The passing of the bills for the much-awaited National Health Insurance System (NHIS) in Cyprus by the Parliament on the 16th of June has been described as an important step towards its realization. The new law unties the Health Insurance Organisation’s (HIO) hands to move on with the next steps, so as full implementation of the System comes into effect on the 1st of June 2020, as the timetables foresee.
In an interview with the Cyprus News Agency (CNA), the Chairman of the Board of Directors of the HIO Thomas Antoniou explains the next steps, as well as all the details that citizens need to know about the implementation of the NHIS, which as he noted will address the problems of the health sector.
Asked about the actions of the HIO following the passing of the legislation, Antoniou referred to four basic steps:
“We have already completed much of the strategy for the implementation of the Health System. A great deal of preparatory work has been done. What has fallen behind is what we could not complete without the bill and the timetable for the implementation” he noted.
Now that we have both, the Organisation works on the following, he added:
First, the regulations, which need to be adapted to the law passed by the Parliament.
Secondly, the deals with healthcare providers with regard to the way they will operate and their reimbursement.
Thirdly, the guidelines for medical checks that have to be agreed between the HIO and the Pancyprian Medical Association.
Fourthly, and last, the computerized system which is expected to be delivered at least six months prior to the implementation of the NHIS.
“The NHIS law ensures equal accessibility, universality and social solidarity” Antoniou noted, speaking to the CNA, adding that the HIO will be the coordinator. “There is a relatively complex mechanism for the management of the central fund and the compensation of doctors. The Organisation will operate all its services to compensate healthcare providers and control the quality of relevant services” he explained.
The issue of the citizen`s contact with the NHIS, he said, is simple. “The NHIS is the application of the principle that we all contribute on the basis of our financial capabilities and we enjoy services according to our needs. All citizens will have a Personal Doctor for their primary health care. The Personal Doctor will refer them to a Specialist Doctor or simply issue a prescription. The prescription will be executed at any pharmacy of the patient’s choice. In addition to Personal and Specialist Doctors, and medication, the citizen will also receive diagnostic tests and nursing services. So, in essence, the public and private health sectors are unified under an umbrella and the citizen is free to choose the use of the services of a public or private doctor or medical centre”.
The contributions are set at 2.65% for workers, pensioners and rentiers, 2.9% for employers, 4% for the self-employed and 4.7% for the state, which accounts for 50% of the total cost of the NHIS and is the amount already spent by the state on public hospitals. “All this money will make around €940 million. Another sixty million will come from co-payments. This makes €1 bn which is the budget of the NHIS”.
With regard to co-payments, Antoniou explained that today there is a framework of contributions to the public hospitals paid by the citizens, which are not an alternative funding of the system, but rather their purpose is to prevent its abuse. “This framework will be used by the Health System in the first phase with the following differentiations: Firstly, there will be no contributions or co-payments for the use of the services of the Personal Physician. Secondly, there will be no contributions for the use of inpatient services. Thirdly, there are settings to protect the general population, but especially vulnerable groups”. In particular, vulnerable groups, that is the Guaranteed Minimum Income recipients and low pensioners, will pay co-payments not exceeding €75 annually, whereas for the general population the ceiling has been set to €300. “The existing arrangement has been adopted with these improvements. The system will be tested and if there other population groups have a problem with this, it will be corrected along the way”.
On medicines, the HIO chairman said that the middle line between two extreme scenarios has been adopted. The first scenario is the current situation in public hospitals where the patient’s only choice is the medicines purchased by the state through bidding procedures, while the second would be for the NHIS to reimburse any medication the doctor prescribes, which would not be viable. “So, we have adopted a middle line which ensures good prices as well as the plethora of medicines in the system. The system will reimburse the cheapest generic in the system, but the citizen will have the choice to pay the difference and get the most expensive one, be that the original or another generic” he explained.
The Chairman of the HIO said that the e-health system has three pillars. The Organisation’s computerised system, the internal management systems of the hospitals and a third one for the patients’ file.
The HIO’s system, he said, will connect the Organization to ten thousand healthcare providers – doctors, hospitals, pharmacies and other healthcare providers, such as psychologists, psychotherapists, physiotherapists – and the general population.
With regard to the patients’ electronic file, Antoniou explained that a separate legislation is required from that of the NHIS. “We expect the bill to be prepared in September” he said.
Concluding, the HIO chairman stressed that “the health sector in our country has reached its limits and is facing serious problems which can be corrected only by implementing the NHIS. The NHIS is the application of the principle that everyone contributes according to their capacities and takes services on the basis of their needs and this is not just socially fairer but also financially more effective”.