Today, if you fall ill, you can call your personal doctor, receive a referral, book an appointment with a specialist, undergo tests, collect medication from a pharmacy and be admitted to hospital without worrying about the financial cost. Seven years ago, this was not self‑evident.
Before the introduction of the General Healthcare System (GeSY) on 1 June 2019, illness in Cyprus was often accompanied by a second anxiety: “How much will it cost?” A visit to a specialist, a test, long‑term medication or hospitalisation could become a family budget issue, a postponement or a forced choice. For many citizens, healthcare was not only about diagnosis and treatment, but also about affordability.
GeSY changed that rule. In its first seven years, it brought citizens closer to doctors, medicines, diagnostic tests and hospital care. It did not cure all dysfunctions, nor did it eliminate inequalities. It did, however, establish a new baseline: patients are no longer left alone to face the cost of care.
That is precisely why the discussion about seven years of GeSY cannot be limited to another balance sheet of successes and shortcomings. The question is no longer whether Cyprus needed a universal healthcare system. That answer has been given in practice. The question now is what kind of system has been built – and what needs to change to make it better.
To answer that, it is not enough to count how many doctors joined, how many visits took place or how many prescriptions were filled. We need to examine GeSY where it is truly tested every day: prevention, access time, support for those who need continuous care, and its ability to measure quality, not just quantity.
Test 1: Does it prevent what kills?
The first test for a healthcare system entering its eighth year is not how many tests it reimburses, but whether it can prevent disease before it becomes a diagnosis, hospital admission or complication.
The Country Health Profile 2025 for Cyprus identifies among the leading causes of avoidable mortality conditions such as ischaemic heart disease, diabetes, colorectal and breast cancer, and stroke – all of which can be addressed through timely and effective care.
If we know what makes people ill and what kills them, the question for GeSY becomes very specific. Is there an organised mechanism for early risk detection? Is there monitoring of how many citizens are screened for blood pressure, blood sugar and cholesterol? Are patients with hypertension or diabetes followed up to ensure their condition is controlled? Is there an active reminder system for preventive tests, or does prevention remain the responsibility of the citizen who remembers, asks and insists?
In this direction, the inclusion of basic routine laboratory tests for asymptomatic adults is a positive step towards building a culture of prevention. Under certain conditions, GeSY covers tests such as:
- full blood count,
- fasting glucose,
- urea,
- creatinine,
- kidney function tests,
- liver enzymes, cholesterol, and
- urinalysis.
The frequency varies by age group:
- every five years for ages 18–44,
- every two years for ages 45–64, and
- annually for those over 65.
In a country where hypertension, diabetes, cardiovascular disease and their associated risk factors remain major public‑health challenges, such tests can serve as early warning points rather than simply another medical act.
Low participation in prevention
The Pap smear provides an even clearer illustration of what prevention means in practice. This is not just another routine test. It can detect pre‑cancerous lesions and prevent their progression to cervical cancer.
GeSY has covered the Pap smear since day one. For women without symptoms or relevant medical history, it is recommended every two years up to the age of 65.
Yet availability does not automatically translate into participation. In 2024, only 22.3 per cent of eligible women underwent a Pap smear, and in 2025 the figure was 21 per cent, bringing total coverage for the two years to just 42.7 per cent.
At the same time, Cyprus is planning a population‑based cervical cancer screening programme, while the national cancer strategy sets a target participation rate of 80 per cent.
The same pattern appears in dental prevention. An annual preventive dental check‑up exists, but uptake remains limited. In 2024, 32.7 per cent of beneficiaries used dental services through GeSY; in 2025, the figure rose slightly to 34.1 per cent.
A cleaning may be covered, but if the examination reveals the need for a filling, root canal treatment or other procedures, patients know they may be pushed back into private expenditure. As a result, a service introduced as prevention risks functioning with an asterisk: it exists, but does not always change behaviour or prevent problems from escalating.
