MINISTER of Health Petros Petrides announced after the last visit by the troika that the full implementation of the National Health Scheme, which would offer universal healthcare coverage, would be put back by a year. It would still be introduced in 2015, as is stipulated in the MoU, but it would be implemented in stages that would be completed a year later.
This could not have come as a surprise to anyone given the continuous postponements of the scheme’s introduction since it was first put together in 2001. Some could even speculate, flippantly perhaps, that the new delay is a government ruse for avoiding full implementation as we would be out of the assistance programme in 2016 and less inclined to follow the Troika’s diktats.
Then again that we are now talking about the scheme as a real possibility is entirely down to the Troika, which has included an implementation time-frame in the MoU and is directly involved in the drafting of plans. If it were not for the Troika, the scheme would have remained in the planning stage indefinitely, politicians carrying on talking about it without ever taking action.
It has always been this way. The Clerides government commissioned the first blueprint, the Papadopoulos government established the state bodies that would administer it and the Christofias government, predictably, did nothing. The truth is that all governments, including the current one, have been terrified of implementing the scheme, never venturing beyond the planning stage, and for good reason.
The scale, cost and complexity make it a project that no government wants to touch, because the likelihood of it resulting in an unmanageable and costly mess is high. Could we really trust our technocrats and officials to administer such a complex system competently, let alone cost-effectively, or would the scheme turn into a black hole into which huge amounts of the taxpayer’s money would keep being poured?
Even the basics relating to the scheme seem beyond our technocrats. For many years now, the EU has been asking the Cyprus government to carry out a costing of its public health services, because the bill for treatment offered to an EU national should be sent to his country of origin. Our technocrats have still not been able to do this, even though it is essential for the proper functioning of a national health scheme. How could there be insurance cover when the cost of carrying out an operation at a state hospital is not known?
Other factors contributing to the fears of the politicians are the many vested interests they would have to satisfy in some way. There are the private clinics and practices wanting to secure maximum charges, the state hospital doctors and nurses wanting to protect their earnings and overtime pay, the state pharmaceutical services that wield excessive power, the pharmacies with their guaranteed profit margins and the assorted unions all of which want the best possible deal for their members at the expense of other groups.
Now the government would also have to contend with the reservations of employers’ organisations, whose support for the scheme has diminished, because businesses do not want an additional cost to their payroll; employers would have to contribute a percentage of each salary they pay to the scheme. Talk that the health scheme would be bad for our struggling economy because it would push up labour costs is more than justified.
And that is not all. The government is keen on involving private insurance firms in the scheme rather than relying exclusively on the state’s Health Insurance Organisation for dealing with claims, payments and negotiation of prices, presumably because it does not want to create another inefficient state monopoly. There is reportedly disagreement between the government and the Troika on this issue, with the latter believing that involving private insurance firms would increase rather than reduce costs.
All fears and reservations about a National Health Scheme are understandable, but the government cannot keep putting back its introduction indefinitely. Access to free healthcare for all citizens is as important as access to free education, which is provided by our society even though its low standard does not justify its very high cost. If the government is afraid that a health scheme would end up the same – low quality, high cost – perhaps it should consider bringing in foreigners to run it and ensuring unions and political parties have no say in its running.