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A national health system which makes medical care available to all is a wonderful idea. Countries which have had such a national health system for years consider it a proud achievement.
Hopefully, it will prove to be so for Cyprus, but the obstacles are challenging.
The implementation of a national health system here has to overcome the proven failure of successive governments in the management of far less complicated types of enterprise.
This refers not just to Cyprus Airways and the Co-op Bank.
There is also the Post Office which cannot deliver anything within a month of Christmas, a secondary school system which relies on private tuition, the defunct Laiki bank, the Limassol Port, etc.
In Britain with some 80 years of experience with a national health system hardly a week goes by without some major scandal and complaint, be it lengthy waiting times for certain operations, the unavailability of certain medicines or simply miss-management.
The proposed General Healthcare System (GHS) is a much larger and more complex enterprise in terms of money (estimated at over 1 billion euros) the number of employees, the number of autonomous units (hospitals) and the skills required than anything which the government has launched in the past.
Its impact on Cypriots will be immense both in terms of medical services and on their incomes – much more than is now generally realised.
Some citizens with low incomes who have had virtually free medical treatment at the present General Hospital will now find their salary reduced to pay for the GHS. Many who are already enrolled in private health are now paying for both GHS and for an existing private scheme.
Not a Good Start
The early beginnings are not promising. Citizens have found that their pay has been deducted to pay for medical services before many of these are available and before it is clear which medical facilities they will be able to access.
Reportedly, a number of major hospitals have not joined the system. This may not be important to government planners, but it is important to many potential patients who may have an ongoing relationship with doctors at these hospitals.
The fees for this new health service, 1.7% of income for individuals and 1.85% for private employers are scheduled to increase to 2.65% and 2.90% by next March.
On a national level, these payments represent a major redistribution of income whose macroeconomic impact is yet to be recognised.
There is talk that these fees may have to go even higher. The UK spends an estimated 7.5% of its national GDP on its national health system, much more than is indicated by the proposed charges in Cyprus.
Before embarking on such an ambitious project, it might have been sensible to investigate past performance.
Why have state enterprises had such a bad record? Let me hasten to say that it is not due to the quality of government employees. Having taught many of them here in Cyprus for a good many years, I can vouch for the general high quality of their abilities and their qualifications.
Not surprising since the state pays so well. Despite this, state-sponsored enterprises routinely underperform.
Organisations owned and supported by the state typically do not have the same competitive pressures as a privately owned enterprise.
State-sponsored enterprises may have targets and measures of performance but here and in other countries, these have all too often proved inadequate and ineffective.
In the final analysis, they can resort to the state for support. Private enterprises must compete for customers to succeed and to survive.
National companies are influenced by their political supporters. These can continue to exert influence even after the enterprise has been established, opening the door to “rusfeti” (nepotism).
Even more destructive is the civil service mentality which government support brings with it. An ethos which all too often promotes mediocrity rather than excellence, undermining the moral and motivation of even the best employees.
Also, unions which fight for workers benefits even if it is at the expense of the recipient of the services they are supposed to provide.
First, Do No Harm
Cyprus today has some excellent private hospitals which should be preserved. My own recent experience has shown that doctors in private hospitals work abnormally long hours.
They do not follow the relaxed work schedule associated with most government associated employment.
A stay at one private hospital revealed a working day for doctors there which started at 7:30 am.
They were still-checking on their patients at 6:30 pm. Coming to work Saturday morning seemed to be part of their routine They were even available Sundays if needed. This meant patients regularly had access to their own personal doctor.
Will this sort of dedication change after the GHS? Hopefully, it will not.
Whatever happens, the political impact of the new medical system will be significant. Cypriot citizens have proved they can put up with a lot of abuse, particularly after 2013.
They may grumble but carry on much as before. Whether this tolerance will apply to something which impacts the health of themselves and their children remains to be seen.
Foreign governments with existing national health schemes have found that they are one of the most politically sensitive issues that they have to deal with. In Cyprus, the political repercussions of a national health system at the ballot box are still in the future.
National health schemes have been successful in other countries facing many of the same challenges noted above.
But each country is different. Cyprus is a small country where everyone knows everyone else and is often related to them.
The question is not whether a national health system can be successful, but rather will it work, here in Cyprus at the present time, in the present situation and with the apparent flaws in planning.
