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    Landmark Year for Healthcare

    Health

    The winning combination of internationally experienced doctors, advanced technological capabilities, and world-class medical services coupled with a new national health system ensure the Cyprus health sector will flourish and expand.

    The calibre of healthcare in Cyprus is improving in leaps and bounds with new specialised medical services and research, as well as the long-anticipated implementation of a comprehensive national healthcare system (NHS), which is set to make the sector more streamlined and cost-effective. Cyprus is internationally renowned for its world-class medical research and top-notch health professionals. Most medical professionals in Cyprus are educated at reputable universities in the UK, Greece, Western Europe, the US and Russia – an influential factor in the strong development of the country’s private sector, which boasts an impressive 75 private hospitals and clinics. The wealth of talent and specialisation has also led to the development of a burgeoning medical tourism sector attracting foreign patients to the island’s shores.

    New NHS Launch

    It has been a landmark year for the Cypriot healthcare system with Parliament finally passing three bills into law in June 2017 to put in place an NHS – 16 years after passing the Founding Act for the scheme. In the interim, the plan had only gained new momentum during the island’s economic crisis in 2014 after healthcare reform was included in Cyprus’ bailout programme. The passing of the NHS bills was an enormous victory for the government of President Nicos Anastasiades after months of haggling with MPs and negotiating with healthcare workers and their unions. The President has likened this major development in the health sector to the adoption and introduction of the social insurance system in the 1960s.

    The bills, one creating an organisation that will oversee the autonomous state hospitals, and another harmonising the original law with European Union requirements, as well as a set of ordinances regulating labour issues and contribution rates, should see phase one concerning outpatient care completed by June 1, 2019 – and the new NHS in full swing by 2020. In the meantime, as implementation will be gradual, healthcare is likely to remain highly centralised and most planning, organisation, administration and regulation will continue to be the responsibility of the Health Ministry.

    Protecting Public Health

    Health services in the public sector are provided by five district hospitals and one paediatric/gynaecological hospital, three small rural hospitals and 38 health centres, along with 230 sub-centres with a touring medical team. Additionally, the Ministry implements a sponsored patients’ abroad scheme under specific conditions and terms.

    Hospital autonomy will be the biggest step to the full NHS. In 2017, a new body branded the State Health Services Organisation (OKYY) began work spearheaded by former Chief Executive of NHS England Sir David Nicholson. The body is tasked with the management, control, supervision and development of public hospitals and primary healthcare centres. Among the overall objectives is improving the quality of service and access to services for patients and delivering the financial stability the health service needs. Eventually, OKYY will replace the Health Ministry in providing health services.

    Currently the health system in Cyprus is still exclusively financed by the state budget, with services provided through a network of hospitals and health centres directly controlled by the Ministry. Contributions to the planned NHS as a percentage of salary or pension will start on March 1, 2019 and will initially cover only outpatient care. This is set at 1.70% for employees and pensioners, 1.85% for employers, 1.65% for the state, and 2.55% for the self-employed. A year later the contributions will rise respectively to 2.65%, 2.90%, 4.70% and 4%, and cover both outpatient and inpatient care.

    Substantial investment in the state sector has meant that procedures such as kidney transplants and open-heart surgery, which once necessitated a journey overseas, are now routinely carried out within Cyprus. The private system is financed mostly by out-of-pocket payments and to some degree by voluntary health insurance (VHI). It largely consists of independent providers, and facilities are often physician-owned or private companies in which doctors are usually shareholders.

    In the short term, steps have been taken to reduce patient waiting time through the introduction of minor injuries units and an automated bed availability system. A special A&E is also being created at the Makarios Children’s Hospital in Nicosia in 2018 so that mothers and children do not have to wait long hours at the general hospital’s emergency room. Waiting lists in the public sector were reduced in 2017 through outsourcing to the private clinics, many of whom saw business drop off after the financial crisis, when private insurance became a burden for many families who turned to state hospitals. In 2017, some 274 private doctors took part in the scheme and around 18,000 patients were referred for treatment by the state sector.

    Opportunities in e-Health

    The Health Ministry has also embarked on an ambitious programme to digitise medical provision and develop an integrated e-health monitoring system. This involves the introduction of digitised health records, the expansion of medical services to remote areas via telemedicine and robotics, and access to international medical data banks. In this context, an investment opportunity that could be tapped into is e-health solutions, which will be the cornerstone for the new Cyprus NHS.

