of the private sector, due to increased unemployment, the reduction of salaries and the non-taxation of state emergency support benefits due to the pandemic, which cover about 60% of the salaries of the eligible workers.
As a result, the Health Insurance Organisation is now implementing a three-year plan, in which the surpluses (about EUR 250 million) are being implemented. EUR), recorded in the first year of operation of the General Health System (2019) will be distributed to compensate for the deficit created in 2020.
Following negotiations in the period May-June 2020, new remuneration terms and new agreements with the providers were introduced, taking into account the new treaties.
