Boasting world-renowned scientists and a national health system that has improved quality healthcare access to thousands of people, Cyprus has excelled in its handling of the global Covid-19 pandemic, swiftly vaccinating the majority of its population and gaining global recognition for its efforts.
For decades, the Cyprus health sector has been primarily known for its excellent private healthcare with its highly trained and internationally experienced professionals, specialised medical services and globally renowned research. The majority of its medical professionals are educated at top-tier universities in the UK, Greece, Western Europe, the US and Russia, and international expertise and specialisation have been key factors in the development of the Cyprus’ formidable private sector with 75 private hospitals and clinics, along with numerous smaller private practices. In fact, between 2013 and 2018, the relative ratio of physicians in Cyprus marked the largest increase across the EU, jumping 27.5% or from 320 physicians per 100,000 inhabitants to 407 per 100,000.
2020 marked a milestone in this sector with the long-anticipated national health system (NHS) coming into full effect with the promise to modernise and upgrade healthcare into a more streamlined, transparent and cost-effective system. Within the first two years since the NHS came into force, 892,000 beneficiaries have signed up for the NHS with almost all of them visiting their GP and some 650,000 acquired medicine through the system. With the new NHS, the aim is to offer the public equal access to a healthcare sector that boasts excellent professionals, technology and innovation.
International rankings further underline the strength of the health sector with Cyprus rated as the 21st healthiest country in the world, according to Bloomberg’s 2019 edition of its Healthiest Country Index. Cyprus also has good access to quality health services, ranking 24th out of 195 countries in the Healthcare Access and Quality Index (HAQ) – a study funded by the Bill & Melinda Gates Foundation. In the index Cyprus ranks higher than Germany, Israel and the US, which rank 25th, 28th and 37th respectively. Cyprus’ dedication to healthcare is also evident in health spending as a percentage of GDP, reaching 7% while accounting for 9.63% of the government budget.
Covid-19 Impact
2020 and 2021 have been scarred by the coronavirus pandemic and its effects on the global economy. Cyprus took staunch measures before several of its European partners, taking a proactive stance and carrying out some of the highest test rates in the world. Compared to many of its European counterparts, Cyprus fared much better with a peak fatality rate of 2.5%, and a case fatality rate of 0.4%, one of the lowest in the world.
The island’s efforts were praised by the European Centre for Disease Prevention and Control while doctors from both the public and private sector joined forces to fight the spread of virus. Patients from Cyprus also took part in a global trial of Japanese antiviral influenza drug Avigan (favipiravir) while the governments of Cyprus and Israel worked together sharing expertise and training methods. Renowned Cyprus-based pharmaceutical manufacturer Remedica, imported five tons of chloroquine from India to be processed and subsequently sent to Israel in return for 50 ventilators.
Vaccines became available in late December of 2020 with health professionals and the elderly being the first to receive the jab. Although vaccines have remained optional, the uptake reached almost 80% by September in 2021 and residents were offered an option for which vaccine they preferred. Booster shots were also quickly rolled out in September 2021, with thousands of elderly residents getting an extra jab to protect themselves. Cyprus has dealt significantly better with the pandemic than many other countries as a result of the early adoption of measures and the lower density of its population.
The testing rates have also been amongst the highest across the globe, allowing the government to have a clear picture of the epidemiological situation across the country and take the difficult decisions required for managing hospitals and the health of the public. Cyprus’ vast number of tests it carried out came at great risk for the tourism industry, as with more tests it meant more cases were identified, making the country seem more risky as a travel destination. Nonetheless, with a speedy vaccination uptake and health being a top priority, Cyprus is managing to secure the best of both without one coming at the cost of the other.
More importantly, Cyprus’ NHS made handling the pandemic far more efficient, due to the central database containing every individual’s procedures. Additionally, GPs also joined the fore, being able to vaccinate their patients and speeding up the nation’s immunity.
