THE PURCHASE of heart surgery services from the private sector was suspended last week after the government accused interested parties of overcharging.
The argument broke out at last week’s House Health Committee meeting when public doctors stopped short of calling their private sector colleagues entrepreneurs in lab coats.
Three hospitals, including the Aretaeio hospital, the Achilleon hospital and the American Heart Institute, participated in the tender process to sell their surgical services to the state. Having quoted their prices, the government has now decided the fees demanded by the private institutions are too steep.
Specifically the hospitals have asked for fees in the region of £9,000 per procedure. The government wants this reduced to £7,000, claiming that it has found an institution that has offered its services for this fee.
But none of the three hospitals were told which medical establishment had made such an offer. Head of the American Heart Institute, Dr Marinos Soteriou, wanted to know which institute had been allowed to bypass the tender process and why prices they’d offered as part of their package were being brought into dispute now.
“We’d like to know how come the government declared a tender and all of a sudden it is negotiating prices that have been obtained outside the tender,” he said.
Soteriou said bypassing the tender process was illegitimate, particularly when the new prices on the table did not include a breakdown of the costs and package.
“How can we be sure that they are similar packages as to what we are offering?”
Government doctors union president Dr Stavros Stavrou said prices in Greece and Israel were cheaper than what the three hospitals were claiming.
“How is it possible that heart surgery services will cost almost double the price of what is offered in Israel and Greece… It’s inexcusable,” he said.
Stavrou also said the price of medical services could not be compared to the UK or US because their socio-economic backgrounds were dissimilar.
“If we are going to compare other countries to Cyprus, we will compare countries that are similar socioeconomically similar [such as Greece and Israel],” he said.
But Soteriou pointed out that Stavou was not comparing like with like and that Greece’s Onasion Hospital, for example, was subsidised by the government.
“We cannot compare products and services to subsidised services and subsidies… The Onasion gets subsidies from the government and every year it’s making a loss. I think that says it all,” he said.
Soteriou also pointed out that the majority of heart patients were not sent to Greece or Israel for treatment, but were sent to the UK where prices were far more expensive.
“Why when we can offer the same services here are patients being sent to the UK for surgical procedures,” the cardiac surgeon said.
He also questioned whether the hospitals in Greece, Israel or the UK had gone through some sort of tender process or whether they had simply been selected after being visited by a government official.
Stavrou said it was important to try and improve and upgrade local medical services but that to do so at the expense of patients was unforgivable.
“I ask for a price and then negotiate that price. But they’ve threatened that if we don’t accept their prices they’ll terminate any co-operation and that people will die.
“Well, people haven’t been dying for years and if we have to we’ll work around the clock.”
Soteriou said he had made no such threats and called on Stavrou to state who had.
He also said Stavrou was not an economist and did not possess the competency to determine whether prices were outrageous or not.
He also questioned his colleagues’ motives behind offering to work overtime and asked what safeguards would be set in place to prevent public doctors from overcharging the government as had happened in the past.
He added: “People think that fees we quote go into doctors’ pockets. They do not.
“When we calculate our costing we include the building, its maintenance, the purchase of equipment, it’s maintenance, the cost of heating and cooling the building, investing in know how, training staff and so on.
“This expenditure is not included in the costing done by the public sector and then they come and say they’re cheaper. If you were to take out all those costs then you could make my product cheaper too. But this is money being spent and should be included in costing.”
Soteriou said public doctors didn’t take into account the extra costs involved in running a medical centre.
“They don’t understand what goes into the costing. They are not cost sensitive. They only bring their personnel costs to the table.”
He said almost £3 million was spent on electricity and oil per year at the new Nicosia general hospital.
“Who’s going to pay for this? Who is going to clean the place? Who is going to buy the equipment? Who is going to pay for the maintenance contracts of the equipment, which runs into the millions? These things belong in proper costing. They have to give us the full details and then we can compare prices.”
Soteriou also pointed out that local medical centres paid income tax, defence fund and social insurance.
“When you calculate all these things then the cost of open heart surgery in Cyprus is costing the government less than £2,000. They’ve chosen to ignore that and I still don’t understand why,” he said.
Soteriou said he wanted to know why the government continued to send patients overseas when medical centres here contributed to society, employed locals and upgraded local services.
He also said competitive medical centres would attract medical tourists and that already tourists were undergoing procedures at local private hospitals which was a start in the right direction.
“If we keep trying to affect people who are trying to create services and infrastructure in Cyprus then it is not going to make progress….
“Medical tourism is the big buzzword of the century. There is tremendous patient mobility with patients from the US, Canada and the UK looking for medical services overseas. Who is going to attract these patients? Government hospitals that are overwhelmed with the locals?”
But Stavrou said Cyprus was incapable of becoming a regional medical hub when it neighboured medically superior countries such as Israel, Jordan and Turkey.
“We should strive to upgrade and improve our services but only when we become a regional power will we become a regional medical hub,” the government doctor said.
Again Soteriou pointed out Stavrou’s lack of economic qualifications and that the private sector already had a substantial contribution to its income from tourists and non-Cypriots.
He also disagreed with Stavrou’s estimate regarding Turkey’s superiority in the medical sector, saying Turkish Cypriot patients frequently crossed the Green Line for treatment at the institute, though they could have received free care in Turkey.
The issue will be discussed in parliament in two weeks. In that time the government has been asked to confer with the Accountant general whether the tender process was so far legitimate.
Soteriou said he had sought legal advice and had already sent a letter to the auditor general, stating the Institute’s position and was waiting for answer.
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