Cyprus is internationally renowned for its world-class medical research and health professionals, and with a long-awaited national health system coming into play, 2019 will see the beginning of a transformation of the health sector.
Cyprus has long been synonymous with excellent healthcare thanks to its highly trained and internationally experienced professionals, specialised medical services and globally renowned research. The reasons behind this acclaim is that for decades healthcare in Cyprus has been heavily dominated by the private sector, with most medical professionals educated at reputable universities in the UK, Greece, Western Europe, the US and Russia. The return to Cyprus of this wealth of talent and specialisation was an influential factor in the development of the country’s formidable private sector, which now boasts an impressive 75 private hospitals and clinics, along with numerous smaller private practices.
However, the status quo is set to undergo an immense transformation after the long wait for an integrated national health system (NHS) is drawing to a close. A true milestone for Cyprus will be achieved in 2019, as phase one of the NHS implementation was rolled out in June. The NHS is set to modernise and upgrade the health sector into a more streamlined, transparent and cost effective system, and finally bring Cyprus on par with its European peers in terms of efficient and affordable public healthcare.
The NHS Roll-Out
The first phase concerning outpatient care provided by GPs, specialist doctors, pharmacies and labs was introduced in June 2019, while phase two concerning inpatient care will be rolled out a year after that in June 2020. Two bodies have been set up in a bid to allow the NHS to materialise. The Health Insurance Organisation (HIO), which is tasked with reimbursing healthcare expenses including pharmaceuticalsand the State Health Services Organisation (OKYY), which will be responsible for the management, control, supervision and development of public hospitals and primary healthcare centres.
Cyprus already boasts high access to quality health services, ranking 26thout of 195 countries in the Healthcare Access and Quality Index (HAQ) – a study funded by the Bill & Melinda Gates Foundation. In the index Cyprus ranks higher than the US and Israel, which rank 29thand 35threspectively. With the new NHS, the aim is to offer the public equal access to a healthcare sector that boasts excellent professionals, technology and innovation.
One of the many advantages the comprehensive NHS is set to bring once it comes into full force, is reduced waiting lists which have plagued the sector for years. The load on state hospitals has been slightly reduced over the past two years after agreements to refer patients to the private sector were made, however these came at a cost to the state. The passing of the NHS bills in 2017 was an enormous victory for the government of President Nicos Anastasiades, who has likened this major development in the health sector to the adoption and introduction of the social insurance system in the 1960s.
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.
Investing in 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 roll out. 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.
The health system in Cyprus was exclusively financed by the state budget, with services provided through a network of hospitals and health centres directly controlled by the Ministry, but NHS contributions as a percentage of salary or pension started on 1 March 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.
Those eligible for the NHS are Cypriot and EU citizens, as well as third country nationals legally residing in Cyprus and refugees or persons with supplementary protection, legally residing in the Republic.
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.
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.
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 number of graduates from the top-tier medical schools in Cyprus are also expected to provide more medical personnel in the sector and fill the gap of potential shortages in the coming years.
Doctors Beyond Borders
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 greater 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.
Cyprus has also signed multiple Memoranda of Understanding (MoUs) with various countries to facilitate more cooperation in the medical field. For example, Cyprus and Israel have signed an MoU 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 transplantations from the two countries, as well as of the Transplant Centre of the State of Israel and the Transplant Council of Cyprus.
In addition, Cyprus and Canada have 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 2018, Cyprus and Jordan signed a number of bilateral agreements including one on public health and medical science, with a similar protocol also signed with Russia.
Another important 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. The German Oncology Centre, along with numerous other private hospitals, has announced their intentions to integrate their services with the new NHS.
Potential in 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. The global medical tourism market is expected to reach US$46.6 billion by 2021, with positive future growth prospects. Cyprus has excellent medical infrastructure, hospitals, laboratories and other diagnostic centres making it a prime destination for medical tourism. Services are affordable and easily accessible, and this coupled with its large pool of highly educated healthcare professionals and expert services, are positioning the island as a key centre for medical tourism in the Mediterranean region.
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.
The country’s ideal year-round climatic conditions 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.
Cyprus is also fast becoming a popular wellness destination with new luxury spa resorts and rural retreats springing up across the island, with holistic therapies and beauty treatments readily available. Fresh and saltwater pools, whirlpools, saunas, steam rooms and hammams, are all present in abundance in hotels around the island for the growing number of wellness orientated and health-conscious tourists.
Investment in both medical and wellness tourism continues to be a serious opportunity for investors, as this sector has been earmarked by the government as one with immense development potential with growing demand from European tourists. According to the state’s strategic report, the development of wellness centres should be considered an integral element of future new resorts or added to existing assets in a bid to upgrade and enhance their value proposition.
Medical Research and Education Hub
The Cyprus education and research sector has seen formidable growth over the last few years, boasting a vast 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. Today, Cyprus has three medical schools – one public and two private – all of which are affiliated with hospitals throughout Cyprus and with prestigious international medical institutions, such as St George’s Hospital (University of London).
Over the past three decades, 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.
Another interesting initiative is the Health Ministry’s plan to introduce the cultivation and trade of medical cannabis. Apart from the benefits it would bring patients – a number-one priority – it can also boost the economic development of the island, as well as attract significant foreign investment for the entire production chain.
In February 2019, Cyprus took a step forward and passed a law allowing for and regulating the cultivation and distribution of medical cannabis. Three licenses will be granted to private companies at a cost of €500,000 each for 15 years to grow medical cannabis and distribute it to pharmacies. The annual cost of renewing the license amounts to €30,000. The law regulates the import of cannabis seeds and plants, the cultivation, production, import and export of pharmaceutical cannabis and its use for research for medical purposes. Before the NHS comes into full force in 2020, medical cannabis will be available in state pharmacies, however, once the ball is rolling with the health system it will also be available for distribution by private companies. The move is expected to put Cyprus on par with many other states such as Israel and Germany, where medical cannabis has been legalised and offers patients more options for treatment, though the law stipulates the drug can only be offered after all other available options have been exhausted.
A New Vision
The implementation of the new Cyprus NHS is expected to enhance the efficiency and productivity of public hospitals, support digitisation, 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 restrict unneeded medical examinations through a more cost-efficient referral framework fostered by the new e-health system.
As with many other EU countries, challenges could arise from the worldwide health workforce shortage, but the rapid growth of the education sector in Cyprus and with fresh graduates being pumped out of its three new medical schools, the country has the tools to ensure the future success of its health sector. In addition, the Cyprus medical tourism sector is still relatively untapped providing investors with multiple opportunities to be the leaders in shaping Cyprus into a strong player in the health and medical field in the wider region.
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