Although a monumental step forward after decades of fruitless discussion, Friday’s voting of laws introducing the national health system (Gesy) was but one of several more required for the reform to materialise.
Universal coverage, equitable healthcare and free choice for patients are the key pillars supporting the planned system, with all income-earners, employers and the state, contributing a part of their revenues to help fund its operation.
Everyone will also be free to supplement this mandatory coverage with private-sector health insurance, either to cover specialised services not covered by Gesy (for instance, branded medicines), or for purposes of securing things like ward upgrades for in-hospital stays – or even to be able to do away with Gesy rules altogether and visit any doctor, whether Gesy-affiliated or not, at any time.
As agreed unanimously by the political leadership, on March 1, 2019, the payment of partial contributions into Gesy will start, with wage-earners, pensioners, income-earners and state officials contributing 1.7 per cent of their income, employers 1.85 per cent of their payroll, the state 1.65 per cent and the self-employed 2.55 per cent.
Three months later, Phase 1 of Gesy will be rolled out, which will feature out-of-hospital care only.
On March 1, 2020, proper contributions will be imposed, with wage-earners, pensioners, income-earners and state officials paying 2.65 per cent of their income, employers 2.9 per cent of their payroll, the state 4.7 per cent and the self-employed 4 per cent.
Phase 2 will see the full Gesy offering unveiled on June 1, 2020.
Various co-payments, put in place chiefly to prevent abuse of the system, will cost a maximum €10, with an annual cap of €300 per patient and €75 for pensioners and state-aid recipients.
What Gesy will mean to patients is free choice of a general practitioner – or ‘family doctor’ – for any and all visits, free of charge, who may then refer them to a specialist doctor as needed (with the exception of dental or gynaecological issues, for which patients can visit a specialist of their choice directly).
But, as pointed out by numerous MPs during Friday’s House debate, until free healthcare and free choice enter our lives, several risks threaten to undermine implementation of the massive reform.
According to the agreed timelines, by the end of this year the government needs to have found and appointed the board for the organisation that will implement and oversee state-hospital autonomy.
As envisioned, state hospitals must become individual entities, independent of each other and, crucially, the health ministry, and learn to operate on a budget, before being pitted against each other and private hospitals in direct competition when Gesy is introduced.
This is because one of the main goals of Gesy is to contain expenditures and eliminate waste, by making sure “the money goes where the patient goes”, in the sense that the money allotted to each hospital will be the direct result of patient preference.
The organisation – the State Health Services Organisation (SHSO) – will be tasked with making several key decisions, with costing perhaps the one bound to cause the most friction.
An itemised pricing list for medical interventions and all other healthcare-related goods and services will be prepared, with Gesy-affiliated practitioners paid according to the number of interventions they perform, at the agreed price.
The SHSO will also be mandated with hiring staff to operate the new entities – each individual state hospital – according to the provisions of the regulations passed on Friday.
In addition, by the time the phasing-in of Gesy provisions starts – June 2019 – the Health Insurance Organisation (HIO), which was created in 2001 to administer the planned Gesy, must have arranged for the deployment of the required software, without which introduction of any facet of the system is impossible.
Still, perhaps the single greatest threat to Gesy is political, rather than practical. Unanimous agreement on the need to introduce a universal-coverage health system notwithstanding, presidential elections in February next year mean implementation will inevitably be seen through by a new administration.
Days before Friday’s House vote, a tweet by Health Minister Giorgos Pamboridis claimed the vested interests that oppose Gesy had launched its “last-ditch effort” to find a political party leader – “for the role of Judas” – to stop the Gesy train in its tracks, “and it looks as though they found him”.
Several fingers were pointed at Diko and Edek leaders, wild rumours of ruling Disy’s involvement also made the rounds, angry denials were issued, and a silent Pamboridis revelled in the frantic, and very public, hunt for ‘Judas’ that all but guaranteed no one would want to be seen as being on the wrong side of the Gesy debate.
But whoever ‘Judas’ may have been, if there ever was one, the possibility that he – or she – might be part of the next government cannot be ruled out.
On the other hand, reversing course at this point may be harder than it sounds. Both last July’s deal among political parties – the ‘roadmap to implementation’, brokered by President Nicos Anastasiades, which enabled Pamboridis to push his agenda through much more aggressively – and Friday’s vote were unanimous, meaning all parties committed themselves to introducing Gesy as offered.
There is also the matter of the software commissioned to run Gesy.
In March, the HIO signed a contract with NCR Cyprus for the supply and administration of the software – deemed the “backbone of Gesy” – that will register and record contributions and medical interventions, hold and update patient histories, and feature a host of other functions necessary for the system to operate.
The seven-year contract will cost the HIO nearly €30 million, so anyone who decides to hold implementation back will face not only political questions but the charge of quite literally squandering taxpayer money.
While a giant step toward full, unfettered health coverage of the entire population was taken on Friday, there remain potential obstacles to look out for in the coming years. Pamboridis, who on Friday emerged victorious after months of fighting, may have been wrong in diagnosing the establishment’s “last-ditch effort”.