Doctors and nurses refuse to sign up for the scheme over pay and budget fears

Financial Mirror (Cyprus) - - CYPRUS - By Kyr­i­a­cos Kil­iaris

In­tro­duc­ing the Gen­eral Health­care Sys­tem (GHS), the big­gest shake-up in the history of Cyprus health, is head­ing for a crash as doctors and nurses refuse to join the new scheme.

Health worker unions and doctors’ as­so­ci­a­tions have told their mem­bers not to sign con­tracts of­fered to them by the State Health Ser­vices Or­gan­i­sa­tion OKYPY, ex­press­ing their strong dis­agree­ment with those in­di­vid­ual con­tracts on of­fer.

Doctors and nurses have de­scribed these con­tracts as in­com­plete, vague and dis­ap­point­ing, stress­ing that they were not given enough time to eval­u­ate them as they had only ten days to re­ply after re­ceiv­ing them just be­fore Christ­mas.

There­fore, OKYPY has post­poned the date of the of­fi­cial of­fer of con­tracts to each em­ployee, which was ini­tially set for Jan­uary 7.

A round of dis­cus­sions has kicked off be­tween the govern­ment and the other par­ties, with a fo­cus on the doctors, with the Health In­sur­ance Or­gan­i­sa­tion, the au­thor­ity set up by the govern­ment to over­see the im­ple­men­ta­tion of the GHS, con­fi­dent that the scheme will take off with­out any hitches.

Pres­i­dent Ni­cos Anas­tasi­ades has stepped in to hold two meet­ings with the Cyprus Med­i­cal As­so­ci­a­tion (PIS) this week with the two sides still far apart. De­spite re­ports that the govern­ment has ac­cepted most of the doctors’ de­mands, the as­so­ci­a­tion claims that they are far from reach­ing a mu­tual un­der­stand­ing.

After doc­tor’s re­fusal to par­tic­i­pate in the GHS, Anas­tasi­ades said on Fri­day: “I would like to be­lieve that the over­whelm­ing ma­jor­ity of physi­cians, after the di­a­logue that we have started, will de­cide to par­tic­i­pate in the GHS.”

“I be­lieve that the over­whelm­ing ma­jor­ity of doctors place above all else their Hip­po­cratic oath, as well as their so­cial sen­si­tiv­ity and con­tri­bu­tion that dis­tin­guishes the med­i­cal world of Cyprus”.

Doctors fear that they will be over­loaded with work, and while they will be join­ing the GHS as self-em­ployed con­trac­tors, at the end of the day they will be treated as em­ploy­ees of OKYPY, the au­thor­ity over­see­ing the man­age­ment of au­ton­o­mous health in­sti­tu­tions. They also ar­gue the GHS budget falls short of what is re­quired.

“The con­tracts handed to us con­tain all the obli­ga­tions of a pub­lic ser­vant, but not the ben­e­fits,” said pae­di­a­tri­cian Dr Anas­ta­sia Symeou, sec­re­tary of PIS.

She ar­gued that doctors sign­ing a con­tract with OKYPY will not be en­ti­tled to prac­tice pri­vately and will not be al­lowed to re­ceive pay­ments from pri­vate in­sur­ance com­pa­nies. PIS in­sists that doctors be given the right to freely prac­tice pri­vate med­i­cal care in a GHS en­vi­ron­ment, some­thing re­jected by the Health Min­istry.

Symeou said this is not some­thing that en­dan­gers the phi­los­o­phy of the health scheme, nor will it re­quire a change in the legislation.

At the same time, the Med­i­cal As­so­ci­a­tion in­sists on a long-term guar­an­tee of the unit price per med­i­cal prac­tice for spe­cial­ist doctors.

Symeou said doctors are also con­cerned about the budget, de­spite the govern­ment’s com­mit­ment to fi­nan­cially sup­port the pub­lic health care sys­tem if it comes un­der pres­sure.

“The Health In­sur­ance Or­gan­i­sa­tion is not truth­ful in try­ing to con­vince the pub­lic that the GHS will of­fer the same con­di­tions found in pri­vate medicine. This can­not be done, it is im­pos­si­ble. We know that doctors will have a very large num­ber of vis­its and the personal GP will be forced to see too many pa­tients daily. You can­not set a limit on the num­ber of times a pa­tient is al­lowed to see their GP,” said Symeou.

She added that the Cyprus Med­i­cal As­so­ci­a­tion be­lieves that the HIO has got things wrong re­gard­ing its budget plans.

