Constantinos Ioannou, the recently appointed Minister of Health for Cyprus, discusses the upcoming implementation of a national healthcare system in the country, GeSY, his key priorities during these times of change, as well as the impact the new healthcare system will have on the public and the private sector.
You were recently appointed as Minister of Health of Cyprus at a moment when the governmental agenda is busy with the implementation of GeSY and the hospitals’ plan to be autonomous. How is the current Ministry of Health supporting these ambitions?
“When one sets about reforming a specific sector completely, one should be ready to face the opposition of parties/stakeholders. It is only through dialogue and correct argumentation that one can eventually reach one’s target.”
June 2017 was a landmark for the Cypriot health sector. We had all acknowledged over the years that the existing system was outdated and has already outlived itself. After the enactment to law of the two pieces of legislation, the GeSY and the autonomization of public hospitals, Cyprus has laid the foundations for the implementation of a National Health Scheme, equal to that of any other European country, designed on the principles of universality and equal access to healthcare services for all citizens. In the meantime, and until 2019 when the first phase of GeSY will be implemented, we can only start improving aspects of the existing tired and out-of-date system.
The greater challenge of the wider reform to take place in the health sector is the autonomization and the modernization of public hospitals. The goal set by the Ministry of Health is to support the hospitals of the public sector, by creating the conditions that will eventually allow them to respond effectively under the new GeSY environment. The Ministry of Health makes all necessary actions that will facilitate the preparation of the hospitals to be smoothly introduced to the new conditions. For instance, we are in the process of reforming the Primary Healthcare Sector, by merging the existing Health Centers and expanding the working hours. Through this win-win measure, we offer our patients more alternatives in regard to their healthcare provider and we support our health professionals by creating improved conditions for them to practice medicine. Re-organizing the Primary Healthcare Sector falls within our effort to make the public medical centers “attractive” for Cypriot patients, by placing more services under one roof.
The Ministry of Health also promotes collaboration between the public and private health sectors through the implementation of a plan that contributes in eliminating waiting lists for doctors’ appointments.
Although we have already achieved a lot, there are and always will be more to do and all our actions are guided with by the same principle that of the welfare of the patient.
What are the key priorities you are focusing on at the moment to ensure the financial sustainability of the model while broadening patients’ access and increase the healthcare services’ quality?
When one sets about reforming a specific sector completely, one should be ready to face the opposition of parties/stakeholders. It is only through dialogue and correct argumentation that one can eventually reach one’s target. Stakeholders indeed expressed serious concerns, because they viewed these reforms as a possible threat.
Therefore, the Ministry of Health in full collaboration with the Health Insurance Organization, had to reassure all parties involved of the necessity of proceeding with these reforms. The financing and reimbursement program was the conclusion emerged by an actuarial study, which determined the comprehensive budget. The final reimbursement program is currently under negotiation by the Health Insurance Organization together with the Pancyprian Medical Association and I am positive that they will come to an agreement very soon.
What are your expectations regarding the pharmaceutical sector in your endeavor to improve the health of the Cypriot population and how are you responding to each stakeholder’s interests?
The Pharmaceutical Sector is one of the key sectors that will undergo considerable change. This positive change will be of benefit to all stakeholders, including the pharmacy profession, industry, patients and other healthcare professionals. Primarily, with the implementation of the GeSY, out-patient pharmacy services within public hospitals and health centres, in locations where private pharmacies operate, will be discontinued and the public will obtain their medicines from their convenient local neighbourhood pharmacy. Secondly, the role of the pharmacist in hospital will be upgraded. There will be a move away from out-patient dispensing to providing ward and clinical pharmacy services, thereby enhancing the quality of service received by the patient within the autonomous hospitals.
Currently, the establishment and operation of pharmacies within private hospitals is not permitted and pharmaceutical products must be obtained from a private pharmacy. Likewise, it is not currently possible for these private hospitals to offer in-patient pharmacy services where medicines are procured and supplied to patients. With the implementation of the GeSY, new legislation is proposed which will introduce the opportunity for hospital pharmacies to be established in such private hospitals and provide in-patient pharmacy services. The hospital pharmacies will have to meet tight requirements in accordance with the new legislation. The pharmacy shall be a self-contained unit within the hospital and the proposal establishes, among other items, a legal framework for the responsibilities of the clinical and hospital pharmacist.
