Cyprus Mail 2 August 2025 - by Georgia Georgiou
Dr Pantinos Mavrogenis, member of the Gynaecological Society of Cyprus, has openly criticised the health insurance organisation (HIO) over its proposed system of financial penalties for doctors performing high rates of non-emergency caesarean sections, branding it as an unscientific and ethically questionable intervention.
Speaking to the Cyprus Mail, he warned that Gesy’s approach risks undermining the autonomy of women and placing both mothers and babies in danger. “Empowering women and ensuring their involvement in childbirth decisions is not achieved through external pressure or imposed limits,” he said.
“We must not underestimate women. Let us give them the right information and the tools they need to co-decide based on scientific advice from their doctors.”
The HIO, in its latest attempt to reduce Cyprus’s caesarean section rates, which remain among the highest in the EU, has introduced a rewards-and-penalties system for gynaecologists, set to officially take effect in early 2026.
Under this framework, gynaecologists whose non-emergency caesarean rate remains below 30 per cent will be rewarded with up to a 15 per cent bonus on their childbirth-related income.
However, doctors exceeding this threshold will face progressively harsher financial penalties.
For example, those with caesarean rates between 30 and 40 per cent will see their bonus reduced to 5 per cent. No incentives will apply for rates between 40 and 50 per cent, while doctors performing over 50 per cent will see deductions ranging from 5 to 35 per cent applied to half their caesarean-related earnings.
In practice, a doctor performing 159 births, with 85 being non-emergency caesareans, a rate of 53.4 per cent, would receive €461,300 instead of €468,900, incurring a penalty of €7,500.
This simulation-based system is already in place throughout 2025, with doctors receiving monthly breakdowns illustrating how their income would be affected if the policy were active.
While the HIO maintains that this strategy is part of a broader national effort to promote normal deliveries and reduce medically unnecessary interventions, gynaecologists remain unconvinced.
They argue that the formula lacks nuance, failing to consider the complexities of modern childbirth and the unique medical profiles of patients.
Mavrogenis emphasised that many women in Cyprus seeking gynaecological care are over 40, with a significant number undergoing IVF treatment. These cases, he explained, carry higher risks and often justify planned caesarean sections.
Furthermore, due to changes in parental diet and lifestyle, today’s newborns tend to have a higher birth weight, while many women have narrower pelvises, reducing the safety and feasibility of vaginal delivery in certain cases.
“What Gesy fails to acknowledge,” he added, “is that a caesarean at the mother’s request is still a medically indicated procedure. Denying women this option infringes upon their autonomy and damages the trust in patient-doctor relationships.”
He also raised concerns about the legal risks gynaecologists face. According to Mavrogenis, more malpractice claims arise from complications during natural deliveries than caesareans.
As such, he warned, doctors may be forced into unsafe decisions to meet arbitrary quotas rather than basing their judgement on clinical needs.
Between 2021 and 2023, Cyprus recorded caesarean rates of over 60 per cent, with only 15 to 17 per cent medically necessary, according to data from the health ministry.
While the government acknowledges the urgency of tackling the issue, critics argue that financial disincentives are not the solution.
“The answer lies in education,” Mavrogenis added. “Not only for doctors, but for women, too. Let’s give them proper information, allow them to understand the risks and benefits, and support them to make the best choice for themselves and their babies. That is what true, patient-centred medicine demands.”
