Top officials have been quick to admit the new national health scheme has had a variety of teething problems, but can they all be resolved?
By Brian Lait
The long awaited and much discussed Cyprus health scheme (‘Gesy’) officially kicked off on June 1, 2019 with much fanfare. It is being run by the Health Insurance Organisation (HIO), although Assurance would be more comforting.
There are aspects of the scheme, once you are fortunate to get registered on it, that appear to be working very well, and the planners and developers of the relevant software must be congratulated for their work. An example is where a GP issues a prescription on a computer, the patient takes the prescription to a pharmacist who, with the prescription number, can find it on the Gesy system and dispense the required medicines. Prices to be paid for the medicines are listed on the prescription, along with dosages. The pharmacist also records what has been issued to the patient and when.
With that prescription number the patient may then visit any Gesy registered pharmacy for further issues of the prescribed medicine, although the dosages prescribed by the GP, plus information on the system tells any pharmacist the exact status of what has been dispensed and when, so the patient cannot abuse the system by either trying to get medicines in advance, or more than once.
However, the initial, very prolonged and tiresome challenge for my wife and I was getting on the system at all, despite living here for over 17 years, paying income taxes, having ID numbers and Cyprus driving licences issued when we first arrived, holding title deeds to our property, obtaining our MEU3 several years ago, etc., etc.
I tried registering online towards the end of April, but the system blocked progress on my third attempt because, apparently, my e-mail address and mobile number were already in use! So, on to the Greek language manual registration and the completed forms were duly delivered to our chosen GP at the beginning of May, but by separate telephone calls on May 29 my wife and I were informed that our registration had failed “like all foreigners”. We were given telephone numbers to call, all to no avail, were refused help at two social insurance offices because we had never worked in Cyprus and one and all told us to go back to “them”. But who is, or was, “them”? Nobody seemed to know.
At the end of the first week in June we mailed copies of the Greek language registration forms originally submitted in May, our passports, MEU3 and E121 to an address in Nicosia supplied by the very helpful staff in the clinic in Kofinou. With nothing heard by mid-July, the Citizens Advice Bureau in Larnaca found our full details on the Gesy website, but with a note imposed on top simply saying, in Greek, “Application made”. So, back to the helpful staff in Kofinou who managed to get us fully registered, and our chosen GP signed our forms on the spot, a mere two and a half months after starting. Without such registrations, hospitals and clinics would soon decline to continue treatment previously received.
We were two of many hundreds who encountered inexplicable registration problems, which included a Cypriot doctor whose Greek wife and daughter born in Greece could not register, while his other daughter born in Cyprus was registered with ease. Then there is a Cypriot, taken to the UK as a child, who has been back here some 15 years and receiving medical assistance under the ‘old’ scheme, but was denied access to Gesy until he re-registered as a Cypriot. And so the list goes on.
On July 26 the HIO announced “…that a number of issues related to the registration of persons entitled to Gesy have been concluded….”. Good to hear, given that registration started on April 24, but my suspicious mind wonders if that really is the case, and why there were so many issues at all.
Unfortunately, the supply of certain medicines also lacks some forethought. It was made very clear that at the end of August hospital pharmacies would only dispense medications to in-patients and, therefore, prescribed medications must be obtained from private pharmacies which had joined the Gesy system. While this is easy to state, it isn’t easy to do. The state pharmacies are fairly few in number and, thus, the stocking and supply of expensive and fairly rarely issued medicines is not too difficult. Under Gesy, however, there are nearly 500 pharmacists registered across the island. Does the HIO intend to stock all pharmacies with expensive medicines that may only be dispensed through a few of them? If not, and understandably not, then what is the solution?
According to the powers that be (i.e. the civil servants in charge of starting and running Gesy and the politicians who have played football with the scheme for decades) we should simply shrug our shoulders at all of this and sweep it under the heading of “teething problems”. In the world I operated in it was called crass managerial incompetence and heads rolled; but then I did not work in the civil service.
As late as May 13 top officials “were concerned that the scheme might not be ready for its June 1 launch”. Alekos Stamatis who heads up the state health services organisation (Okypy) said on the same day “improvements that should have been made in recent years had not taken place and this meant that changes were being made five minutes before the implementation of Gesy”. A senior officer of the HIO, Angelos Tropis, added that “there have been big issues over the procedures for non-Cypriots registering with Gesy”. Did he mean funny foreigners like me who have held all necessary identification papers and have been paying taxes for years and years?
And finally we have the health minister himself, Constantinos Ioannou, on the very eve of the start saying “The ideal would be to be completely prepared. As the ideal is not possible, we are proceeding with what’s possible. There will be problems and obstacles. We are aware of this and we are expecting this”. And, as if any sane individual was not already aware of the root cause of all the “teething problems” he kindly informed one and all that it was about time Gesy was implemented after many discussions that “sparked a lot of tension over the decades”. I’d never have guessed.
Regardless of the so-called teething problems, etc. the big question is: will Gesy survive?
My old auditor’s antennae are waggling quite vigorously. It seems that an awful lot of money is being sloshed around which makes me wonder if there will be sufficient income to meet the outgoings. General practitioners (GPs) are being paid €107 annually per patient registered with them. With a maximum of 2,500 patients per GP that will give a GP up to €267,500 annually, a mighty generous income for a GP by any standards. Before the end of July, there were 384 GPs registered with Gesy. And then there are the paediatricians and the specialist doctors.
The latest population figures are from 2017 when the Republic had 816,000 persons. Assuming each and every one was signed to a GP, the cost would be €87,312,000 to be paid to GPs alone; fees to paediatricians and specialist doctors are to be added on. Medicines and sums paid to pharmacists must be costed in, and the latest generous offer to GPs announced a week ago will allow a doctor to earn €100 for a 2.5-hour shift on a weekday evening, €480 for an eight-hour shift on Saturdays and €240 for a four-hour shift on a Sunday. Do we conclude here that the original planning assumed there would be no illnesses on any weekends?
One comfort the authorities can have is that all these generous payments can be partly clawed back by an increase in declared income for personal taxation, about which I suspect the medical profession is a tad economical with the truth at present.
So, watch this space, although I can already hear the faint cries of anguish regarding funding and the supply of various medicines.
Brian Lait is a retired chartered accountant living in Cyprus