I’ve written about healthcare in Cyprus several times already. But now, everyone here is talking about a long-discussed government initiative that’s finally arriving at our doorstep. Its name is GHS (General Health System), or GESY (pronounced “yesi”).

And since I’m naturally inclined to dig into things, I decided to figure out what exactly this is and how it might affect me personally. I don’t claim to have all the answers, but I’ll explain what I know and understand..

The Idea

Overall, the concept behind it is good. The thing is, healthcare in Cyprus can be divided into two groups: public and private. Public healthcare is cheap, but there are few doctors, which leads to long waiting lists—sometimes months ahead. Private healthcare costs around 40-50 euros per visit, and there are almost no queues (except for very successful doctors who are in high demand, but even then, it’s usually just a matter of a few days at worst).

In Cyprus, you can get a card for public healthcare that offers services for free or at a reduced cost, but only if your family’s annual income doesn’t exceed a certain threshold. Otherwise, services are priced at much higher, more “commercial” rates, as they used to say at the end of the Perestroika era in the USSR.

For private healthcare, you either pay for everything yourself or use medical insurance. For example, a standard insurance policy covers doctor visits, prescribed medications, and lab tests. The main detail is that you usually pay for the services upfront and then submit specially filled forms (completed by the doctor) to the insurance company, which reimburses you within 2-3 weeks. Depending on the insurance, there may be various limitations, but that’s the general process.

The main difference in quality is really in the accessibility of services—in terms of price and the number of doctors. For instance, in the public sector, there are about 800 doctors and 40 pharmacies, serving roughly 75% of the population. The remaining 25% use private doctors (around 2,300 private practitioners) and buy medicines from private pharmacies (about 500 in total). Private healthcare is clearly more profitable, which explains the larger number of providers.

Despite this, there are very few specialists, both in the public and private sectors.

The government looked at all of this and decided: let’s make it better for everyone. That is, let’s create true socialized medicine. Everyone will chip in with a special tax, and in return, all services will be high-quality, available to every citizen without exception, and almost free. It’s a solid idea for proper socialized healthcare. But, as always, the devil is in the details.

The system took a long time to prepare, and there have been many debates (and they’re still ongoing), but the first phase of implementation began in March 2019. The new system will be available to both Cypriot citizens and anyone legally living or working in the Republic. There are four phases in total, and I’ll use figures for employees (they differ slightly by category, but the principle is the same):

1. Starting from March 2019, taxpayers began contributing. Initially, at a “reduced” rate—1.7% of income paid by the employee and 1.85% by the company. Nothing was working yet, but the money was already being collected. Just how we love it 😉
2. In June 2019, the system starts operating, but in a limited version: services under the new scheme are provided by personal doctors, other specialists, pharmacies, and laboratories.
3. In March 2020, the tax will increase: taxpayers will pay 2.65% of their income, and companies will contribute 2.90%.
4. Finally, from June 2020, the system will be fully operational, with services extended to include hospitals, dentists, and other specialists not previously covered.

This effectively means a rise in income taxes for anyone working in Cyprus. Whether you plan to use the system or not, you’ll be paying for its upkeep from March 1st.

But that’s not the biggest issue. The implementation of the system (which, I remind you, isn’t fully operational yet) has raised many concerns from the very beginning, both from doctors and ordinary citizens. But first, let me explain how the system is supposed to work.

How it’s supposed to work

Not all doctors, pharmacies, and hospitals can work within this system, only those who join (and they are being actively encouraged to do so). Anyone who wants to benefit from the system must register in it and then choose a personal doctor (a GP for adults or a pediatrician for children), who will become the main point of contact. In Cyprus, it’s common practice to go to such a doctor first, who then refers you to specialists. With insurance, you can go directly to a specialist.

It all seems simple enough. But here’s where the details begin, the ones causing all the debates.

The personal doctor becomes your main guide in the system. You can’t do anything without this doctor. If you get sick, you go to them. If you need medication, you go to them for a prescription. If you want to see a specialist, you can only go with permission and a written “referral” from your personal doctor. You can go directly, as before, but not all “benefits” will be covered for you.

