THE NATIONAL health scheme, known as Gesy, is fast becoming the new Cyprus problem, its introduction as elusive and difficult as a settlement. The idea of a system of universal healthcare was first suggested by the Vassiliou government in the early nineties and was adopted by the Clerides government which hired consultants to advise it how it could be implemented, but took no action.
The latter was wary about health infrastructure initiatives after its disastrous administering of the Nicosia General Hospital project which was completed several years later than scheduled and tens of millions of pounds over budget. Tassos Papadopoulos was the next president to take up the Gesy cause and although he had many misgiving about the ability to conceive and execute such a complex undertaking he set up the Organisation of Health Insurance 11 years ago.
The organisation, run by a board, hired dozens of workers and a highly paid general manager to set up the data-base for universal health cover and negotiate charges by health providers. After more than 10 years of existence and spending tens of millions of euro on staff costs, the organisation has still not managed to award the contract for the design of the software and setting up of a database. It is not entirely its fault, given how every tender for a public contract ends up in the courts for a couple of years before the process is cancelled or abandoned. New tenders are currently being submitted.
The Christofias government paid a lot of lip service to Gesy, but did nothing of practical value, confining its pitiful effort to discussions with health sector unions. It was the much-maligned Troika that brought up universal health cover in its bailout discussions with the government in 2013 and insisted the matter was included in the memorandum which the government signed. The Troika had even set deadlines for its introduction, which the government kept putting back.
But as in the Cyprus problem we are opposed to suffocating time-frames. As the Cyprus Medical Association said in an announcement issued on Wednesday, there was a danger the scheme could collapse from “inadequate and hurried planning of reforms in the health sector” in which case the “consequences would be very serious and perhaps irreversible.” Doctors want a viable and workable Gesy and are therefore against a rushed plan.
The mindset and the rhetoric is the same the only difference being that we cannot blame the failure to implement the scheme on Turkish intransigence and maximalist demands.
In the case of Gesy, the intransigence is being displayed by the public health sector unions, which have the unwavering support of the conservative forces of Akel that wants to maintain the status quo – an inadequate, poorly-organised state health system that serves less than a third of the population badly but its employees extremely well. President Anastasiades even called a national-council type meeting, last summer, at which the party leaders agreed on a plan of action for the introduction of Gesy, but there has been little movement since then. According to the deeply frustrated health minister Giorgos Pamborides, two bills that would take the scheme forward by starting the process of making hospitals autonomous have been at the legislature awaiting approval for four months.
Meanwhile, conditions at state hospitals are going from bad to worse with reports about 18-month waiting lists for operations, patients sleeping on ward floors or waiting for hours to be seen, serious shortages of consumables and a steady exodus of overworked doctors. Doctors’ and nurses’ unions have been vehemently opposing the autonomy of hospitals for years, their primary concern being protecting the privileges they enjoy as public employees.
They have now found another pretext to fight autonomy – they claim they want hospitals to be re-organised and extra staff taken on before each one became an autonomous entity, a process that according to Akel and Edek should involve a transitional period of a couple of years. The irrationality of this proposal beggars belief. How absurd would it be to address the staffing needs of hospitals under the current system of centralised state control which would be replaced after two years by autonomous hospitals? One of the main reasons the hospitals are in such a mess is because of decades of mismanagement by the state.
The sensible thing would be to go ahead with the process for autonomy and then address the staffing needs of each hospital, but this seems too rational an approach for Akel and the unions. As in the Cyprus problem, the campaigners against change will use any ploy to maintain the status quo, from delaying tactics to defiant rhetoric and, in this case, repeated strike threats. They will do anything to maintain the status quo that puts public health workers’ interests above those of patients.