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14 January 2025 | Policy Analysis
The General Health System of Cyprus – a five-year review -
14 January 2025 | Country Update
Modernization and digitalization of the infectious disease surveillance system in Cyprus
2.6. Health information systems
The integrated information system of the GeSY is the backbone of the new system and the basic tool for collecting, reporting, monitoring and analysing its activity (https://www.gesy.org.cy/launchpad.html). It consists of two subsystems, the Beneficiary Portal and the Provider Portal, which are available online via the GeSY website to beneficiaries and providers respectively. On the Beneficiary Portal, beneficiaries can: i) open an account as a GeSY beneficiary and register on the list of the personal doctor of their choice; ii) submit questions and lodge complaints; iii) have access to their personal information; iv) have access to their medical record and the medical record of their children under the age of 18; v) have access to directories of providers; vi) view their open referrals, prescriptions and laboratory orders; and vii) view their co-payments information.
Providers can use the portal to: i) apply for enrolment and contracting; ii) have access to their personal information; iii) manage the beneficiaries list (for personal doctors); iv) issue all referrals; v) issue prescriptions for pharmaceutical and consumable products; vi) issue referrals for laboratory and diagnostic tests; vii) submit laboratory and diagnostic tests results; viii) access and update beneficiaries’ electronic files; ix) submit payment requests; x) submit questions and lodge complaints; and xi) receive automated reminders and announcements.
The GeSY information technology (IT) system is a tool for collecting, reporting and analysing data. It supports all internal processes of the HIO including the fund’s claims management, payments and all relevant subsystems required for the proper functioning of the health care system. Being a new system, it has the potential to be further developed by linking spending to quality indicators and performance monitoring.
The information systems of the MoH, used for public health monitoring and surveillance, have been shown to be robust and responsive; for example, real-time data were available for the development of COVID-19 response policies and decision-making. Improving data completeness and data quality will support more in-depth health system performance assessment. It would also enable Cyprus to engage more fully with the European Health Data Space initiative, which aims to promote health data exchange and support research on new preventive strategies, as well as on treatments, medicines, medical devices and outcomes (OECD & European Observatory on Health Systems and Policies, 2021).
Since 2007, a Health Information System has been in operation in two public hospitals (General Hospitals of Nicosia and Famagusta). It consists of 13 subsystems and deals with operational procedures such as electronic patient records, patient billing, managing e-prescriptions, laboratory tests, etc. A survey in 2017 revealed that users’ opinions of the system were moderate across five categories (satisfaction, collaboration, system quality, safety and procedures), indicating the need for further improvement (Stylianides et al., 2019). In September 2022, an agreement was signed between the SHSO and a private company (OTE Group) for the development and operation of the new Integrated Health Information System for all public hospitals and health care centres (see Section 4.1.3). In addition, from March 2024, the project for the “Digitization of Medical Records” began to be implemented, by the project contractor who won the relevant tender. It is worth mentioning that technology played an important role during COVID-19. Only a few weeks after the onset of the pandemic, the University of Cyprus, along with the Deputy Ministry of Research, Innovation and Digital Policy, created a portal recording all confirmed COVID-19 cases in real time along with their geographical distribution, the number of tests that had been performed, patients that were hospitalized with COVID-19, and deaths. The portal provides information about other countries as well and facilitates comparisons (University of Cyprus, KIOS Research and Innovation Centre of Excellence, undated). Also created was the CovTracer app, which allowed people to trace their location and notify people in case the user tested positive. Moreover, throughout the COVID-19 pandemic, various information and communication technology (ICT) systems were developed to support the MoH in effectively managing the crisis. These systems were designed to seamlessly record, manage and monitor several crucial aspects such as: a) suspected cases that were reported to first responders of the emergency response hotline 1420 (operated during the early pandemic period; b) COVID-19 diagnostic tests; c) confirmed cases with hospitalization and disease outcome data; d) essential epidemiological information crucial for outbreak investigations; and e) the administration of COVID-19 vaccinations. Additionally, the country introduced complementary systems, such as an EU digital COVID certificate issuance platform and a contact-tracing application. Many of these systems remain operational, playing a pivotal role in ongoing COVID-19 surveillance efforts.
In 2024, Cyprus’s General Health System (GHS), Γενικό Σύστημα Υγείας (ΓεΣΥ), marked its fifth year of operation, providing universal healthcare coverage to all citizens based on residency. The system has achieved significant milestones, including expanding services, improving quality, and maintaining financial sustainability. An actuarial study by the International Labour Organization (ILO) projects that the GHS will remain financially viable until 2031, with reserves totalling approximately EUR 590 million as of 2023.
The GHS has made substantial strides in healthcare service accessibility, with over 90% of the population registered as beneficiaries. The system has expanded its service offerings, improved care quality through performance-based remuneration, and implemented advanced IT solutions for better patient care. However, challenges remain, notably in areas such as waiting times, coverage of certain treatments, and the need for more specialized care. Below, we outline key achievements, ongoing improvements, and strategic recommendations to further enhance the system’s effectiveness.
Achievements and key statistics (June 2023–June 2024)
- Registered beneficiaries: 969 722 (over 90% of the population)
- Utilization of services:
- 807 331 visits to Personal Doctors
- 637 536 visits to Special Doctors
- 319 259 visits to Radiology/Diagnostic Centers
- 501 035 laboratory examinations
- 318 990 dental visits
- 698 650 prescriptions filled
- 83 166 surgeries performed
- New services and providers added: Four new hospitals, two accident and emergency departments, two daycare centres, homecare, and palliative care providers.
