Seven years ago today, I was up at the crack of dawn waiting for my local pharmacy to open its shutters. The pharmacist had barely unlocked the door before I was asking her to fill my prescription through the GHS. It was one of the very first prescriptions processed through the system. I asked for a printout, kept it, and every time I come across it I feel a lump in my throat.
The GHS — its structure, its architecture, its character, its philosophy — is not merely an achievement. It is a blessing. The tragedy is that only those who suddenly find themselves facing a serious, life-threatening health condition truly feel that in their bones.
I will never stop fighting for the GHS and standing behind it. And it is precisely because I will never stop fighting for it that I feel obliged to say something plainly to my dear friends at the Health Insurance Organisation: I can no longer keep supporting decisions that are now being taken with one sole purpose — to swell the GHS fund’s surplus.
Dear friends, the HIO is not a private, profit-driven insurance company. Until that is fully understood, the distortions will never be fixed.
When you sit down to make decisions, you should not be thinking about how large your surpluses will be at the end of the year. You should be thinking about how much more you can offer to Cypriot patients.
And this is not just about directors and departments. It concerns the entire structure.
The excuse “but the Finance Ministry cut our budget” needs to stop. You were never left to fight alone when you pushed for budget increases. You had the backing of the media, of patients, of all the organisations that supported and continue to support the system.
To have the courage to do that, of course, you need to shed the Finance Ministry’s coat — which, given where things stand, looks unlikely — and put on the coat of all of us who make our monthly contribution to the GHS fund.
When you decide not to cover consumables from the Z List for in-hospital use, you need to understand that whatever your full-to-bursting fund refuses to cover, the patient will pay out of pocket.
And to those of you who have already told me, “But we didn’t say the patient should pay — we said the hospital should cover it”: you are living on another planet.
When you formally authorise hospitals to charge patients who are still occupying a bed simply because they haven’t yet found an affordable rehabilitation or care facility, you need to remember that it is you who drip-feed rehabilitation services into the GHS.
We were told it would be phased in. We were told there was no legislation. We fought tooth and nail to get the legislation passed — and we are still waiting. If you fall and break your right side, you’re covered for rehabilitation. Fall on your left, and you’re not.
When you decide that an anaesthesiologist is not needed for an endoscopy, bear in mind that the cost of one will be borne by nobody other than the patient.
The fact that some doctors say one thing and others say another is not the patient’s problem. Your job is to find a way to ensure that GHS beneficiaries receive everything they need and everything the system is supposed to cover. “But we didn’t say the patient should pay for it” — that belongs on another planet too.
We imposed millions of rules and restrictions out of fear of abuse. In the end, we created the abuses ourselves. We said we would strengthen the institution of the personal doctor — and now we are strangling it with our own hands.
We made a great noise about waiting lists for specialist doctors. A whole performance. Measures were announced. Some were implemented — but only the ones targeting the attitudes of certain beneficiaries and certain doctors. Most of the restrictions on personal doctors remain in place, and we persist in sending thousands of patients to endocrinologists for a simple prescription, at a time when we don’t have enough endocrinologists to go round.
We said we would cut unnecessary specialist referrals — and then loaded specialists with caps and clawbacks on their fees. The result: unnecessary procedures inside the system went up, as some doctors found ways to compensate for lost income.
At some point, someone somewhere decided that long-term care falls outside the GHS’s remit. I have no idea on what basis. Perhaps those who made that decision assumed they would always be young and healthy.
And so we have arrived at the point where, as our population ages, we are failing to provide even the bare minimum to people who need nursing care and medical supervision. Because what use are six plus six physiotherapy or nursing visits a year to someone who needs six a week?
The tragedy is that the person who doesn’t receive the nursing care they need ends up in hospital for a month — and the GHS fund pays three times as much to get them well again.
We said we would cap consumables and other medical supplies and devices — and in doing so, we are quietly dismantling the GHS’s own character from within. If you have money, you get the latest sleep apnoea device. If you don’t, you get an older model and make do.
We fought to escape the tender procedures and single-option straightjacket the Health Ministry used to impose. We fought for equality between patients. And now we are reintroducing inequality inside the GHS itself, because all we have in our heads is the budget — not the patient, not their needs.
Dear friends at the HIO,
I could keep writing examples, but I have to stop somewhere. The slogan “The GHS is you” needs to be lived in practice — because right now, it increasingly seems the operating slogan is “The GHS is its surplus.”
I am asking you — pleading with you — stop behaving like a private insurance company. Stop thinking only about the Audit Service’s old reports. Stop thinking about every MP or party leader who keeps banging on about the GHS’s financial sustainability, because that soundbite has lodged in their brain and they can’t see past it.
The GHS has a thousand operational problems and zero sustainability problems. And absolutely zero problems with its structure, character, or philosophy.
The fund needs a specific reserve to be secure. Keep a bit extra for additional security. Everything else — turn it into services for the people who need them.
Apply rules and restrictions where they are genuinely needed. Target your audits and stop treating every beneficiary and every provider as a thief and a fraudster. Build an oversight mechanism that actually catches the thieves and fraudsters without putting everyone else through the wringer.
You are dismantling the character, the philosophy, and the greatness of the GHS — with your own hands.
Mr President of the Republic,
For the HIO to function as a semi-governmental organisation acting in the genuine interest of citizens, it needs your full and unequivocal support. The citizens of this country make their monthly contributions. So do employers and businesses. So does the state.
The structure, architecture, philosophy, and character of the GHS point the way forward by themselves. Free the GHS and the HIO from the shackles that some have cleverly imposed and others have, sadly, simply accepted and internalised.
We have buried it in rules and restrictions, and in the end nobody is getting any room to breathe — not ordinary citizens, not providers, not the system itself, not even the HIO.
Finally: find out what is actually going on inside the HIO, because the problem almost certainly has everything to do with the organisation’s internal workings — and it is getting worse by the day.
