Cyprus has been excluded from the 2017 Euro Health Consumer Index (EHCI) because it is the only one of the 35 European countries surveyed that does not have a national health insurance scheme.
But the annual comparison for assessing the performance of the national healthcare systems published on Monday still raised some serious concerns over the state of Cyprus’ existing health system. These included the suspiciously low number of recorded visits to private doctors and the staggeringly high number of caesareans. At nearly 60 per cent, it was the highest figure among the countries surveyed.
The EHCI analyses national healthcare on 46 indicators grouped in areas such as Patient Rights and Information, Access to Care, Treatment Outcomes, Range and Reach of Services, Prevention and use of Pharmaceuticals.
“The percentage of public expenditure on health is around 41 to 42 per cent of the total health expenditure and is indeed the lowest in the EU,” the report said about Cyprus. “The share paid from private insurance companies on health is about 11.4 per cent, whereas the out-of-pocket household expenditure without any insurance coverage come up to 44 per cent of the total health expenditure.”
Including the healthcare services accessed by private payments would trivialise the exercise, the report explained, as this would result in full scores for many countries, especially when it comes to access to care.
At least for this year, Cyprus is not included as “it does not really have a public healthcare system in the general European sense”, as the researchers put it.
Since the Cyprus parliament passed a bill in June 2017, providing universal coverage from next year, the Health Consumer Powerhouse (HCP) conducting the research is hoping this will come into effect so that the country can be included in next year’s report.
Taking into account the low amount of public expenditure on health in Cyprus it is perhaps not surprising that Cyprus has the second lowest percentage of total pharmaceutical sales paid by public subsidy, around 24 per cent, with only Malta having a lower score of 20 per cent. In comparison, in the UK, the top country in this category, 85 per cent of the sales are paid by public subsidy.
Cyprus also has the lowest number of outpatient visits to doctors per year among the countries. Unlike in Albania, which has the second lowest ranking, this cannot be attributed to a lack of doctors. The number of doctors in Cyprus is average compared with the other European countries. The HCP suggests another reason.
“The very low numbers of visits per doctor in Cyprus or Greece (which has by far the highest number of doctors per capita) could possibly be under-reporting of visits for tax evasion reasons,” they noted.
Another issue where Cyprus stands out negatively is the number of Caesareans. Among the 35 countries surveyed, it is the only one with a rate of close to 60 per cent of deliveries, and all other countries are below 50 per cent, including Greece which comes second.
This is despite the fact that according to the World Health Organisation (WHO) caesarean sections are associated with an increased risk of maternal death and puerperal complications, so use should be restricted to a few well-defined indications such as dangerous placental or foetal position. The orgnisation estimates that no more than 10-15 per cent of deliveries are associated with a medically justifiable reason for a Caesarean section.
Though the 14 top countries covered by the report hover around 15 to 20 per cent, none of them is below 15 per cent, suggesting there is room for improvement in most cases.
In scoring, the Health Consumer Powerhouse assumed that high caesarean rates are an indication of poor prenatal support and poor baby delivery services – consequently, a high caesarean rate has been given a red score. The general recommendation is that a woman should not have more than two caesarean deliveries, which strongly indicates that complete recovery cannot be expected.
They added even though a caesarean is costly, there is definitely no positive correlation between national wealth and high caesarean rates; rather the reverse.