OKYPY will have the "bill" for the millions of euros spent in recent years to upgrade the ambulance service ready by September with the aim of claiming compensation from the state in view of its transfer to the National Ambulance Agency under establishment.
At the same time, the Organization is called upon to shape its new operating framework after 2027, when it will take over the in-hospital transfers of patients itself, while, at the same time, it raises the issue of financial autonomy, fair compensation of public health services and the cost arising from on-call duties, the maintenance of additional beds for reasons of security of the country's health system and the special status of seconded civil servants.
As the general financial director of OKYPY, Roberto Karahannas, pointed out, speaking to "F", before any discussion about the financial autonomy of public hospitals, it should be clarified what is the role they are called upon to play within the health system. "We need to define our demands as a state and as a society from public hospitals and then clarify what we mean when we say we want autonomy," he said.
First recording costs and needs and then transporting the ambulances
"The Organization has invested several millions in the last six years to upgrade the service so that it responds adequately and qualitatively to the needs of Cypriot citizens."
The Organization "will proceed in the next period of time to claim the investments it has made and has already begun the recording and costing that includes the specialized ambulances, the systems, the equipment, the training and the staff, in order to determine the size of the claim".
At the same time, the Organization "must from January 1, 2027 undertake the transfers of patients between its hospitals to meet its own needs. And on this issue, a study is being carried out to record our needs."
In this context, "and if the two interrelated studies that are in progress (costing and recording of needs) are completed, it will also be decided how the transfer of the ambulance service to the Ministry of Health will be made".
As Mr. Karahannas explained, "all scenarios will be examined on how to ensure the ambulances, the necessary equipment, but also the necessary staff in order to ensure the smooth operation of the Organization after the creation of the National Ambulance Agency".
He stressed that OKYPY "recognizes the need for the operation of the National Agency", but underlined that "the smooth operation of the Organization itself must be ensured at the same time", which, as he said, "must be done smoothly and in cooperation with the Ministry of Health".
The two studies are expected to be completed by the end of September.
Financial autonomy and the role of OKYPY in the health system
Referring to the financial course of the Organization, Mr. Karahannas underlined that OKYPY is steadily working in the direction of economic autonomy. "It is easy to attempt financial autonomy by ignoring basic distortions that affect the operation of the Organization and which OKYPY tries to resolve through dialogue and documentation."
As he explained, "the institutional role of OKYPY is to provide services to both GHS beneficiaries and non-GHS beneficiaries, as well as public health services, and in this context it is in intensive dialogue with the HIO for fairer compensation for the services it provides". He noted, in fact, that "although theoretically it could limit loss-making services to reduce deficits, as the private sector can easily do, this would negate the public nature of the Organization's mission, as well as the universal access of patients to public hospitals". As he characteristically stated, "unlike the private sector, OKYPY does not select cases, but accepts all patients, has no available beds".
This is also reflected in the statistics, since "while it has about 40% of the beds, it treats 75% of the country's pathological and pulmonary cases, which mainly concern elderly patients, people with comorbidities, chronic patients and long-term hospitalizations, as well as the very difficult, complex cases. The compensation received by the Organization is disproportionate to the actual cost of these services, as well as the critical infrastructure it must maintain in order to dispose of them, which contributes significantly to the creation of operational deficits," said Mr. Karahannas. And he explained: "OKYPY is obliged to maintain sufficient beds even when they are not fully utilized in certain periods, as is the case for example at the Famagusta Hospital, where the needs increase significantly during the summer months due to domestic or foreign tourism, while in winter they decrease."
Accordingly, "the Organization must maintain readiness for periods of infections, epidemics or pandemics in all hospitals, but without the relevant cost being reimbursed". At the same time, "it is the only provider that maintains on-call duties in all specialties and operates fully staffed clinics on a continuous basis, which means that there are always doctors available". Something like this is not done in the private sector and no one has a requirement from the private sector to do it." In other words, despite the fact, he said, "that we have different requirements from public hospitals and we demand that a safety net be maintained for patients, the reimbursements from the HIO are not proportional".
Staffing Issues and Additional Operating Costs
The general financial director of OKYPY also made special reference to the issues related to seconded civil servants, sick leave and light work regime, pointing out that unlike the private sector, where such cases are covered by social insurance, in OKYPY they burden the Organization itself with tens of millions of euros, both due to absences and due to overtime of staff who are called upon to fill the gaps.
As he stated, "these data are not taken into account in the way the Organization is billed by the state, which leads to a distorted picture of its financial results. It is unfair to present OKYPY as a deficit organization, when the reasons for the creation of the deficits are known. Only by taking into account all these parameters can correct decisions be made for the future of the Organization and its real financial picture can be reflected."
At the same time, he reminded that an action plan is underway based, among other things, on axes of revenue growth and cost reduction and is implemented through agreements.
He stated that the Ministry of Health views the positions of the Organization positively and that "an agreement has already been made on public health services, which is at the stage of legislative control. There is also a positive response from the HIO, to which documented data have been submitted on the relevant claims of the Organization and a continuation of the dialogue is expected."
As far as the Ministry of Finance is concerned, "there are difficulties mainly on issues related to the status of employees", expressing, however, the assessment that solutions will be found.
As far as the upgrading of public hospitals is concerned, in addition to accreditation, tens of millions of projects are underway in all hospitals. "With the completion of the Organization's action plan, the goal is to become the first choice for the Cypriot patient and when this happens, then OKYPY will definitely become autonomous."
