HEALTHCARE AND PUBLIC HEALTH

 History and current system

 

After the 2ndworld war, public health in Cyprus steadily improved due to increasing prosperity and the eradication of malaria. Since 1960, the relevant ministry has been working to improve public health facilities and the supervision of the private sector in health care. Due to the Turkish occupation of 1974, a lot of new medical infrastructure had to be set up. Because the University of Cyprus has no medical school, doctors, specialists, dentists, veterinarians and pharmacists are trained abroad. For each of these categories there is a government supervisory board that recognizes diplomas. As of 2003, less relevant recognition criteria (eg Cypriot citizenship) have been abolished. There is a separate training for nurses and midwives. In Greek Cyprus, disease prevention and health education are at the forefront. Around 2000, for example, information campaigns about healthier eating were on the rise. In the field of mental health, educational institutions are working on a better understanding of different values and views through communication training.

 

According to http://www.cyprusnet.com/Greek Cyprus has a public medical service of the Ministry of Health for civil servants, military and police, students and low income groups and a fairly large private medical sector. In addition, trade unions have their own medical services for members and there are schemes through employers. The private sector has more choice and fewer waiting times and lists, but the service does depend on the premium paid. It controls around 65% of outpatient care and 35% of inpatient care. In the public sector, the relationship is reversed. In order to make the organization and management run more efficiently and to better coordinate the private and public sector, a law was passed in 2001 on a national health insurance system (NHIS). It was wanted to be introduced in 2007, but in 2008 the introduction was not yet complete. Most cities in Cyprus did get a new general hospital (Nicosia in 2006). In October 2008, in an article on the state of affairs regarding the introduction of the NHIS, the president of the Greek Cypriot General Practitioners' Association, Dr Mary Avraamidou, mentioned the lack of coordination between the private sector and government and poor quality measurement in both sectors as problems.

 

Assessment of care

 

In 2002, satisfaction with the health care system in Greek Cyprus was widespread by EU standards (72% satisfied, 4th highest Eu25: EU15 44%). Compared to 1996, general satisfaction had fallen somewhat. Although the government facilities are well equipped and always open, in 2002 people were more satisfied with the private facilities. In 2003, the own health care system was rated 6.1 (highest EU10 after Malta, EU25: 6.2) and in 2007 the figure for care and facilities for the elderly was slightly below the Eu27 normal (5.9 and 6. 1 and 5.5 to 5.6). In mid-2009, the proportion of the population that considered health care to be the top 3 problem children was small by EU25 standards (9 at 16%; NL 27%; Be 8%: Special Eurobarometer308, wave 71.1). The same was true at the end of 2006 for the proportion that classified care for the elderly below this (8 at 13%; NL 25%, Be 14%). Care for the disabled then scored 5% (EU 4%, NL 6%; Be 4%). At the end of 2006, concerns were not widespread for the next generation either. Here, 7% (EU 17%) included health care, 6% (EU 10%) elderly care and 1% (EU 2%) disabled care in this top3 (Special EB 273, wave 66.3) .

 

The table below shows the results for Greek Cypriots (GC), the EU27 and the Dutch from an opinion survey conducted in 2007 into the quality, availability and price of healthcare institutions (source special EB 283 wave 67.3 ). The Greek Cypriots score reasonably on quality and high on both accessibility/availability and price. The part that thought the doctor, dentist or specialist was too expensive fell below the EU top, but the part that thought the hospital was too expensive was small by EU standards.

 

Payment of care

 

The state care is in Greek Cyprusin principle free and intended for those who cannot afford it and for those in government service. However, it can also often be used through trade unions and collective labor agreements. Because the quality leaves much to be desired, many people who can afford it take out private insurance to be able to use the private circuit. Yet many pay personal contributions because otherwise the premium will be too high. In 2002, 5.8% of GDP (EU25: 9%) was spent on health care. Around 2003, less than half of this (2.8%) was paid for by the government. The rest was paid for from capital investment from abroad, private insurance and co-payments.

 

According to Dr Avraamidou of the General Practitioner Association, healthcare expenditure in 2007 was 6, 4% of GDP and went up annually in the private sector by 8% and in the public sector by 11% (OECD countries including 19 EU countries averaged 3.8% p/y between 2000 and 2007). In addition, according to her, the own contributions have skyrocketed. In 2006, the share of the public and private sectors was equal at 50%(statistical abstract 2007) . For 2006, Eurostat came to 3.53% of GDP (smallest share in 22 EU countries) in healthcare expenditure. The government's share was 42% (also very small) and that of the private sector at 58% (private insurance private 4%, idem company 3%; own contributions almost 50%, very high by EU standards). By function, 1.45% of GDP went to hospitals, 0.09% to nursing homes and institutions, and 1.15% (a relatively large amount) to outpatient care providers. In 2007, the TRNC spent 3.9% of GDP and 8.6% of the government budget on health care.