At a time when in most European countries citizens are paying more and more money out of their own pockets for health services, Cyprus is following the opposite course.
It is the exception to the European rule, with per capita direct payments recording a decrease in the period 2014 – 2024, a development that is directly linked to the implementation of the General Health System.
Change is not limited to the money patients pay when they need care.
Within a decade, the GHS has substantially overturned the way health is financed in Cyprus.
Between 2013 and 2023, the share of total health expenditure covered through state resources and compulsory insurance mechanisms increased by around 30 percentage points, when the corresponding increase in the European average was only 2.6 points.
This, of course, does not mean that the state has borne the additional costs on its own. This funding also includes the mandatory contributions to the GHS, which are paid by employees, employers and other categories of contributions.
The figures are included in the report Health financing in Europe: Collection, coverage, pooling and purchasing by the European Observatory on Health Systems and Policies, which collaborates with the World Health Organization and examines 31 European countries.
The rest of the countries
The differences are great. In 2024, in Greece and Bulgaria, direct household payments accounted for 35.1% of total health expenditure and in Latvia 34%. In the countries with the lowest participation, they were limited to 9%, while the average of the 31 countries was 19%.
In Cyprus, according to the separate Cyprus Country Health Profile 2025 report, the share of direct payments decreased from 44% in 2018 to 18% in 2023, i.e. by 26 percentage points.
These payments relate to money paid when using services or purchasing health products. They do not include the mandatory contributions to the GHS. Therefore, their reduction does not imply an equal reduction in the total financial contribution of citizens.
The big change
In the 31 countries examined by the report, the share of public and compulsory funding increased from 73.6% in 2013 to 76.2% in 2023. In Bulgaria, Hungary, Ireland, Malta and Poland the increases ranged between five and seven percentage points.
Cyprus stood out with a change of about 30 points. This category includes state schemes, compulsory social health insurance and, where applicable, compulsory private insurance. This is therefore not a 30% increase in public spending, but a change in the share of care that is collectively financed.
Share of health
Another indicator captures the change. The percentage of total government expenditure directed to health increased in Cyprus from around 7% in 2013 to 15% in 2023, against a European change from 13% to 14%.
In 2023, Greece, Hungary and Latvia spent less than 10% of their government spending on health, while Germany, Ireland, Sweden and the United Kingdom were around 19%.
The index shows the position of health in the state budget, not the per capita expenditure or the quality of services.
Payments
Despite the reform, private payments have not been eliminated. The report points out that even in universal coverage systems, citizens are charged for certain services, as is often the case with adult dental care.
In Cyprus, direct payments for outpatient, home care and rehabilitation services are also recorded, but this does not mean that these services are totally outside the GHS.
The next bet, as pointed out in the report, is to maintain financial protection, fill the gaps and make the system viable, so that costs do not become an obstacle to citizens' access to care.