Additionally, in parallel to the implementation of the GeSY, the autonomous National Pharmaceutical Authority is to be established. This will have countless benefits for involved stakeholders such as patients, the pharmaceutical industry, pharmacists and other healthcare professionals. It is expected that the pharmaceutical regulatory services in Cyprus will be enhanced in such a manner as to allow for cost-efficient operation, improved turnaround times and elimination of bureaucratic red-tape in key procedures for the regulation of medicines for human use, medical devices, cosmetics and food supplements.
Thomas Antoniou from the Health Insurance Organization told us how the system would help gather more country data and introduce electronic health more smoothly. How is the MoH supporting the establishment of patient registries and healthcare digitalization?
Electronic health is indeed one of our priorities. We have drafted a new legislation on electronic health, which allows the introduction of the medical file for each resident of the Republic in an electronic form.
At the same time, it is a major challenge for us, as, apart from its introduction at a national level, we are working towards fully harmonizing with our partners at the EU level. All Cypriot citizens, from the first day of their lives, will have their personal electronic health file. Therefore, every healthcare provider will have access to the patient’s medical record and data.
Collecting health-related data is of high importance for us. Data helps us to understand the needs of our population as regards the healthcare services they should receive and enable us to better formulate strategies and objectives for the future. Also, and more importantly, data are necessary for developing programs for the prevention of some diseases and the effective tackling of others. Going digital will allow patients to receive their treatment faster and remotely.
How would you assess the collaboration between the Ministry of Health, its European counterparts and local stakeholders to implement the best practices in Cyprus?
Cyprus works closely with its European partners, as well as with other neighbouring countries, such as Israel. We have already signed important agreements with some of those countries, such as the one for organ transplant signed with Israel or the Valetta Declaration signed by nine EU countries strengthening their negotiation value with the pharmaceutical industry as regards to the price of medicines. Furthermore, we have a trilateral cooperation with Israel and Greece in the framework of the high-level cooperation of the three countries. We are promoting a cooperation with Spain in organ transplant and with Greece both in organ transplant and the prices of medicines, to name a few.
Cyprus is also a member of the World Health Organization, in the context of which we participate in initiatives to help exchange best practices and expertise that can lead us to adopting new techniques that could benefit our patients.Our country, despite its small size, is important in the region of Europe and especially in the Mediterranean. We aim to develop synergies that will be beneficial for our patients. We very often exchange both expertise and best practices with neighbouring countries in an effort to upgrade healthcare services.
Looking forward, what are the main goals you would like to achieve during your mandate to shift the healthcare paradigm in the country and provide the Cypriot population with a greater healthcare access?
First and foremost, the main goal is the implementation of the National Health System. The framework of the reforms is already in place and what needs to be implemented are the different phases of the roll-out of all these reforms in the next two years. It is about time Cyprus creates all the preconditions that will offer our citizens universal qualitative free healthcare that many other European citizens enjoy. We fell short of delivering this privilege to all our citizens, and it was time we did so.
Furthermore, the second biggest reform in the health sector of Cyprus is the autonomy of the public hospitals. Our hospitals need to be autonomous to be functional and competitive in the NHS environment. This would be to the benefit of both the patients and health professionals.
Additionally, our vision is to eventually turn Cyprus into a regional center for Research and Development. Towards this direction, we: (i) promote the establishment of University Clinics, and the collaboration of academics and health professionals, to improve the provided services, invest in human resources and obtain EU funding to develop the sector of medical research; (ii) are in the process of regulating the cultivation, production and export of medical cannabis, to, inter alia, attract medical tourism and foreign investments, thus creating beneficial conditions for the sectors of businesses and development; and, (iii) facilitate the development of private initiatives in healthcare sector specialized in treatments for severe or chronic diseases, also taking advantage of the weather conditions in the island that contribute in the treatment of several illnesses.
* Photograph Source: Press and Information Office (PIO)