The National Health System
The roll-out of the new NHS has been a painstaking yet crucial task in bringing Cyprus on par with its European peers in terms of public healthcare. The first phase concerning outpatient care provided by GPs, specialist doctors, pharmacies and labs was introduced in June 2019, while phase two concerning inpatient care was rolled out a year after that in June 2020. Two bodies have been set up in a bid to allow the NHS to materialise. The Health Insurance Organisation (HIO) – known locally as GESY, which is tasked with reimbursing healthcare expenses including pharmaceuticals and the State Health Services Organisation (SHSO), which will be responsible for the management, control, supervision and development of public hospitals and primary healthcare centres.
Revenue from contributions to the NHS was expected to reach to €1.25 billion in 2021 after a year of operations, while expenses were estimated at €1.29 billion. Deficits were said to be covered by accumulated reserves of €300 million. One of the many advantages the comprehensive NHS has brought about, is reduced waiting lists which have plagued the sector for years. The passing of the NHS bills in 2017 was an enormous victory for the government of President Nicos Anastasiades, who has likened this major development in the health sector to the adoption and introduction of the social insurance system in the 1960s.
Health services in the public sector are provided by five district hospitals and one paediatric/ gynaecological hospital, three small rural hospitals and 38 health centres, along with 230 sub-centres with a touring medical team. Additionally, the Ministry implements a sponsored patients’ abroad scheme under specific conditions and terms. Substantial investment in the state sector has meant that procedures such as kidney transplants and open-heart surgery, which once necessitated a journey overseas, are now routinely carried out within Cyprus. The private system is financed mostly by out-of-pocket payments and to some degree by voluntary health insurance (VHI). It largely consists of independent providers, and facilities are often physician-owned or private companies in which doctors are usually shareholders.
Adopting Tech Solutions
Part of its ambitious plans to upgrade the health sector, the Health Ministry is focused on digitising medical provision and developing an integrated e-health monitoring system. This involves the introduction of digitised health records, the expansion of medical services to remote areas via telemedicine and robotics, and access to international medical data banks. Also part of this evolution is to take actions to encourage further investments in areas such as e-health, medical tourism, rehabilitation services, medical schools and pharmaceutical services. A key organisation supporting investors and encouraging FDI is also the country’s investment promotion agency Invest Cyprus, who acts as the first point of contact for foreign investors looking to enter into the Cypriot market.
Meanwhile, the advantages of blockchain technology have become obvious to the health sector with Mediterranean Hospital and Aretaeio Hospital adopting a Cyprus-made blockchain. It allows patients to have a digital healthcare passport and an encrypted NFC card which allows patients to automatically identify themselves at the registration desk, check their queue using their mobile device and safely manage their medical records. Using blockchain allows hospitals to collect data on their efficiency and as such, the global healthcare market spending and investment on blockchain-based technologies is expected to hit $5.61 billion by 2025 according to a report by BIS Research.
Only a few weeks after the Covid-19 pandemic reached the island, top health and technology researchers came together to develop a series of apps and portals. The University of Cyprus along with the recently formed Deputy Ministry for Research, Innovation and Digital Policy created a portal recording all reports of confirmed Covid-19 cases in real time, along with geographical data and risk assessment, which the Health Ministry utilised to make key decisions.
Engineers also created the CovTracer app, allowing people to trace their location and contact history to notify people in case the user tests positive. Another app born from the corona crisis was WaitLess, which has the ability to show people real time traffic in supermarkets, in a bid to avoid large groups of people and reduce the spread of the virus.
Technology will also be at the forefront of helping forecast the needs of medical, nursing and paramedical personnel. The number of graduates from the top-tier medical schools in Cyprus are also expected to provide more medical personnel in the sector and fill the gap of potential shortages in the coming years.
