By Angelos Anastasiou
AMIDST controversy and attempts to crush the idea, discussion of the proposal to introduce a ‘mini-national health scheme’ (NHS) in mid-2017 with all stakeholders will commence this week, a spokesperson for embattled Health Minister Giorgos Pamboridis has told the Sunday Mail.
Pamboridis, a plain-spoken outsider who has diagnosed an “unholy alliance of various interests across the health sector, and the entire economy”, unveiled his draft plan to kick-start implementation of a universal-coverage health system, devised over 25 years ago, to staunch criticism by nearly every group with a stake in the sector.
According to the proposal, the system will be introduced as planned in mid-2017, offering universal health coverage to every Cyprus resident, but only at public hospitals – as opposed to final implementation, which includes private-sector hospitals, too – and financed by a 1-per-cent contribution on total earnings by the entire population.
Though the idea was born more out of necessity than choice, so that much-needed funding for healthcare reform can be obtained, Pamboridis places equal – if not more – weight on the chance of utilising the operation of the NHS on a smaller scale as a ‘test run’, prior to full implementation.
“In order to prepare the introduction of the NHS, it will be good to run certain of its functions earlier – for instance, the Health Insurance Organisation,” he told state TV on Thursday.
“This is an interim solution that will resolve a multitude of problems, while familiarising patients, who are at the heart of the whole reform effort, with the system. Everyone will be insured, and if and when public hospitals fail to cope, or fail to cope in a timely manner, patients will be referred to the private sector.”
But although every stakeholder has agreed on the need for radical reform over the decades since the decision to introduce the NHS was made, many have balked when the time for action came, and this time is no different.
“The single problem in the introduction of the NHS is major private-practice doctors,” former health minister and 2013 presidential hopeful Stavros Malas told the Sunday Mail.
“In the private sector, it’s entirely possible to make €25,000 a month, while the public sector can only offer up to €3,000 or €4,000. These private-sector doctors have significant political clout, and I have first-hand knowledge of them using it against reforms such as the NHS.”
According to Malas, doctors and nurses at public hospitals “have no problem” with the introduction of a universal health-coverage system, a view not shared by Pamboridis.
“My proposal has weakened an unholy alliance that has been resisting reform – though, I must say, without coordination,” the health minister said.
“I can only term an alliance that finds public-sector healthcare practitioners with insurance companies and major private-practice doctors united against reform. Of course, everyone is entitled to fight for their own interests. But I will not allow one group to hide behind another in explaining why reform should not be attempted.”
The effort to persuade will commence this week, a spokesperson from the health ministry said. Pamboridis has scheduled meetings with each individual stakeholder group, so that discussion can start on how to best shape the proposal.
For the health minister, autonomous operation of public hospitals – a prerequisite to the introduction of the NHS in any incarnation – is the ball game. Autonomous operation, essentially transforming each public hospital into a self-sufficient organisation, is scheduled to come into force on January 1, 2017.
“By definition, in the effort to introduce the NHS, we must strengthen public hospitals, so that they can operate under private-market conditions, in turn allowing them to cope with the unrestrained competition that the NHS is expected to bring,” Pamboridis explained.
“The biggest challenge in this effort is, on the one hand, improving the quality of services offered, and, on the other, transforming the culture of public healthcare practitioners into seeing the patient as a customer to be satisfied, instead of a problem to be dealt with.”
For instance, he explained, public hospitals remain inactive after 2:30 pm every day. Extending the time in which resources can be used, the argument goes, could go a long way towards making public hospitals more competitive.
Completion of the effort for full autonomy would take, the minister said, two to three years, at which point talk of introducing the final version of the NHS can begin.
“But for me, autonomy of the hospitals is everything,” he noted.
“And, of course, autonomy requires funds” – enter the universal 1-per-cent levy on all income.
But Malas believes the problem with the plan is that, if adopted, the taxpayer will have simply funded a return to 2011.
“When I was at the helm of the ministry [from August 2011 to October 2012], public hospitals served about 80 per cent of the population,” he said.
“Today, public hospitals are struggling to cope with this number. This proposal aims to have everyone pay their 1 per cent contribution, and offer the healthcare services of the public sector only – basically, what was on offer in 2012. In other words, you are taking the contributions but not giving back what that contribution was designed for.”
We have to start somewhere, Pamboridis counters.
“The final plan has not been abandoned, or amended, or replaced,” the health minister said.
“The endgame remains a unified health market, with patients able to choose from anywhere in the public and private sector. There can be no future in the health sector without a universal-coverage system.”