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Our View: Mini-NHS will further burden state healthcare

Health Minister Giorgos Pamborides

THERE was another twist to the ongoing saga of the National Health Scheme last Thursday with the announcement, by Health Minister George Pamborides, of government plans to set up a mini-NHS, as an intermediate stage, before moving on to the real deal.

He said that all required legislation would be prepared for approval by parliament before it shuts down for the May elections, with the objective that all hospitals would be on the way to becoming autonomous entities by the start of 2017. In the second half of the year, the mini-NHS would be up and running with everyone eligible for free healthcare at the autonomous hospitals, as people would be contributing about one per cent of their monthly salary towards the scheme (employers would contribute the same amount).

The one per cent mentioned by Pamborides was an estimate as finance ministry technocrats will have to calculate amounts needed before coming up with an actual percentage. He did try to put a positive spin on this, arguing it would be significantly less than the 2.3 per cent monthly contribution envisaged for the NHS proper, as if we were being offered a bargain. The truth is we will be receiving nothing for our contribution.

At present, much less than half the population is eligible for free healthcare at state hospitals and patients have to wait hours to be seen and six to 12 months for an operation or an MRI scan. What will be the waiting time when everyone is eligible for free treatment? A patient would have to sleep in the hospital waiting room for two days to be seen by hospital doctor and waiting periods for operations might reach two years. Patients could be referred to a private clinic if they had been waiting for too long, but only after approval by the health ministry. Knowing how slowly the ministry bureaucracy works the initial waiting period would be extended by an additional few months.

Pamborides tried to keep expectations low when asked by a journalist if a person would be able to phone and book an appointment at a state hospital. “We said we are going to reform the healthcare sector, not work miracles,” he quipped. “Calling to book an appointment… I don’t think we’re quite there yet.” In fact it would be a miracle if the mini-NHS achieves anything other than lengthening hospital waiting lists to unmanageable levels. State hospitals cannot cope with current demand for healthcare, with doctors repeatedly warning that resources were being stretched to breaking point, so how will they cope when demand more than doubles?

The truth is that people will be paying one per cent of their salary for the mini-NHS, but also pay a private doctor when they are ill, because the hospitals will not be able to treat them. People will be perfectly entitled to conclude that the only reason for the ‘mini’ would be to take their money as their eligibility for healthcare will be theoretical and of no practical value. This is guaranteed to create public opposition to the NHS project, and it would be no surprise if people who have health cover refuse to pay, while it will be very difficult for the government to justify the contribution when nothing is offered in exchange.

We suspect the minister has set a January 2017 start date for the ‘mini’ so that he can have a deadline for making the hospitals autonomous, a pre-requisite for the NHS, and thus apply pressure for difficult decisions to be taken. But he will indeed have to be a miracle worker to impose autonomous hospitals in less than a year, given the strident opposition of doctors’ and nurses’ unions. His predecessor resigned because the unions vetoed most of the reforms needed for the autonomy drive and the president sided with them. Pamborides is fully aware of the negative role of the unions, pointing out that the public employee factor was the reason for today’s poor state of hospitals because it blocked change.

How will the obstacle to hospital autonomy be removed so that the government can implement the mini-NHS? Does he think doctors and nurses will adopt a more flexible attitude because people will have to start making monthly contributions at the start of next year? This seems a very optimistic plan and we wish Pamborides success, but his decision to start charging for healthcare which the state hospitals will be unable to provide is a miscalculation that could easily backfire and destroy his plans.

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