The belated implementation of a long-awaited health system in Cyprus and the role of interest groups

Abstract

It is really a paradox that 60 years were required to establish a modern health system in Cyprus, despite the expressed positive attitude οf all political parties and most governments. This article investigates the planning and implementation of the National Health System (NHS) and its delay determinants, by employing qualitative research of published sources, audio material and 33 interviews with elite key informants. A major anti-reform alliance, consisting of private doctors, private hospitals and health insurance companies was identified, further supported by doctors of the “old” public system, whose benefits were threatened. Delay contributions additionally arose from media and patient groups, whilst the pharmaceutical sector imposed insignificant influence. Τhe prevailing political, economic and social environment, along with aspects of the proposed reform, fueled this anti-reform movement. However, climate in favour of the NHS implementation gradually developed, attributed to the power balance shift supportingthe Minister of Health and the government, mobilization of important actors/stakeholders, including the Federation of Patients' Organizations of Cyprus and the Media, and significant decrease in the influence of reform-resistant groups. The new dynamics created a supportive environment leading to the NHS launch on June 1st, 2019; thus Cyprus has ceased to be the last state of the European Union (EU) without a universal health coverage system. The process of introducing this new system in Cyprus is a prime example of resource and power redistribution amongst different interest groups and of the catalysts required to exit the orbit of an extremely “path-dependent” system, potentially inspiring future reformers.