Healthcare services are divided into three financial categories:

1. Free (everything is covered by the system)
2. Co-payment (partially covered by the system, partially by the patient)
3. Reimbursement (paid fully by the patient)

Completely free services include:

1. Visits to your personal doctor
2. Dentist (but only one teeth cleaning per year, everything else is paid by the patient)
3. Emergency services (though the exact coverage isn’t clearly explained in any of the presentations)
4. Hospital treatment

What is co-payment? It means that for every corresponding service that is prescribed (this is important, without a prescription or referral you pay the full amount), the patient makes a fixed payment, with an annual cap on how much the patient can pay (after which, as I understand it, services become free). For regular people, this cap is 150€ per year, and for children (under 21) and low-income individuals, it’s 75€ per year. Services under this category include:

• Medication: for each prescribed medicine, you pay 1€.
• Lab tests: 1€ per test (but no more than 10€ for a group of similar tests).
• Specialist visits with a referral: 6€.
• Radiologist: 10€ (separate rate).
• Visit to the emergency department: 10€.

The referral to a specialist from your personal doctor can cover either three visits over three months or six visits over a year.

Everything else costs money but is still cheaper than outside the system:

• Specialist visit without a referral: 25€ (in private healthcare, specialists currently charge 40-60€ per visit).
• Medication: there’s a nuance here too. Under the system, the pharmacy will give you the cheapest medicine in the group (by active ingredient, for example, ibuprofen). If you want something else, you pay the price difference between the cheapest option and the one you choose. This will likely lead to mostly generic medications being sold within the system.

The Devil in the Details

At first glance, everything seems great. Yes, sometimes you’ll have to pay a bit of money, but it’s not much. And you don’t need to buy insurance anymore. But then, you have to compare how much insurance costs versus how much of your salary you’ll be contributing in percentages. With expensive specialists, the difference might not be as rosy.

But that’s not the main issue. Now let’s look at the system’s limitations.

Everything described above works only for doctors, hospitals, pharmacies, and labs that have joined the system. But right now, not everyone is rushing to join.

For example, nearly ALL pediatricians in Cyprus are boycotting the system. So, there aren’t many options for taking your children to the doctor. Just a couple of weeks ago, it was announced that 14 of the largest private hospitals in Cyprus have refused to join the system. Among them are three in Nicosia that I’ve personally visited. And even with personal doctors, things aren’t as optimistic just yet.

Proponents of the new system often say that Cypriot doctors are simply greedy, and that young, less spoiled doctors from Greece will soon flock to join the system in droves.

But let’s think about why so many are against the system. When a patient registers in the system, they have to choose a personal doctor (or a pediatrician for their children). And here, a number of restrictions immediately come into play for both parties:

1. A personal doctor can have a maximum of 2,500 registered patients. That’s the cap—no more. This limit is in place because the doctor receives a fixed payment per patient, whether the patient visits them or is just on the list.
2. A doctor registered in the system cannot provide services outside the system anymore. So, it’s the end of their private practice.
3. If a patient chooses a personal doctor, they can only change to a different one after 6 months (for pediatricians, 3 months).

And these three points alone are enough to sow chaos. Here are a few simple examples, to which the system currently offers no clear answers:

• The best specialists in Cyprus currently have far more than 2,500 patients. Sure, those patients don’t visit every month, but they do visit. For example, my children’s pediatrician is one of the most in-demand pulmonologists in Cyprus. I’d like to stick with him, but he hasn’t joined the system yet, and he’s still very unsure if he should.
• If I want to use the system and my doctor hasn’t joined, I have to choose another one. And here are two potentially risky scenarios:
  1. I choose a beloved doctor, but they already have 2,500 patients. They’d love to take me, but they can’t—because of the limit.
  2. Or my doctor hasn’t joined yet, so I choose another one from the list. But then, my preferred doctor changes their mind and joins the system. Too bad—I missed the window, and now I have to wait 6 months. By that time, my preferred doctor might reach 2,500 patients, and I’ll miss out completely.
  3. Again, I choose a doctor, go to them, and it turns out they’re incompetent, and I don’t like them at all—oh well, I still have to wait 6 months before I can switch to someone more competent. And by then, the better doctors might already be fully booked.

These are just the most obvious examples.

So, we’re all waiting for the system to start, and we’ll see how it goes. Right now, many are very pessimistic about this whole initiative, and some are even angry—after all, no one is thrilled about suddenly losing nearly 2% of their salary.

I think we’ll see by the end of the year whether anything actually works. As I mentioned, there are almost no pediatricians in the system so far.