Here, the role of the personal doctor is decisive. If the institution is reduced to issuing referrals, GeSY loses its most powerful prevention tool. If, however, the personal doctor acts as a population‑monitoring hub, they can become the person who reminds, checks, connects and intervenes before illness advances.
Test 2: Does it deliver in time?
The second test is time. Access is not judged only by whether a service is covered, but by when the patient can actually receive it.
In some medical specialties, waiting times exceed six months or even a year. You may book an appointment with an endocrinologist in mid‑2026 and, at best, be seen in the first quarter of 2027. The problem is even more acute in paediatric‑related specialties, such as paediatric rheumatology, reflecting Cyprus’s very limited number of doctors in certain fields.
This becomes even more critical in specialties linked to chronic diseases that are prevalent in Cyprus. Cardiovascular disease is the leading cause of death, accounting for around 2,000 deaths annually, while one in ten adults has diabetes.
If diabetes and cardiovascular disease are among Cyprus’s major health challenges, access to endocrinologists and cardiologists is not a luxury. If colorectal cancer is a condition that can be better managed through early diagnosis, then access to gastroenterologists and related tests has preventive value. If a child presents developmental difficulties, ADHD or autism‑spectrum traits, waiting months for a child psychiatrist, paediatric neurologist or assessment is not just a delayed appointment – it is lost time for early intervention.
Urgent referrals
The Health Insurance Organisation (HIO) has attempted to address part of the problem through urgent referrals. Specialists are required to see patients with an ‘urgent’ referral within ten days of the appointment request.
This is an important intervention, recognising that not all cases can sit in the same queue. However, it does not resolve the broader issue of non‑urgent but essential needs – cases that are not emergencies, but also cannot wait months without cost to the patient.
This is the gap that must be measured. Today, patients know they have the right to choose a specialist and that a standard referral has a defined duration and number of visits. For chronic patients, there is also a long‑term referral valid for 12 visits over 12 months.
But a referral answers the question “Am I entitled?” It does not always answer “When will I be seen?”
Test 3: Does it cover real needs?
The third test concerns people whose interaction with the system does not end after one visit. For a chronic patient, a person with a disability, a child with autism or ADHD, a stroke survivor or an elderly person gradually losing functionality, healthcare is not a single appointment. It is a journey.
Here, the question is not only whether a service is included in GeSY, but whether the coverage provided is sufficient for the beneficiary’s real needs. The Cyprus Federation of Patient Associations (OSAK) has repeatedly raised this issue, noting that chronic patients are often forced to pay out of pocket for services from other health professionals because the number of covered sessions is not always adequate.
All equal, but…
Physiotherapy is a characteristic example. For an orthopaedic case, a limited number of sessions may be sufficient. According to HIO guidelines, indicative coverage includes six sessions for mild musculoskeletal conditions, nine for more severe cases, and 12 for acute, subacute or chronic neurological conditions or other serious diagnoses.
But for a patient with a chronic neurological condition, a person with a disability or someone who needs ongoing maintenance of functionality, the practical question is simple: are these sessions enough to prevent loss of mobility, autonomy or quality of life?
The problem is even more pronounced in occupational therapy. OSAK has described this as a service that exists “on paper”, while in practice parents pay out of pocket to secure therapies for their children and adults are forced to turn to public hospitals.
For children with autism, GeSY provides up to 48 occupational‑therapy sessions per year until age 18 and up to 12 sessions in adulthood. For children with ADHD, up to 24 sessions per year are covered until age 18. The problem, however, is access: services are provided only through the State Health Services Organisation (OKYpY), with limited availability, schedules that often clash with school hours and long waiting lists.
Beyond this, even access to specialist doctors is not always seamless. A standard referral has a fixed duration and limited number of visits, while long‑term referrals offer 12 visits over 12 months. Once these visits are exhausted, or when a patient requires additional follow‑up without meeting long‑term criteria, the process starts again through the personal or specialist doctor and system controls.
These controls were designed to prevent abuse. In practice, however, they can also delay or restrict access, leaving beneficiaries at risk of paying out of pocket for services they reasonably believe should be provided within GeSY.
