Cyprus Mail
CM Regular Columnist Opinion

Crossing red lines

By Hermes Solomon

DESPITE Health Minister, Philippos Patsalis’ threat to ‘cross red lines’ in an effort to overhaul the island’s health system, few believe he will succeed in introducing the new national health scheme (GESY) over the next three years – 2014 inclusive.

The scheme is part of the island’s bailout terms and certain to meet as much opposition as the NPL’s bill, which is still floating about in ‘dreamland’, held aloft by a year and a half of opposition-party hot air.

I do not envy the health minister his task, but like many others am preparing for a total collapse in public healthcare services as soon as the first red line is crossed.

If only the minister would tell us a little more about GESY. But he doesn’t, and until he does I cannot see anybody taking his red lines threat seriously given the militancy (hot air) of healthcare unions, the private sector, healthcare insurance firms and major drug companies (cartels) all with their own House of Reps lobbyists.

The minister’s comportment thus far has been exemplary – diplomatic and receptive, listening to all parties involved without waving any red flags. But when his draft legislation hits the House in two weeks time, I expect all hell to break loose.

I can tell you that GESY will operate similarly to the German healthcare system (a German consultancy firm designed the GESY scheme between 2004 and 2008), where adherents can expect to pay a lump sum annually (250 to 300 euros per family member) to a state fund – the Health Insurance Organisation (HIO) – which will cover all healthcare expenses (family doctor/GP and hospital treatment) whether public or private, but not the total cost of aftercare drugs.

Below the poverty line citizens have yet to be excluded from the annual lump sum cost and no mention has yet been made of what ex-pat long term residents can expect to pay.

Patsalis said Cyprus had to take the “creative leap” so as to move forward – but from what to where? Without telling us a lot more about the implications surrounding GESY, it sounds more like a leap in the dark than anything else.

Forcefully introducing ‘an efficient cost effective health system’ with the present staffs’ existing mentality is a non-starter. ‘Cushy jobbed’ public health workers are already balking against GESY mobility requirements – being moved to where they are needed – which could mean working in another town. Will there be travel and time wasted allowances?

Disenchantment with GESY will be expressed by health workers taking increased sick leave and working to rule even though a recent circular to the Public Administration and Personnel Department has instructed agency heads throughout the civil service to tighten monitoring of sick leave. But in the case of health workers, who issues ill-health certificates if not doctors?

We have a nation of two halves – those with health insurance that patronise the ‘pricey’ private sector and those that stand in long queues and are ‘eventually’ treated at a derisory cost by the public health sector.

Today’s overstretched public healthcare and underworked private sector must link facilities and work together. But who will benefit after the introduction of GESY and who will lose out?

If there is an across the board annual lump sum cost covering all treatment then it seems that health insurance companies are out of business and private healthcare sector charges will come under the HIO microscope, which will seek to pay the lowest common denominator for services rendered.

Private healthcare is a business like any other – primarily profit motivated. And like our developers and construction industry, private healthcare practitioners are now seen as fast-buck merchants.

It is common knowledge that GP’s, the private healthcare sector and health insurance companies have unfairly exploited the patient and the system for years. Many accuse the private sector of outrageous over-pricing of the insured, performing unnecessary operations, excessive and expensive diagnostic procedures and poor aftercare services.

Health insurance is big business for the private sector, which inflates costs accordingly. I cannot see insurance companies and the private sector welcoming GESY with open arms.

Under GESY, a family doctor’s consultation fee will be controlled and paid to the doctor by the HIO, not the patient. Cash payment of fees will cease and appropriate taxation of a doctor’s income will ensue.

A regulated number of patients, comprised of mixed age groups, will become statutory and family doctors/GP’s will be reduced to being a link in the chain rather than a law unto themselves; an end to recommending patients to a specific ‘friendly’ clinic and prescribing drugs on which GP’s are paid commission.

Under GESY, all will be treated equally. And if Minister of Health, Patsalis can succeed in his aim to introduce GESY according to troika directives, we are all beneficiaries.

“The red lines set by the parties involved are so many there is no common denominator on which everyone agrees,” said the minister.

But is a common denominator necessary given that the introduction of GESY will eventually be passed into law indifferent to those anticipated innumerable ‘tiresome’ gripes of all parties involved?

Patsalis is correct in saying that Cyprus had to take ‘a creative leap forward’. And he did not mean only in healthcare, but in ‘mercilessly’ modernising all departments of our ‘archaic’ public administration.

 

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