Despite progress in healthcare since the advent of Gesy in 2019, a number of gaps remain, particularly in terms of preventative medicine and long-term care, a new report shows.

The 170-page report from the European Observatory of Health Systems and Policies titled ‘Health Systems in Transition’ highlights the gains made under Gesy but also points to a number of glaring weaknesses.

With a rapidly-ageing population, it said, Cyprus lacks a comprehensive and integrated long-term care (LTC) strategy.

By 2050, over 24 per cent of the population will be aged 65 or older, signalling an urgent need for LTC services.

However, public expenditure on LTC remains among the lowest in the EU.

“The lack of an integrated institutional framework, fragmentation in provision, and inadequate LTC facilities compel many families to seek private services,” the report said.

This is compounded by low wages and poor working conditions, making it an unattractive sector to seek employment.

While Gesy has laid a strong foundation for healthcare reform, it said, its long-term success hinges on financial sustainability and addressing such gaps.

Current services focus on people with high levels of dependency, such as those with chronic illnesses or disabilities, but coverage remains insufficient.

“Cyprus must adopt a comprehensive approach to long-term care and improve workforce conditions to meet future challenges,” it added.

Similar gaps exist when it comes to palliative care. “While the 46 inpatient beds for palliative care are sufficient, more trained teams for home care are needed,” the report said. It noted that a lack of institutional frameworks defining care delivery and qualifications also further hampers progress.

Responding later on Wednesday, Health Minister Michalis Damianos said during his Christmas visit to the Makarios children’s hospital, that a bill addressing palliative care was being finalised.

It would be sent to the legal service in the next few days, he said. “We are proceeding with this,” he added.

He did not comment further on the report, according to which, elsewhere in the system, despite numerous successes, systemic weaknesses persisted.

It said public hospitals struggle to compete with private facilities, raising questions about their financial sustainability and autonomy.

Workforce imbalances were also evident, with shortages of GPs and nursing professionals exacerbating the strain on public hospitals. Most doctors, it said, work in the private sector and most nurses in the public sector, creating a major imbalance in the system.

The report also criticises the absence of quality and performance indicators in provider compensation and highlights inefficiencies in specialist referrals, often driven by patient pressure.

“Prescriptions and referrals are sometimes issued without an in-person consultation, a practice that escalated during the pandemic,” it said.

Additionally, limited access to innovative medicines, chronic psychiatric care, and community-based services such as physiotherapy and speech therapy “remain areas of concern”.

Preventive care, comprising just 2 per cent of health expenditure, also requires attention, with high smoking rates and childhood obesity flagged as pressing public health issues.

Achievements, according to the report, include significantly improving beneficiary coverage, greater patient choice and easier access to services.

Over three-quarters of the Cypriot population report good health—higher than the EU average of 68 per cent. Life expectancy stands at 81.7 years, surpassing the EU average by one year.

The system also excels in preventing avoidable deaths, the report said. “Cyprus has the lowest mortality rate from preventable and treatable causes in the EU,” it added.

Main challenges that remain are the reorganisation and reform of public hospitals in order to compete with private ones, the introduction and use of e-health, the implementation of university clinics in public hospitals and the integration of quality and performance indicators into the compensation mechanisms of Gesy providers.

The report also included numerous datasets such as health expenditure per capita coming in at US$ 4,206 and as a share of gross domestic product (GDP) 9.4 per cent in 2021- both below European averages.

In addition, the number of practising doctors in Cyprus has nearly doubled since 2000, reaching 467 per 100,000 population in 2020, above the EU average while the number of nurses has not increased at the same rate, standing at 498 per 100,000 population in 2021, well below the EU average.