    The goal is the creation of Regional Health Networks (RHN) to exchange information in real time between all hospitals, health centres, regional clinics and private doctors. The RHN will enable healthcare providers to have access to the right information, any time they want for better and higher quality medical care. The expected timeline for project completion is August 2019.

    Technology will also be at the forefront of helping forecast the needs of medical, nursing and paramedical personnel. The establishment of top-tier medical schools in Cyprus is also expected to provide a better indication of the needs and shortages of medical personnel in the coming years.

    Foreign Talent and Investment Boost

    The presence of numerous prestigious private healthcare facilities significantly enhances the island’s reputation as a centre for medical excellence and highlights the opportunities available to foreign investors. The island has also opened more opportunities for foreign doctors to carry out procedures in the country, a move that is fostering more cooperation in the international medical field.

    Doctors from Israel, the United States and other non-EU member states are now allowed to provide services in Cyprus, under certain conditions, with procedures overcoming bureaucracy and delays. This decision not only promotes medical tourism and generates income mainly for private hospitals, but also promotes further training and knowledge exchange for Cypriot doctors, with a number of hospitals becoming centres of excellence for the eastern Mediterranean region, the Middle East and Europe.

    In 2017, Cyprus and Israel signed a Memorandum of Understanding for cooperation in the field of kidney transplants. It will allow people who seek to donate kidneys to their loved ones to have a better opportunity to do so through paired donations, as it creates a larger pool of potential donors and increases the chances for successful organ exchange between donor-recipient pairs. The memorandum was the result of a joint effort between the specialists in the area of trans plantations from the two countries, as well as of the Transplant Centre of the State of Israel and the Transplant Council of Cyprus.

    Also in 2017, Cyprus and Canada signed an MoU on health cooperation that includes medicine, research and education, more specifically the Canadian Commercial Corporation (CCC) – a Crown Corporation of the Government of Canada – will work in collaboration with the University of Cyprus and the Health Ministry to develop a world-class university teaching hospital, an advanced learning institute and a medical education hub in Cyprus. In early 2018, Cyprus and Jordan signed a number of bilateral agreements including one on public health and medical science. A similar protocol was also signed with Russia in October 2017.

    Another important new asset in the provision of high quality healthcare was the founding of the German Oncology Centre in Limassol in 2017. Established through private funding, the centre covers the whole spectrum of services from prevention and diagnosis, to treatment, rehabilitation and support for patients, offering modern radiotherapy techniques. Previously, the Bank of Cyprus Oncology Centre in the capital city of Nicosia was the sole provider of radiotherapy, but the new private radiology unit complementing state health services is a welcome addition catering to the needs of patients in both Limassol and Paphos regions.

    Developing Medical Tourism

    Cyprus is credited as being one of the first entrants into the European medical tourism sector, and some years ago, the island established a national initiative to promote medical tourism. In fact, Cyprus has a long history of attracting patients seeking remedies for their ailments. Since 9,500 BC visitors came to Cyprus to be treated by Cypriot doctors, such as Apollodorus of Kition who was famous for recommending radish seeds in water as a remedy against poisoning. Synesis the Cypriot (4th BC) was mentioned by Aristotle as a ‘famous doctor’, as was Apollonius of Kition (1st century BC) who was also known as the Cypriot Hippocrates.

    Today, on a global scale the world medical tourism industry is worth as much as US$40 billion and accounts for approximately 2.5% of international tourism revenue – with positive future growth prospects. Medical tourism is a highly viable sector to be developed in Cyprus, as the country has excellent medical infrastructure, hospitals, laboratories and other diagnostic centres. Services are relatively affordable and easily accessible. These aspects coupled with its large pool of highly educated healthcare professionals and expert services, are rapidly establishing the island into a centre for medical tourism in the Mediterranean region and beyond. The country’s ideal climatic conditions throughout the year make it an attractive destination, where patients can combine treatment with a holiday and recovery with relaxation. The majority of medical tourists come from the UK, Germany, the Netherlands, Russia and the Middle East and most seek either dental or cosmetic procedures. However, increasing numbers now visit Cyprus for fertility treatment, while the island is gaining a reputation for other specialist procedures.

    A vast array of quality medical treatments for patients from all over the world are offered in Cyprus, from basic check-ups and diagnostic tests to major surgery, kidney haemodialysis, transplants and cardiothoracic surgery procedures, orthopaedic, musculoskeletal surgery and many more. In early 2018, the President of Cyprus inaugurated the new heart centre at the Mediterranean Hospital in Limassol saying it would contribute to the greater goal of making the island a regional hub for medical services.