“The med­i­cal world is called upon to take on that risk. From the mo­ment that doctors were ex­cluded from the de­sign process of the GHS they should not be asked to take the risk”.

On what hap­pens next, Symeou said: “We will give col­leagues all the in­for­ma­tion. If the HIO goes knock­ing on the door of each doc­tor in­di­vid­u­ally, he or she will de­cide whether or not to join the sys­tem. As far as the 260 pae­di­a­tri­cians work­ing in Cyprus, their po­si­tion is clear. We are against join­ing the scheme as it stands to­day”.

Mean­while, the union of State Doctors (PASIKI) re­jects sign­ing any in­di­vid­ual con­tracts and is call­ing on OKYPY to adopt col­lec­tive agree­ments with health work­ers. Nurses’ unions have also called on their mem­bers not to sign the pro­posed con­tracts.

Nurses wor­ried about pay

State nurse’s union PASYNO has urged mem­bers not to sign con­tracts as they feel that they are vague with some clauses elim­i­nat­ing ben­e­fits they have in the cur­rent pub­lic health­care sys­tem.

Theodoros Petelis, PASYNO’s pres­i­dent, told the Fi­nan­cial Mir­ror that the con­tracts of­fered can­not be con­sid­ered at­trac­tive for nurses, es­pe­cially those al­ready em­ployed in the pub­lic health sys­tem.

“Wages are not clear, holidays are less than what they cur­rently are. Con­tracts of­fered by OKYPY fore­see wage in­creases ev­ery three years, while nurses in the pub­lic health sec­tor see an in­crease ev­ery year,” said Petelis.

He said that con­tracts of­fered do not in­clude clar­i­fi­ca­tions as to what other ben­e­fits the nurses will be en­ti­tled to.

“We do not know if we will be en­ti­tled to night shift al­lowances and whether we will be paid for over­time or how much that will be.”

Fur­ther­more, Petelis said the eval­u­a­tion process of staff em­ployed by the OKYPY was not ex­plained.

He added that one of the nurses’ de­mands was that the in­tro­duc­tion of ‘health­care as­sis­tants’ to the hos­pi­tals.

“A health­care as­sis­tant will be a per­son who will take care of tasks not as­signed to nurses, but cur­rently car­ried out by them. Such as trans­port­ing pa­tients from one de­part­ment to an­other or tak­ing care of pa­tient’s personal hy­giene. This will help re­lieve the prob­lem of un­der­staffed hos­pi­tals,” said Petelis.

“These are all mat­ters that could have been solved if the au­thor­i­ties had talked them over with the par­ties in­volved. How­ever, we were not given the chance to form and ar­tic­u­late our views in ne­go­ti­a­tions with them.”

PASYNO’s head wants all is­sues to be ad­dressed be­fore the launch of the GHS or it “will not be the GHS peo­ple de­serve” not­ing that hos­pi­tals and doctors don’t seem to be on board ei­ther.

Au­thor­i­ties set up to fi­nance and man­age a univer­sal health­care sys­tem do not seem con­cerned about the dif­fi­cul­ties the GHS may face when it launches on June 1, 2018.

An­ge­los Tropis, head of the Health In­sur­ance Or­gan­i­sa­tion, is not con­cerned over state­ments and moves made by the unions as he is con­fi­dent that come June, they will have enough doctors and health in­sti­tu­tions on board.

Tropis said the GHS is bet­ter as it re­moves the work over­load on pub­lic health care. “So, doctors should not be con­cerned that they will be over­loaded with work,” he said.

He added that with the GHS, doctors will be given the in­cen­tives to in­crease their pro­duc­tiv­ity and will in no way lose out on salaries or ben­e­fits pre­vi­ously en­joyed by health work­ers. He said the HIO is in con­tin­u­ous ne­go­ti­a­tions with the var­i­ous health work­ers re­gard­ing their pay and con­di­tions.

He said that health work­ers should not be wor­ried over the budget of the GHS as the aop­proved budget EUR 1 bln, the same amount ap­proved last year for the pub­lic health sec­tor. He added that con­tri­bu­tions will also start com­ing in as of March, so fi­nanc­ing prob­lems are not ex­pected.

Doctors ar­gue that the budget al­lo­cated to the GHS should be equal to 10% of the coun­try’s GDP and not the cur­rent 7%.

“The budget and its al­lo­ca­tion were de­signed after a study by the com­pe­tent au­thor­i­ties. Doctors are ask­ing for an in­crease in the budget, but they are not telling us where they want the ad­di­tional money to go to,” said Tropis.

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