By Dr. Michalis Zouvanis:
January 2019! The decades-long-discussed reform aimed at improving the level of public health services, especially the low-paid ones, is beginning to be implemented. The government has made the firm decision that a specific Plan will be implemented, despite the reactions of the Medical world, which will be called upon to implement it. And so GESY was made!
Let us see, however, whether the already promoted Plan serves the purpose for which it was made. As we have already mentioned, the aim was and should be, to improve the level of health services received by the Cypriot citizen. This has always been a requirement and a basic pursuit of the medical world and its leadership. To this end we have worked and fought for many years. The question, then, is whether the current System will serve its purpose, or will have the opposite effect. The study with which this Plan is imposed and the insistence of the rulers to proceed despite the reactions and warnings, certainly leaves many questions floating.
And it is obvious, even to its biggest supporters, that it has many flaws and contains many pitfalls, which could lead to the collapse of the system, with incalculable consequences for all involved. Consequences that mainly concern the citizens, but also the Medical world. They will be on board if it sinks, not the political leadership and those around it who are promoting it. They will, in their beloved habit, find a way to abdicate any responsibility.
The first feature of the new GESY is that it is a single insurance system. That is, the only insurance company, OAY, will be responsible for managing the health of all permanent residents of the country. Citizens who already have health insurance are asked to leave it or pay double, maintaining their old insurance. No one wants to think about what will happen if the OAU fails, but this is still a realistic scenario, the thought of which makes the medical world shudder. There are no provisions for supplementary insurance, nor other protection mechanisms.
The initial intention of the current government for a multi-insurance system, as it was in the program of Mr. Anastasiadis in 2013, was abandoned without sufficient justification, something that leaves many questions floating. Multi-insurance would be an ideal solution for change from the current system, as it would improve the services received by the poorest sections of society, while at the same time ensuring a smoother transition for the medical world, so as to avoid the reactions we see today.
The leadership of OAY, supported by the political leadership, unequivocally rejects it on the grounds that it is contrary to the basic philosophy of GESY, which is equal access to health services for all citizens. In our case, equality in the field of health will indeed be achieved for the great mass of the people, but which will come through the leveling of all and not through the raising of the lower strata. As for the small group of the privileged, they will continue to be more equal than equals, receiving Health services in luxury clinics in Cyprus and abroad (examples are known). Equality is an elusive and illusory dream that does not exist in any area of social life. The aim here is to ensure adequate health services for the ordinary citizen, not equality. By setting a deceptive goal we run the risk of losing the effort.
The OAU will be called upon to implement the GESY through a global budget, which means that the money that will be allocated can in no case be increased. No one is willing to raise their contribution, believing that it gives enough in favor. But what if the calculations of the OAV nesters are wrong? They insist on the accuracy of their calculations, the medical world is worried and disagrees. The calculations that PIS has from a reputable company, give the impression that half the money is missing. If someone bothers to search the internet for the Health budgets of other European countries that have better Health Services than us (the aim is to become better), they will notice that Cyprus is a tail and will remain! The budget is incomplete and this will have an impact on the level of Health services offered. The OAY and the rulers preferred, instead of discussing the substance, to turn the discussion into a major issue of "remuneration" of doctors. The way to pass their own opinion was to spread and deconstruct the doctors, calling them greedy, traitorous, tax evaders, etc. But the prudent see the reality. It is not just doctors' fees that will suffer, but health services in general. Clinical fees, quality of consumables and materials, quality of analyzes, examinations, quality of medicines and much more. All this will have to be paid from the global budget which in no case can be extended. As a result, health services are likely to be worse than they are today.
The other feature of the new system is the institution of the family doctor. An institution that exists in several European countries, having started in the United Kingdom and that has many positive and negative points. It should be better considered whether this system fits in Cyprus in 2019. All citizens are invited to register with a general practitioner who will manage their health. But this contradicts the doctrine of the free choice of the doctor. The Cypriots usually learned to visit a specialist doctor of their choice, who is aware of their problem.
As a country, we do not have enough general practitioners, so the OAW, by improvising, upgraded unskilled doctors to general practitioners and in a way "degraded" the general practitioners to general practitioners, offering them some benefits of practicing their specialty to entice them. However, Cyprus has several specialist doctors, but GESY restricts patients' access to them without the permission of the family doctor. Any bypass of the family doctor is punishable by a fine.
Personally, I believe that this institution is incompatible with the Cypriot society of 2019 and there should have been a free choice of any doctor by the patient. In my opinion, the OAU insists on the institution, for the purposes of financial control of the system, since the family doctor will be the "key emperor" of GESY finances and through this the organization will impose its policy, indifferent to the quality of Health. As long as the global budget comes out. Logic of the Percussionist!
Another problem that concerns the medical world is the practice of private medicine. In today's European Cyprus, the free practice of all professions without exception in conditions of healthy competition is a fundamental principle of democracy. In our case, the practice of our profession will be determined by the OAU, both financially and scientifically in some cases. The reaction of the medical world has been suppressed and doctors are muddied daily by some media outlets, which have been drafted with the OAY, in order to force doctors to succumb. The Minister in moments of magnanimity decided to allow the doctors who will contract with GESY, to practice private medicine in the evenings and on weekends. That is, if we want to stay and work until we collapse! If one bothers to read the new regulations for the implementation of the GESY for doctors, one will find conditions of enslavement that even an occupying country does not impose on occupied citizens. As for the right of reaction, which everyone has, doctors are not given, crushed and devalued daily.
In addition, doctors who decide not to contract with OAY, do not have the right to healthy competition, since all their potential patients will be trapped in GESY. The patient who will dare to see a doctor of his choice outside GESY and pay him himself, does not even have the right to enjoy the other rights provided by the system as a reward for his financial contribution, ie examinations, medicines, tests. etc. If you dare, that is, and get out of the corral, you will be thrown to the wolves, even if you have paid your debts and did not burden the system extra. Even if it is a democracy! There are already opinions from reputable lawyers that this is unconstitutional.
There are many other points of friction concerning private hospitals, investments in equipment and machinery, the management of chronic diseases such as diabetes, the working conditions of doctors and various others, which are probably not present. But it is clear that this plan, which is being promoted with so much study and so much persistence by the political leadership, is full of imperfections and mistakes that will lead to its collapse. The issue, which is the improvement of medical services to the citizens, is not served at all, on the contrary there is a risk of worse situations. The political leadership must stop seeing the Medical world as the enemy that seeks to overthrow the reform, but as the necessary partner for the implementation of a quality GESS. Let it delay its implementation for a while until the problems are resolved. OEB's proposal is on the right footing.
Mr. President of the Republic, you are not throwing an endless boat full of holes into the sea, hoping that it will withstand the storm for three years! Passengers will drown.
Dr. Michalis Zouvanis