The GHS (General Healthcare System) in Cyprus is a comprehensive and universal health care model providing access to health services for all citizens and residents of the country. It was launched in June 2019 after years of discussions and legislative development. The GESI system functions as a single national health care plan that includes both public and private health care facilities.

The basic principle of the system is that all citizens, regardless of their social status, income level or age, have equal access to health services. However, only those who are officially registered with the Cyprus Social Insurance System, which includes citizens of the Republic of Cyprus, citizens of the European Union permanently residing on the island, as well as citizens of third countries who have a residence permit and are working legally, can become users of the system.

Legal aspects and structure of the GESI system

GESI is regulated by a number of pieces of legislation, the key one being the Universal Health System Act of 2001 (Act No. 89(I)/2001). This law established the framework for the operation of the system and describes its main elements, including sources of financing, categories of insured persons and the responsibilities of the parties. An important aspect of the law is that all eligible citizens must participate in the system.

The main elements of the GESI legislation:

1. Categories of insured persons. The law clearly defines the groups eligible to participate in the system:
   • Cypriot citizens.
   • EU citizens residing and working in the territory.
   • Third-country nationals who have an official residence and employment permit.
   • Vulnerable groups including children, pensioners, the unemployed and persons with disabilities.
2. Sources of funding. The GESI scheme is financed through a combination of contributions:
   • Employees: contributions are a fixed percentage of their monthly income.
   • Employers: are required to contribute a percentage of their employees’ salaries.
   • State: covers the cost of health care for socially vulnerable groups.
   • Self-employed persons: pay a certain percentage of their income as contributions.
3. Principle of solidarity. Financing of the system is based on redistribution of resources: wealthier segments of society pay more to ensure access to health services for the poor.

Structure of the GESI system

The GESI system is organized into three levels of care:

1. Primary health care:
   • Patients first contact general practitioners (GPs), who act as coordinators and provide basic medical care.
   • GPs act as the “gateway” to the system: they decide whether to refer patients for additional examinations or to subspecialists.
2. Specialized care:
   • Subspecialized doctors provide services such as cardiology, oncology, orthopedics and others.
   • A referral from a general practitioner is required for specialist consultations, except in emergencies.
3. Inpatient treatment:
   • Hospitalization is provided in both public and private hospitals that have contracted with the GESI system.
   • Includes surgery, intensive care, rehabilitation and other inpatient treatment.

Legislative framework and oversight

To ensure transparency and efficiency of the system, the HIO (Health Insurance Organization) has been established, which performs the following functions:

• Management of GESI funds and control over their distribution.
• Conclusion of contracts with medical institutions and specialists.
• Development of quality standards for medical services.
• Supervision of compliance with legislation by system participants.

HIO publishes annual reports on its activities, including financial indicators, referral statistics and patient satisfaction scores. This data is used to analyze and subsequently improve the system.

Example: According to the HIO’s 2023 report, about 95% of Cyprus’ healthcare providers are registered in the GESI system and the total number of insured persons exceeded 1.1 million. Health expenditure amounted to €1.2 billion, reflecting a significant expansion of services compared to the first year of the system.

Issues and challenges

1. Lack of specialists. High load on general practitioners leads to longer waiting times for appointments.
2. Financial sustainability. As the population grows and life expectancy increases, health care costs increase, which requires a review of financing mechanisms.
3. Integration of the private sector. Additional incentives are needed to attract more private health care providers.

The GESI system is an example of successful implementation of universal health care in a country with limited resources. Its legislative framework, structure and financing mechanisms can be used as a model for other countries striving for universal health care systems.

Digitalization in the GESI system

One of the key features of the GESI system is the introduction of advanced digital technologies to improve the efficiency and accessibility of health services. The Electronic Medical Record (EMR) has been introduced as part of GESI to:

• Accelerate the exchange of information between GPs and specialists.
• Reduce the likelihood of diagnostic errors through access to a patient’s full medical history.
• Enable remote monitoring of patients’ health status, particularly in remote areas.

In addition, the GESI mobile app is available for patients to make an appointment, receive test results and manage their schedule of visits to doctors. According to data published in 2023, more than 70% of insured persons actively use this application, which indicates a high degree of digital literacy among the population.

Disease prevention program

The GESI system places great emphasis on prevention and early detection of diseases. As part of this program, it implements:

1. Screening programs.
   • Regular breast and cervical cancer screenings for women over 25 years of age.
   • Screenings for diabetes and cardiovascular disease for all persons over 40 years of age.
2. Educational campaigns.
   • Smoking cessation programs that include free counseling and medication to kick the habit.
   • Educational activities on nutrition and physical activity to reduce obesity, which is a major problem in Cyprus.
3. Vaccination program.
   • In addition to standard vaccines for children, the system offers free flu vaccination for people over 60 years of age and people with chronic diseases.

These measures reduced hospitalizations related to complications of chronic diseases by 15% in the first three years of the system’s operation.

The role of international cooperation

GESI is actively engaged with international organizations, including the World Health Organization (WHO) and the European Union. As a result, Cyprus has access to the best practices and technologies in the field of health care. For example, the diabetes program was developed in conjunction with the WHO Regional Office for Europe and includes the use of telemedicine for patient monitoring.

In addition, the GESI system participates in European initiatives to share data between EU health systems. This is particularly important for EU citizens residing in Cyprus, as it allows them to secure their health care when traveling to their home country or to other countries in the Union.

Economic impact of the system

The introduction of GESI has had a significant impact on the Cypriot economy. First, the increased availability of medical services has increased productivity as people have missed fewer working days due to illness. Second, medical tourism was boosted as the system began to provide quality services to individuals and foreign patients.

According to the Ministry of Health of Cyprus, medical tourism revenues in 2023 increased by 20% compared to 2019. This is due to the fact that many private clinics participating in GESI have started to actively offer their services in the international market.

Examples of successful innovations

One example of successful innovation within GESI is the E-Health Cyprus program, which aims to integrate artificial intelligence (AI) into diagnostic processes. Pilot projects were conducted in 2023 to use AI to analyze X-rays and diagnose pneumonia, reducing diagnosis time by 30%.

Another important project was the introduction of robotic surgery in private clinics participating in the GESI system. This has increased the number of complex surgical procedures performed in Cyprus and attracted patients from other countries, including Greece and Israel.

Development prospects

To further improve the GESI system, the Government of Cyprus plans to:

1. Increase funding for medical staff training programs to reduce the shortage of specialists.
2. Expand telemedicine services, including mental health care and rehabilitation.
3. Improve the system of data collection and analysis to improve resource management and the quality of services provided.

In summary, the GESI system demonstrates a progressive approach to health care organization, combining modern technology, preventive medicine, and international cooperation. Its successes and challenges provide a rich basis for analysis and further study.