- Expansion of coverage: New treatments, speech therapy, clinical dietetics, podiatry, and dialysis centres are being incorporated into the system.
Key actions for quality improvement
The Health Insurance Organisation (HIO), the body responsible for managing the GHS Fund, has undertaken a series of actions to enhance service quality and sustainability, including:
- Performance-based remuneration: Health service providers are now remunerated based on quality criteria and performance indicators.
- Clinical guidelines implementation: Collaboration with the Pancyprian Medical Association and NICE to ensure the adoption of evidence-based practices.
- Chronic patient registries: Specific patient categories, such as those with cancer, diabetes, and thalassemia, have direct access to GHS services.
- Referral categorization: The introduction of routine and emergency referral systems aims to reduce waiting times for specialist consultations.
- IT system upgrades: Beneficiaries now receive notifications about preventive care and follow-up visits via SMS, improving health management and patient engagement.
Research conducted in April 2024 found a high satisfaction rate among beneficiaries, with 92% of participants indicating an improvement in the quality of services since the GHS’s implementation. Key benefits highlighted by beneficiaries included reduced access costs (62%), increased choice of providers (32%), improved service quality (21%), and reduced waiting times (19%).
Challenges and areas for improvement
Despite its successes, GHS faces challenges that need to be addressed to enhance its sustainability and quality further:
- Waiting times: 32% of beneficiaries reported waiting times for doctor visits or surgery as the most significant weakness of the system.
- Coverage gaps: 24% highlighted the lack of coverage for specific tests and treatments, and 23% pointed to the need for referrals from personal doctors to special doctors.
- Specialist shortages: 11% of beneficiaries expressed dissatisfaction with the availability of specialists in certain medical fields.
Recommendations for the future
To build on the GHS’s successes and address its challenges, the following strategic actions are recommended:
- Enhance provider accountability and performance monitoring:
- Extend qualitative criteria and performance indicators (KPIs) linked to provider compensation.
- Reinforce on-the-spot checks to monitor and ensure adherence to quality standards.
- Invest in advanced data analytics and AI:
- Upgrade systems for data analytics and implement artificial intelligence tools to inform decision-making and policy development, ensuring the efficient allocation of resources and service optimization.
- Implement clinical decision support systems:
- Integrate clinical decision support software to improve referral processes, particularly for radiological examinations, following European Radiological Society guidelines.
- Expand rehabilitation and specialized services:
- Expand access to rehabilitation services, particularly for respiratory diseases, and ensure the continued development of specialized care in underserved areas.
- Address gaps in coverage:
- Work toward filling existing gaps in coverage for specific tests, treatments, and pharmaceutical needs, ensuring comprehensive care for all beneficiaries.
- Reduce waiting times:
- Continue the categorization of referrals into routine and emergency categories and implement measures to improve efficiency in specialist consultations and surgeries.
- Public awareness and education:
- Launch large-scale informational campaigns to educate beneficiaries and providers on responsible use of the GHS services, their rights and obligations, and preventive healthcare measures.
References
ILO 2024, CYPRUS Second Report to the Health Insurance Organization Actuarial valuation of the General Healthcare System as of 31 December 2021, covering the period 2022–2031, https://www.gesy.org.cy/el-gr/pressrelease/ilo-tf-cyprus-r.26-web.pdf.
Health Insurance Organisation Press Release 30 May 2024, Δελτίο Τύπου «5 Χρόνια ΓεΣΥ» Με στόχο τον συνεχή εμπλουτισμό των παρεχόμενων υπηρεσιών και την αναβάθμιση της ποιότητας (in Greek), https://www.gesy.org.cy/el-gr/announcementdef/20240601-press-release-5-years-gesy-0.pdf.
Republic of Cyprus Press Information Office, Press Conference on the 5 years of GHS (ΓεΣΥ) (in Greek), https://www.pio.gov.cy/assets/pdf/newsroom/2024/05/30052024_GESYPRESENTATION.pdf.
Health Insurance Organisation, Strategic Plan 2024–2026 (in Greek), https://www.gesy.org.cy/el-gr/annualreport/hio-strategic-planning-2024-2026.pdf.
Over the next five years, a major research project will be carried out in Cyprus in collaboration with the Medical and Public Health Services of the Ministry of Health, the University of Cyprus – Medical School and Centre of Excellence for Research and Innovation “KOIOS” – and the Veterinary Services of the Ministry of Agriculture, Rural Development and Environment to improve and digitalize the infectious disease surveillance system within the framework of WHO’s One Health.
The project is called Cyprus Empowered Surveillance Mechanism (CY-ESM) and is co-funded by the European Health and Digital Executive Agency (HADEA) under the EU4Health programmes (call: EU4H-2023-DGA-MS3-IBA) with a total amount of EUR 3.5 million.
The CY-ESM project will identify needs, improve data collection mechanisms and develop digital systems to collect, analyze, and communicate epidemiological data. In addition, public health staff, healthcare professionals and the public will be trained in the importance and functioning of One Health-based infectious disease surveillance systems.
CY-ESM is expected to significantly improve the country’s ability to accurately map the spread of infectious diseases and agents, analyze data in real time, communicate quickly and efficiently with European health authorities and intervene immediately and in a coordinated manner to successfully manage epidemic outbreaks and future potential pandemic challenges in the face of the rapidly increasing consequences of climate change.