2.1. Historical background
There are written sources that confirm the existence of “doctors” and “medicines” in Cyprus from as far back as 2500 years ago. Notable examples of early medical approaches are shown by the bronze Tablet of Idalion,[1] Aristotle’s reference to different kinds of plant in Cyprus that were useful for the art of medicine (4th century B.C.) and a visit of the great Greek doctor Galenos (129–216 A.D.) to collect medicinal herbs and mineral medicines (Chrysanthis, 1991). During the Ottoman rule (1571–1878), health and sanitation conditions were poor and infectious diseases, such as plague, cholera and malaria, were endemic in the island. Outbreaks of cholera, malaria, leprosy, meningitis, smallpox and typhoid were also common during British colonial rule (1878–1960). However, during this time, the first steps were taken to establish basic health infrastructure, including pharmacies and clinics staffed by British and Cypriot doctors, as well as the establishment of the Nursing School. By the end of British rule, small public hospitals were established in the six major cities of Cyprus, as well as health centres and community clinics in large villages. In addition to public health centres, the two major trade unions, the Pancyprian Federation of Labour (PEO) and the Cyprus Workers Confederation (SEK) established their health centres in Nicosia (1943) and Limassol (1963).
Until the end of colonial rule, state hospitals operating in the island’s six cities, plus health centres and community clinics in large villages, were mostly financed by the British government as well as by the municipalities, but also by those patients who could pay for services received in hospitals. This network provided services free of charge to the poor, based on poverty certificates issued by community authorities, while the rest of the population either visited the private sector, which began to be organized and expanded throughout Cyprus (Theodorou & Athanasakis, 2021) or public hospitals, bearing the full cost. This system, with some changes and improvements, remained in operation for almost six decades, until the implementation of the GeSY in 2019.
Since independence in 1960, labour unions, organized groups and the public in Cyprus had called for a national universal and free health care system. Towards this end, at least five proposals and studies for the introduction of a public health care system were prepared on behalf of Cypriot governments (ILO, 1966; WHO, 1972; Zollner, 1980; WHO, 1982; Llewelyn-Davies Weeks, 1988). All experts who analysed the situation in Cyprus from 1966 onwards suggested that an insurance-based scheme would be most suitable.
The most serious effort towards a major health reform began in 1991; this led to the preparation of a document one year later by a team of academics from the universities of Leeds, York and Harvard called “Proposals for a National Health Insurance Scheme” (Consultancy Team, 1992). After a long period of dialogue and negotiations with all relevant stakeholders and interest groups, the Founding Law of the GeSY was passed by Parliament in 2001 and the HIO was established in law (Founding Law 89(I)/2001). Nevertheless, implementation was delayed for another 18 years. Finally, in June 2019, the first phase of the new system was implemented – and completed with the second phase in June 2020. More information on the implementation procedures and the politics behind this delay can be found in Chapter 6.
- 1. According to this tablet, inscribed with signs of the Cypriot syllabary (480–470 B.C., housed in the Bibliothèque Nationale de France, Paris), the doctor Onasilos and his brothers made an agreement to look after the wounded during the siege of Idalion city by the Persians and the Kitians. As a reward, the King of Idalion Stasikypros agreed to give the brothers land and money. ↰