Cabinet appointment signals GESY wars not over

All hell broke loose this week in the health sector of the Republic of Cyprus, after a heart doctor not liked by unions was given a seat on the board of the Health Insurance Organization, signaling core debates about whether the state should stick to uniform rules or expand its single-payer philosophy.

Cardiologist Petros Agathangelou, who serves as president of the Cyprus Medical Association, was given a seat on the HIO executive board until November 2022, replacing Demos Demosthenous from the Cyprus Chamber Of Commerce and Industry who resigned earlier this year.

The appointment made by the President’s Cabinet on Thursday was immediately and heavily criticized by state officials, politicians, industry experts, with unions and stakeholders crying foul after the CMA president had fought hard against the implementation of a single payer system.

Speaking on state radio Friday morning, Cyprus Federation of Patients Associations president Marios Kouloumas argued the appointment aimed at sidetracking the state’s GESY health insurance system.

“A war against the healthcare system is underway,” Kouloumas said.

Agathangelou, who is not participating in GESY, has been calling for an independent audit mechanism, following reports of irregularities and scandals of insurance fraud within the network.

Procrastination and long-drawn-out negotiations

The CMA president has been arguing that his organization’s efforts to help improve the system were being blocked by what he described as “procrastination” and “long-drawn-out” negotiations.

But Agathangelou’s appointment triggered responses from various other officials, including former health ministers.

Former health minister Constantinos Ioannou argued there was a conflict of interest in Agathangelou’s board seat, noting the HIO board had a say in doctor salaries within the network.

“The intentions of some are very clear by now after appointing to the HIO executive board someone who fought and is fighting against GESY for his own reasons,” Ioannou wrote on social media.

Ioannou’s predecessor, George Pamboridis, also weighed in, publicly scolding President Nicos Anastasiades.

Pamboridis, who carried out tough negotiations and reached an impasse with unions before healthcare reform went into effect, warned his former boss that “protecting GESY from its enemies was your personal responsibility.”

“I thought you had the necessary fortitude to stand up to the agents of the establishment. Your move today is an indecent assault on what was painfully won. Pity,” Pamboridis wrote.

Agathangelou’s appointment is expected to rehash an old debate on single payer versus multi payer systems.

Jury still out on GESY philosophy

While the Republic of Cyprus’ recently-launched GESY is based on a single-payer system, competition between public and private providers who chose to stay out of the network require rules based on a multi-payer system or at least a hybrid model.

In a single-payer model, such as the system in Canada, the state is the single purchaser of healthcare that promulgates one uniform set of rules for providers, ranging from the quality and medical necessity of reimbursable health care to uniform payment rates to providers.

A multi-payer system, such as the US model, would operate with many different insurance plans, where risks are not pooled nationwide but are structured based on a number of variables, such as demographics, employment status, age and sex, health status, as well as individual preference for health insurance and willingness or ability to pay.

Experts say a hybrid model, such as the system in Germany, could also function as a multi-payer system but also offer universal care, thus guarantying healthcare to those on low income but also allowing the purchase of private healthcare for those who can afford and choose optional “higher” standards.