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Our View: Health plan is a colossal mess

IT WOULD be a gross understatement to say that the planning for the national health scheme (Gesy) is shambolic. The reality is it is a colossal mess, every few days throwing up another example of poor planning, miscalculation and superficiality. Currently, private doctors and private hospitals are in dispute with the Health Insurance Organisation (HIO) about payment, state hospital doctors and nurses have lashed out against the Organisation of State Health Services (Okyy), from which several directors have resigned, quality criteria for treatment have not been set, while the process for the autonomy of state hospitals has not even begun.

This state of affairs does not exactly inspire the confidence of individuals and businesses that will start making monthly contributions to Gesy from March on the understanding that the first phase of the scheme would be introduced next July. Would the billion-euro budget be adequate or will the contributions have to be upped to cover any shortfall? Or, worse still, would the quality of the healthcare be of a poor standard so that the scheme stays within budget? These are perfectly legitimate questions, to which nobody can provide answers because original plans are being chopped and changed in order to address problems that were not foreseen.

The only thing going for Gesy is the strong public support it enjoys. So much so, it has become a sacred cow, the political parties, media and patients’ groups mindlessly attacking anyone who dares question its proposed mode of operation and viability. When private doctors, quite rightly, questioned the reward system based on a unit that will have a constantly changing value and highlighted the lack of quality controls, they were dismissed as greedy, tax evaders, threatening Gesy for the sake of their financial interests. But how many members of other professions would sign up to a payment system that had not a fixed rate, with the unit rate diminishing in busy times for the profession?

Interestingly, the media have not taken a stand against the state doctors and nurses that were protesting about the failure of Okyy, under the authority of which state hospitals would be moved from the beginning of next year, to discuss the autonomy of the hospitals with their unions. What they really want are guarantees that all their pay, benefits, working hours as public employees would be safeguarded even though Okyy, their employer, is not a state organisation but an independent legal entity.

Meanwhile the union of state doctors, Pasyki, have also raised the issue of pay, their leader warning that if the pay of state doctors was disproportionate to the earnings of private doctors, there was a big possibility doctors would leave the public sector and go private, “as this would be in their financial interest.” And if a big number decided to leave, the public hospitals “would face huge problems.” There was no mention about the greed of the state doctors, who were essentially blackmailing the government, in the media or by patients groups. They not only wanted the security of working for an employer that would guarantee them all the benefits of public employees, including paid holidays, state pensions, overtime pay but they also wanted to be paid more because some private doctors that enjoyed none of these benefits would be paid more.

This highlights the main flaw in the thinking behind Gesy. It is infected by the Akel dogmatism, embraced by almost all the parties and media, that public is good and private bad. Therefore, the greedy, tax-evading, private doctors, had to be kept on a tight leash – if they join Gesy they would not be allowed to practise privately, a condition re-confirmed at a meeting at a meeting at the presidential palace on Thursday. This restricts the right of doctors to freely practise their profession, even though they are contractors and not employees of Gesy, but also deprives people not participating in Gesy – primarily foreigners – from being seen by a doctor of their choice. This could lead to the best specialists staying out of Gesy, which would penalise patients, but fit in to Akel’s championing of mediocrity and disdain for excellence.

The same philosophy prevails in Gesy’s approach to private clinics and hospitals. The HIO has secured low rates for most medical actions, which could make private health establishments unviable or force them to cut costs at the expense of the patient. State hospitals, in contrast, will be subsidised by the taxpayer for up to five years after the introduction of Gesy, thus competing unfairly with private hospitals and continuing being inefficient and wasteful. Even the advice of the consultants that the complete autonomy of state hospitals was a requisite for the introduction of Gesy was conveniently ignored. While private hospitals offer the best healthcare the HIO’s pricing policies is designed to lower their standard of care and bring them down to the level of state hospitals.

Admittedly, there are budget constraints, but these could remain in place if the politicians did not treat the private healthcare sector as the enemy that must be destroyed for the sake of Gesy. Allowing private healthcare to operate in parallel to the scheme by not squeezing it financially, will ensure healthy competition, ensure the best possible healthcare and ease the burden on Gesy’s resources.

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