CONTRIBUTIONS, CO­PAYS AND COMPUTERS: HEALTH SYSTEM REFORM IN CYPRUS

25

Mamas Theodorou is Associate Professor, Open University of Cyprus, Cyprus. Jonathan Cylus is Research Fellow, European Observatory on Health Systems, LSE Health, UK.

Email: j.cylus@lse.ac.uk Note: Cyprus has been a divided island since 1974; in depth discussion of this still-contentious issue is not appropriate for this article. In general, the government of the Republic of Cyprus has no access to information concerning the northern part of the island.

Consequently, unless otherwise stated, all figures and discussions in this article refer to those areas of the Republic of Cyprus in which the government of the Republic of Cyprus exercises effective control.

CONTRIBUTIONS, CO­

PAYS AND COMPUTERS:

HEALTH SYSTEM

REFORM IN CYPRUS

By: Mamas Theodorou and Jonathan Cylus

Summary: Cyprus' new health system, which has been in the planning stages for well over a decade, is expected to come into effect in 2016.

While discussions are still ongoing regarding important elements of the reform, the new health system will lead to sweeping changes in areas such as coverage, financing, co-payments, provider payments, and data collection. In this article, we review some of these and discuss challenges for implementation.

Keywords: Cyprus, Health Reform, Financing, User Charges

Introduction

Cyprus is the only country in the European Union that does not claim to have universal health care coverage.

The legal basis for entitlement to public services is citizenship and proof of having earned below a certain level of annual income. It is estimated that 83% of the population has free-of-charge access to the public health care system, while the rest of the population has coverage either through voluntary health insurance or must pay to use public services according to fee schedules set by the Ministry of Health (MoH). As a result of gaps in coverage and public sector inefficiencies that drive some Cypriots to seek care in the private sector, approximately half(47.6% in 2010) of total health expenditures are out-of-pocket.D The current system is thus divided into two parallel, uncoordinated delivery systems - one public and the other private. This leads to poor continuity of care, duplication of services and other

wasteful practices. The public system is highly centralised with almost everything determined by the MoH, and is plagued by a lack of efficient payment mechanisms and monitoring systems, which contribute to inequalities in financing and access to care, as well as to inefficient allocation and utilisation ofresources. For example, few resources are allocated to disease prevention. On the other hand, the private sector is poorly regulated and suffers from an oversupply of clinical laboratories, radiology and expensive technology imaging services, as well as poor organisation and management.fl For the last ten years, the public system has dealt with long waiting lists for several types of surgery and diagnostic tests, while the private sector has experienced low utilisation of high cost medical technology, which has worsened due to the ongoing economic crisis.

Interestingly, despite low levels of health expenditure as a percentage of gross

Euroheallh incorporating Euro Observer -Vol.18 I No.3 I 2012

D Theodorou M. Patient satisfaction from services provided by outpatient departments of public hospitals in Cyprus: Findings report. Nicosia, May 2009 (in Greek).

El Statistical Service of Cyprus. European Health Survey 2008. Nicosia: Statistical Service of Cyprus, 2010.

Iii Organisation for Economic Co-operation and Development. Health at a Glance: Europe 2010.

Paris: OECD, 2010.

fl Proposals for a National Health Insurance Scheme. Final Report of the study for the national health insurance scheme. Consultancy team, September 1992.

Iii European Commission. Recommendation on Cyprus's 2012 national reform programme and delivering a Council opinion on Cyprus's stability programme for 2012-2015. COM(2012) 308 final, Brussels, 30.5.2012. Available at: http://www.

ec.europa.eu/europe2020/pdf/nd/csr2012 cyprus en.pd!

Iii Proposal for the Implementation of GHIS, HIO, ppt presentation, June 2012 (in Greek).

llil Family Budget Survey 2009. Household Income and Expenditure Surveys, Series I, Report No. 9.

Nicosia: Department of Statistics and Research, Ministry of Finance, 2011.

m

British Medical Journal2010;341 :c3759.

Eurohealth SYSTEMS AND POLICIES

Eurohealth incorporating Euro Observer -Vol.18 I No.3 I 2012