The latest evaluation report of the national health scheme Gesy raised some very important concerns, which could jeopardise its medium-term viability if not tackled in the foreseeable future. It is good that these failings have been identified and recorded because there has been a tendency since Gesy’s introduction to avoid all criticism of it, except if directed at waiting lists. Those who questioned any other aspect of its operation were automatically labelled as enemies of Gesy, conspiring to dismantle the “greatest conquest of the Cypriot people.”

The report, however, did not ignore the weaknesses of the scheme, one of which was the overutilisation of healthcare services, because these were free. As there were no additional costs, patients felt they were entitled to treatment and medical tests for every minor ailment. As the report said, free services led to “patient-driven” decisions that gave no consideration to the financial costs. An entitlement culture has been created with patients demanding costly unnecessary tests and referrals to specialists and pressuring personal doctors to grant these. Patients often assumed the role of doctors, deciding their healthcare services independently, the report said.

This is the reason that clinical labs can now be found in every neighbourhood, as if they are kiosks, while the number of diagnostic imaging facilities has grown unjustifiably given the size of the population. How could Cyprus’ healthcare needs have been covered by a much smaller number of such testing facilities five years ago? It is not as if five years ago people were unable to find a lab for blood testing or a place to have an MRI with minimal waiting time. The difference was that five years ago people were paying for such tests, so they had them only when they were medically necessary.

Now, because they are free, demand for such tests has grown geometrically, and it is not because the number of people with illnesses is much greater than five years ago. Because it is free, Gesy creates excess demand for healthcare services, something that explains why so many new businesses providing medical services have been set up. Healthcare has become a very lucrative industry thanks to Gesy.

Excess medical testing is not the only financially costly abuse of Gesy. Private hospitals within the scheme do not admit patients with pathological conditions, invariably sending them to state hospitals, because the rate they receive per bed is much lower than that for people who undergo surgeries. Although the report does not mention this, it is entirely possible that private hospitals make patients undergo unnecessary operations because this will earn them a high daily rate for a bed. We could probably add the unnecessary operations to the unnecessary MRI testing, blood tests, ultrasounds etc.

Patient culture combined with inadequate controls imposed by the Health Insurance Organisation (HIO), which administers the scheme, has turned Gesy into a cash cow that is being milked by everyone involved with it. As for the grossly overpaid personal doctors, who were supposed to be the gatekeepers of scheme, they have failed spectacularly in this role, signing off unnecessary referrals for specialists and medical testing with carefree abandon – in mitigation, they could cite pressure from patients. The HIO has been trying to place more controls on them but the abuses continue.

The report attributed the lack of a proper healthcare culture and adequate patient education for the overutilisation of services that put pressure on the system financially as well as causing long waiting lists. The problem is that it would take years to educate patients and create a proper healthcare culture, if it could actually be done. By then Gesy will have run out of money and the monthly contributions of workers and employers will have to be increased to keep the system going.

We should not wait for the system to be milked dry. The only way for the culture of entitlement to change is for the government to impose higher charges for all medical actions and referrals. There will be an outcry, but it should be explained that this is the only way to secure the viability of the greatest conquest of the people, ensure there is no increase in monthly contributions and reduce the waiting lists everyone has been complaining about. The culture of entitlement will be restricted when there is a cost to it.