Cyprus
In Cyprus EHFCN has one member:
Health Insurance Organization – HIO
Health Insurance Organization (HIO)
Οργανισμός Ασφάλισης Υγείας
The Health Insurance Organization (HIO) was established by virtue of Law No 89(I) 2001 as a public legal entity and is responsible for the implementation and administration of the General Healthcare System (GHS) in Cyprus. It is governed by a Board of Directors which consists of representatives of all stakeholders such as the government, employers, employees and the patients.
The vision of the HIO is to ensure that each citizen in Cyprus has lifelong and equal access to high quality healthcare. As such, it is HIO’s mission to implement a patient centric healthcare system which is based on social solidarity and achieves universal coverage of the population, equal treatment of all beneficiaries, provision of a comprehensive package of healthcare services and freedom of choice of provider by beneficiaries.
In order to achieve the above, HIO contracts with providers of both the private and the public sector. These healthcare providers include: Personal Doctors, Outpatient Specialists, Laboratories, Pharmacies, Nurses and midwives, Allied health professionals, Inpatient Healthcare Services, Dentists, Palliative, Rehabilitation and Home Care, Ambulance services and Accident and Emergency Departments.
The GHS is funded via a special Fund which was established for the purposes of collecting contributions, copayments as well as income from other sources. HIO administers the Fund out of which all payments to healthcare providers for the provision of healthcare services to GHS beneficiaries are made. A number of mechanisms aiming to safeguard the viability of the Fund have been employed, the most important being the Global budget which assumes that in any given financial year, the actual expenditure for any segment of healthcare providers cannot exceed the predetermined global budget, irrespectively of the volume of services provided.
The Cyprus GHS is supported by a comprehensive IT solution through which all healthcare providers can provide services to beneficiaries. The IT system includes web portals for both providers and beneficiaries. Providers can access the system through their portal and they may view patient history, create visits, issue referrals, prescriptions, lab orders, submit claims as well as submit queries and complaints. Similarly, beneficiaries can access their profile through the beneficiary portal and view their patient history within GHS, their personal doctor as well as medical reports.
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Prevention | Compliance to regulations | Both soft and hard |
| 2 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 3 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
| 4 | Action | Compliance to regulations | All types of action once fraud is detected |
| 5 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
