THE IDEA for a universal healthcare system in Cyprus was first floated by the Vassiliou government in 1991. Everyone applauded it and the Clerides government, which followed, prepared legislation on how it would operate and be funded in 2001. The bill was approved in that year but it was left to the Papadopoulos government to start work on the logistics of administering and funding of what is likely to be the most complex public project ever to be undertaken.
Much of the groundwork has been done, but the Christofias government has been less than enthusiastic about the introduction of a national health scheme, towards which everyone – employees, employers, self-employed – would contribute on a monthly basis. Former finance minister Charilaos Stavrakis was openly opposed to the introduction of the scheme, claiming the cost would be prohibitive and arguing that the monthly contributions would have to be much higher than the original estimates for the project to be viable. Stavrakis’ claims, which were not documented, frightened people off.
The government’s negativity and reluctance to give the green light to the final and most difficult stage of the preparatory work led to the resignation of Kyriacos Christofi, the chairman of the Health Insurance Organisation (HIO) which would manage the National Health Scheme, last July. Christofi had repeatedly tried to extract a commitment to the introduction of the scheme from the government, publicly threatening to resign if nothing was done. The government had simply decided that the scheme would not go ahead, but was content to carry on paying the staff at the HIO to carry on the planning process, without an implementation deadline.
It is quite astonishing that the Christofias government, for which free education and free healthcare provided by the state are articles of faith, could be opposed to a national health plan for everyone. One explanation is that it has given in to the public employees union PASYDY, an opponent of the scheme, because its members, like all other workers, would have to pay monthly contributions, whereas they pay nothing now. Free health care at state hospitals is a public employee’s right irrespective of how high their income is. A health scheme would also eliminate the scope for vote-buying, medical favours being dispensed by the political parties and especially the government. Many people wanting treatment abroad apply to the state for financial help, with the health minister having the discretionary power to decide who goes. Between 30 and 40 million euro is spent by the state every year on sending patients abroad offering big scope for special favours to potential voters.
A national health scheme that treated everyone equally and was run along objective criteria would eliminate the type of corruption on which political parties thrive. It would also eliminate the long waiting lists for operations (sometimes longer than a year) at state hospitals, which are unable to cope with the demand for even primary care. The recession has dramatically increased the numbers seeking care at state hospitals, but resources are limited and decisions need to be taken now.
Health minister Stavros Malas, as if to underline the government’s unwillingness to proceed with a universal health scheme, recently proposed the half-baked measure for dealing with the hospital overcrowding – state hospitals would send in-patients to private clinics, as a first step. How this would resolve the overcrowding caused by day patients, only Malas could say.
Unwilling to wait for a government decision any longer the HIO took the initiative. It put together a proposal package, explaining how the national health scheme would work, how the cost burden would be distributed among different sections of society, the operating costs and its management, what the benefits would be for citizens, the savings that would be made and a host of other related issues. The package was presented to doctors, unions and political parties and on Wednesday it was also given to the media. The HIO says that the scheme could be in operation in two-and-a-half years from now if the go-ahead was given now.
It may need a bit longer than that to get the go-ahead as there will be opposition from other quarters apart from AKEL, but HIO should be commended for trying to inform people and open a public debate about whether we should have a national health scheme. The presidential election campaign will start soon and the national health scheme should feature as one of the main issues on which candidates would have to take a stand. Toying with an idea for 22 years is long enough. Now we need a decision.