    Alongside conventional medical treatments, Cyprus is also home to numerous luxury spa resorts and rural retreats, where comfort and nature harmoniously intertwine with health. World-class pampering, holistic therapies and beauty treatments are available in hotels around the island. Freshwater and saltwater pools, whirlpools, saunas, steam rooms and hamams, are all present in abundance for the growing number of health-conscious tourists.

    Investment in both medical and wellness tourism is still an open market for investors with huge potential to develop this sector further – and especially from the Russian market, according to the government’s strategic tourism plan, which has earmarked central European markets as having the potential to generate demand. The state’s strategic report says the development of wellness centres should be considered an integral element of future new resorts or added to existing assets as a way of upgrading and enhancing their customer value proposition.

    Top-Tier Medical Research and Education

    Cyprus has a great number of recognised researchers, with tremendous contribution to medical science. More recently, the establishment of medical schools on the island has been a strategic move in the ongoing process of improving the sector, as well as fostering international research and innovation. Over the last six years, three medical schools, one public and two private, have been established in Cyprus – all affiliated with hospitals throughout Cyprus.

    The country’s development as a centre for medical excellence received a significant boost with the launch of a four-year postgraduate Bachelor of Medicine and Bachelor of Surgery (MBBS) course at the University of Nicosia (launched autumn 2011). The qualification combines the convenience of training within Cyprus, with all the benefits involved in accessing international expertise. It arose from a unique collaboration between the University of Nicosia and St George’s Hospital (University of London) and it is expected that its graduates will make a significant contribution to medical research on the island.

    Over the past 25 years, Cyprus has made highly commendable achievements in the fields of medical research and innovation. Pioneering research work has been undertaken at the Cyprus Institute of Neurology and Genetics, which developed a ground-breaking, non-invasive prenatal test for Down Syndrome. And in 2017, doctors at the Institute discovered a genetic mutation, which is common only in Cypriot families, that is responsible for most cases of hereditary breast and ovarian cancers on the island.

    Research in the biomedical field has also had a remarkable increase, especially in the field of genetic diseases, hereditary cancer and biotechnology. These ambitious research projects, funded by both local and foreign sources, but mostly through the EU, resulted in data and new knowledge benefitting both the local and international community.

    In 2017 a new strategy was also drawn up to deal with diabetes, another growing disease on the island. The strategy plans for the development of a central research body on health issues and a central research database connected with other European international centres. This kind of top-quality academic work in Cyprus is evidenced by important European funding, including 10 European Research Council (ERC) grants, hundreds of high-impact publications in international peer-reviewed journals and invitations to present their work at major medical conferences around the world.

    A pharmaceutical tech park in cooperation with the Chinese city of Changzhou is also being planned in Paphos and is reported to be one of the largest of its kind in Europe. Changzhou is host to China’s largest pharmaceutical tech park, and the Paphos Chamber of Commerce signed a memorandum of cooperation with the Changzhou Hi-Tech District and the Changzhou Chamber of Commerce in 2017.

    Medical Cannabis Initiatives

    Another interesting initiative is a recent plan by the Health Ministry to introduce legislation for the cultivation and trade of medical cannabis. Apart from the benefits it would bring patients – a number-one priority – it would also bring a boost to the economic development of the island, as well as attract significant foreign investment for the entire production chain. A bill was approved by the cabinet aimed at getting international investors to express interest in the two licences that will be granted, attracting capital and boosting the field of research and development in the pharmaceutical sector and industry. Cyprus wants to get a head start in the region both in treatment of cancer and in further marijuana research. MPs appear to be positive towards passing the legislation and are still discussing the contents of the bill.

    Healthy Prognosis

    The adoption of the new Cyprus NHS laws is expected to enhance the managerial capacity and productivity in public hospitals, support in putting IT systems in place, improve data collection, strengthen human resources strategy and ensure equal competition between private and public health providers. It is also seen as mitigating health inflation, drug overuse, and restricting unneeded medical examinations through a more cost-efficient referral framework fostered by the NHS IT system.

    Challenges could come in the form of the worldwide health workforce shortage, but education and research are growing exponentially in the health sector, which could mitigate the problem. The country’s geographic position and EU membership also provide opportunities for well-trained students, originating from third countries, to acquire qualifications recognised by the EU. Cyprus has the potential to develop the sector even further and establish itself as a strong player in the health and medical fields in the wider region.

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    September 2018

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