By Angelos Anastasiou
WHEN legislation governing the National Health Scheme in Cyprus was passed in 2001, the consensus was that the country was one giant step closer to the goal of implementing it, following discussions and wishful thoughts that had lasted for decades. However, an incredible 13 years later it is still a plan on paper only.
And Cyprus is still coming up with reasons to delay implementation. Apparently, we’ve gotten so good at it that we even convinced the notoriously unbending Troika of the need for a six-month extension to full implementation, to mid-2016.
It hasn’t helped that the Health minister’s office is all but equipped with revolving doors – since Phrixos Savvides’ stint at the ministry ended in 2003, the post saw nine occupants succeed each other, while last week the current government, barely one year into its term, has already had to replace its Health minister due to party politicking. New ministers take time to catch up with the latest developments in the NHS, ask questions and bounce ideas off their staff, and formulate a personal take on key challenges.
The current plan leaves private insurance companies out of the picture in favour of the state-run Health Insurance Organisation which will administer and fund the NHS, reducing them to a minor role where citizens will have the option of buying private healthcare insurance to complement NHS coverage.
The government is hiding behind the Troika to justify the ban on insurance companies but the reason for the decision itself is shrouded in mystery. The only argument presented against insurance companies is that they are ‘uncompetitive’ – but the easiest way to get rid of an uncompetitive company is to let the competitive market do it.
Insurance companies are understandably unhappy about their exclusion, but being left out offers them little leverage to influence decisions. Nonetheless, they have found a powerful ally in the newly-organised private doctors, whose union ENIK was founded in February 2013.
Private doctors number 80 per cent of the total population of doctors in Cyprus, and the scheme can’t function without their active participation. They claim that the current plan makes baseless assumptions and is financially unsustainable.
“The proposed NHS, with monopolistic insurance coverage, cannot be efficient and is certain to collapse within a few years, saddling the country with losses running in the billions,” said Marios Theodotou, ENIK’s head, adding “just look at what’s happening in Greece”.
“The Netherlands, which is considered to have the best NHS in Europe, offers multiple insurance options, while a comparable monopolistic system, England’s, has created four- and five-month waiting lines,” he said.
So why is the government insisting on leaving insurance companies out? Nanny stateism, says Theodoros Panayiotou, head of CIIM and vocal advocate of insurance competition under the NHS.
“The government thinks it can do this alone – but already it is making all kinds of erroneous assumptions, primarily having to do with costing,” he said, before reformulating the private doctors’ prediction of being left with a gaping budgetary hole which citizens will be asked to fill.
Employers’ contributions are another bone of contention. The NHS is designed to be funded by dedicated contributions by the government, employers and employees. As an organised group, employers are unhappy about anything that might drive up labour costs – all the more so with anything that is sure to do so – and the employers’ association has warned that it will not accept employer contributions to exceed the legally mandated maximum.
“We are in favour of the NHS, as long as it comes with controlled expenses,” Michalis Pilikos, head of employers’ association OEV says.
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