As was expected, private doctors stopped consultations with the Health Insurance Organisation (HIO) about the National Health Scheme (Gesy), claiming they could no longer participate in an “infertile dialogue”. At a weekend meeting, the members of the Cyprus Medical Association (CyMA) unanimously backed a resolution setting five conditions for their participation in Gesy that were rejected by HIO, thus bringing the dialogue to an end. CyMA is now demanding meetings with the president and political parties to explain their positions.
One of the main conditions set by the doctors was the increase in the annual budget for the scheme so that it would be closer to the EU average. This would ensure the quality of healthcare provided, the safety of patients and sustainability of Gesy, CyMA said. A reason for the bigger budget the Association did not mention was so that private doctors could receive higher pay per patient. Higher reward for doctors was listed as another condition, which was acceptance of the CyMA proposal for fees. Confusion prevails regarding the reward system, with neither side being able to put across its case clearly.
While it is possible the government would try to reach a compromise on an improved reward system that could make the scheme unsustainable in the medium term, there is no way it could satisfy the other condition set – doctors to be free to work for Gesy and privately at the same time. The HIO, understandably, ruled this out from the start, because it would create a two-tier care system, doctors giving private patients preferential treatment as they would be paying higher consultation fees than Gesy patients. Popular doctors would have an incentive to see private patients promptly while putting the rest on long waiting lists. HIO is right to insist on exclusivity, as this would ensure patients received equal treatment by doctors.
CyMA is correct, however, to insist that the administrative and financial autonomy of state hospitals was established before Gesy was implemented. If it is not, private hospitals and clinics might be forced to accept much lower rates for inpatient care by the HIO than would be paid to state hospitals. There is no way state hospital nurses and doctors would accept pay cuts so that the state hospital would be competitive and charge the same rates as the more efficient private sector. What would happen if state hospitals cannot be made viable? Would the taxpayer carry on subsidising them so its employees could enjoy public service pay and conditions? And would this not create two different classes of health workers?
If the HIO wants to speak from a position of strength, it needs to sort out the issue of the state hospitals. It cannot tell private doctors what they will earn before it has even addressed the issue of the state hospitals and does not yet know what their operation would actually cost.