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Country profiles of health system responses to the crisis | Cyprus 359 User charges • Introduction of a co-payment of €1 per prescription in private pharmacies (2012). • Introduction of new user charges of €10 for emergency department use, €0.50 per laboratory test (capped at €10 per referral), €0.50 per prescribed drug (capped at €10 per prescription) (from 1 August 2013). • Co-payments for a GP visit increased from €3 to €6 and for a specialist visit from €2 to €6. Beneficiaries over 65 years have to pay these copayments (previously they did not pay) (from 1 August 2013); • User charges increased for non-beneficiaries. More specifically they have to pay €15 for a GP visit and €30 for a specialist visit, instead of €14.5 and €15, respectively. Additionally non-beneficiaries have to pay 30% more for inpatient hospitalization and for all medical procedures, examinations and laboratory tests during their hospitalization (from 1 August 2013). Changes to health service planning, purchasing and delivery Prices of medical goods • Wholesale prices of prescription medicines in 10 EU countries to be considered when pricing; prices of new drugs costing over €10 to be updated every 12 months for the first two years and then every two years (2012). • Reduction of the profit cap from 37% to 33% for medical products of €50–250 (giving pharmacists a margin of around 25% of the retail price) and from 37% to 25% for products costing over €250 (pharmacist margin of around 20%) (2012). • VAT introduced for all pharmaceuticals at 5% (2011). • Introduction of a new surveillance mechanism to monitor polypharmacy in the public sector (2010). Salaries and motivation of health sector workers • Reduction in the salaries of all public sector health professionals (2011, 2012). • Additional scaled reductions in remuneration of public sector employees and pension recipients (2012). • Overtime rates reduced (2012). Payment to providers • In accordance with the MoU, the Ministry of Health is required to move from national case-based payment for hospitals to a DRG system (2013).

360 Economic crisis, health systems and health in Europe: country experience • The Pancyprian Medical Association urged doctors in the private sector to reduce prices of outpatient visits and medical procedures (2012). • The Pancyprian Medical Association froze prices included in the list of services agreed with the insurance companies until the end of 2013. Overhead costs: restructuring the Ministry of Health and purchasing agencies • Procurement moved to the Ministry of Health (2011). Provider infrastructure and capital investment • The Council of Ministers approved the Ministry of Health's proposal for the reorganization of public hospitals (2012). The proposal aimed to increase cost control and improve quality by reinforcing managerial structures, allocating budgets to each hospital and clinic and creating hospital clusters between neighbouring districts. In order to facilitate implementation, the Ministry of Health prepared a new structure for the clinics in each hospital, which was approved by trade unions (2012). Priority setting or protocols to change access to treatments, coordination of care and patterns of use • Planned to introduce protocols and financial disincentives (user charges) to minimize the provision of medically unnecessary laboratory tests and drugs (second quarter of 2013). Waiting times • No response reported. Health promotion and prevention • Excise duties increased on tobacco products, beer and alcoholic products (2013).

360 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />

• The Pancyprian Medical Association urged doctors in the private sector<br />

to reduce prices of outpatient visits <strong>and</strong> medical procedures (2012).<br />

• The Pancyprian Medical Association froze prices included in the list of<br />

services agreed with the insurance companies until the end of 2013.<br />

Overhead costs: restructuring the Ministry of Health <strong>and</strong> purchasing agencies<br />

• Procurement moved to the Ministry of Health (2011).<br />

Provider infrastructure <strong>and</strong> capital investment<br />

• The Council of Ministers approved the Ministry of Health's proposal<br />

for the reorganization of public hospitals (2012). The proposal aimed<br />

to increase cost control <strong>and</strong> improve quality by reinforcing managerial<br />

structures, allocating budgets to each hospital <strong>and</strong> clinic <strong>and</strong> creating<br />

hospital clusters between neighbouring districts. In order to facilitate<br />

implementation, the Ministry of Health prepared a new structure for<br />

the clinics in each hospital, which was approved by trade unions (2012).<br />

Priority setting or protocols to change access to treatments, coordination<br />

of care <strong>and</strong> patterns of use<br />

• Planned to introduce protocols <strong>and</strong> financial disincentives (user charges)<br />

to minimize the provision of medically unnecessary laboratory tests <strong>and</strong><br />

drugs (second quarter of 2013).<br />

Waiting times<br />

• No response reported.<br />

Health promotion <strong>and</strong> prevention<br />

• Excise duties increased on tobacco products, beer <strong>and</strong> alcoholic products<br />

(2013).

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