Academic journal article Bulletin of the World Health Organization

Transitioning to a National Health System in Cyprus: A Stakeholder Analysis of Pharmaceutical Policy reform/Transition Vers Un Nouveau Systeme De Sante National a Chypre: Analyse Par Les Parties Prenantes De la Reforme Des Politiques pharmaceutiques/La Transicion a Un Sistema Nacional De Salud En Chipre: Un Analisis De Los Interesados En la Reforma De la Politica Farmaceutica

Academic journal article Bulletin of the World Health Organization

Transitioning to a National Health System in Cyprus: A Stakeholder Analysis of Pharmaceutical Policy reform/Transition Vers Un Nouveau Systeme De Sante National a Chypre: Analyse Par Les Parties Prenantes De la Reforme Des Politiques pharmaceutiques/La Transicion a Un Sistema Nacional De Salud En Chipre: Un Analisis De Los Interesados En la Reforma De la Politica Farmaceutica

Article excerpt

Introduction

In 2013, Cyprus had a population of about 858 000 and a gross domestic product (GDP) of about 16 500 euros ([euro]) per capita. (1,2) The country's health system consists of a public and a private sector. Individuals with annual incomes of no more than 15 400 [euro], the chronically ill and civil servants--together representing about 83% of the population--are eligible for public-sector coverage. (3) The government pays for public-sector health care while patients and private health insurers pay for private-sector health care. Total health expenditure is about 7.3% of GDP. (4) About 43% and 57% of health spending is publicly and privately funded, respectively. (1) In 2010, pharmaceutical expenditure--322 [euro] per capita--accounted for 19.8% of total health expenditure in Cyprus. (1)

In 2013, Cyprus agreed to a memorandum of understanding with creditors from the European Commission, European Central Bank and International Monetary Fund and introduced an economic adjustment programme to address the country's financial, fiscal and structural challenges. (5) The memorandum calls for the introduction of a national health system finance reform by mid-2016 to allow free choice of provider, social equality and solidarity, financial sustainability, and universal coverage of a minimum benefit basket. (6) In the forthcoming system, the government will pay for all health-care services in the benefit basket--subject to cost sharing--and supplement current tax revenues with other sources of funding, including taxes on employers, employees and pensioners. (7) The reform will bring major changes in financing, coverage, provider payment and data collection and monitoring. (3) The government still needs to decide which drugs to cover, which pricing and reimbursement policies to apply and what type of cost sharing to introduce.

Given the lack of research on the Cypriot pharmaceutical system, (8-12) the aim of this study was to review the current system of pharmaceutical care in the private and public sectors in terms of the availability and affordability of medicines. We also wanted to explore how the public and private markets could be efficiently merged in the national health system and to assess the key barriers to the implementation of the new system.

Methods

To collect primary data, we conducted interviews in April 2014 with senior representatives from seven national organizations (Box 1). (13) The interviewees represented all but one of the organizations involved in pharmaceutical care in Cyprus. The exception was the Cyprus Medical Association, whose representatives were unavailable to meet. The interviewees were jointly selected by the researchers, the World Health Organization Regional Office for Europe and the Cypriot Ministry of Health. We met with the representatives from each organization separately over three days and each interview lasted between 30 minutes and two hours. All interviews were held at the headquarters of the health ministry's Department of Pharmaceutical Services, in Nicosia. At least three members of this department were present at each interview.

The interviews were semi-structured (Box 2) but the discussions varied based on the roles of each organization. One of the researchers and a ministry of health employee took notes during each interview, and these notes were discussed with health ministry officials after each meeting, to confirm our understanding of the data. We followed the consolidated criteria for reporting qualitative research checklist (14) and used NVivo 10 (QSR International, Melbourne, Australia) to organize, code and analyse the interview data.

Box 1. National organizations represented by interviewees, Cyprus,
2014

* Cyprus Association of Pharmaceutical Companies, representing
Cypriot drug importers and distributors.

* Cyprus Association of Research and Development Pharmaceutical
Companies, representing research-based manufacturers. … 
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