International Cooperation
Cyprus is signatory to multiple Memoranda of Understanding (MoU) with various countries to facilitate more cooperation in the medical field. For example, Cyprus and Israel have signed an MoU for cooperation in the field of kidney transplants. It will allow people who seek to donate kidneys to their loved ones to have a better opportunity to do so through paired donations, as it creates a larger pool of potential donors and increases the chances for successful organ exchange between donor-recipient pairs. The memorandum was the result of a joint effort between the specialists in the area of transplantations from the two countries, as well as of the Transplant Centre of the State of Israel and the Transplant Council of Cyprus.
In addition, Cyprus and the Canadian Commercial Corporation (CCC) – a Crown Corporation of the Government of Canada – signed an MoU in 2017 on health to foster cooperation in the fields of medicine, research and education, and to develop projects of mutual benefit. In 2018, Cyprus and Jordan signed a number of bilateral agreements including one on public health and medical science, with a similar protocol also signed with Russia.
Marking a significant role on an EU level, Cyprus has one of its own in the role of EU Health Commissioner, Stella Kyriakides with extensive experience working at the Health Ministry and working towards helping cancer victims.
An important asset in the provision of high-quality healthcare was the founding of the German Oncology Centre in Limassol in 2017. Established through private funding, the centre covers the whole spectrum of services from prevention and diagnosis, to treatment, rehabilitation and support for patients, offering modern radiotherapy techniques. Previously, the Bank of Cyprus Oncology Centre in the capital city of Nicosia was the sole provider of radiotherapy, but the new private radiology unit complementing state health services is a welcome addition catering to the needs of patients in both Limassol and Paphos regions. The German Oncology Centre, along with numerous other private hospitals, have already joined the new NHS.
Cross-Border Medical Services
The presence of numerous prestigious private healthcare facilities significantly enhances the island’s reputation as a centre for medical excellence and highlights the opportunities available to foreign investors. The island has also opened more opportunities for foreign doctors to carry out procedures in the country, a move that is fostering greater cooperation in the international medical field.
Doctors from Israel, the United States and other non-EU member states are now allowed to provide services in Cyprus, under certain conditions, with procedures overcoming bureaucracy and delays. This decision not only promotes medical tourism and generates income mainly for private hospitals, but also promotes further training and knowledge exchange for Cypriot doctors, with a number of hospitals becoming centres of excellence for the Eastern Mediterranean region, the Middle East and Europe.
Tapping into Global Medical Tourism
Cyprus was one of the first entrants into the European medical tourism sector, and established a national initiative to promote medical tourism thanks to its extensive private healthcare offering and longstanding status as a tourism destination. The global medical tourism market is expected to reach US$207.9 billion by 2027, with positive future growth prospects according to a report by Grand View Research Inc.
Cyprus has excellent medical infrastructure, hospitals, laboratories and other diagnostic centres making it a prime destination for medical tourism. Services are affordable and easily accessible, and this coupled with its large pool of highly educated healthcare professionals and expert services, are positioning the island as a key centre for medical tourism in the Mediterranean region.
A vast array of quality medical treatments for patients from all over the world are offered in Cyprus, from basic check-ups and diagnostic tests to major surgery, kidney haemodialysis, transplants and cardiothoracic surgery procedures, orthopaedic, musculoskeletal surgery and many more. In early 2018, the President of Cyprus inaugurated the new heart centre at the Mediterranean Hospital in Limassol saying it would contribute to the greater goal of making the island a regional hub for medical services.
The country’s ideal year-round climatic conditions make it an attractive destination, where patients can combine treatment with a holiday, and recovery with relaxation. The majority of medical tourists come from the UK, Germany, the Netherlands, Russia and the Middle East and most seek either dental or cosmetic procedures. However, increasing numbers now visit Cyprus for fertility treatment, while the island is gaining a reputation for other specialist procedures.
Prior to travel restrictions as a result of Covid-19, Cyprus was also fast becoming a popular wellness destination with new luxury spa resorts and rural retreats springing up across the island, with holistic therapies and beauty treatments readily available. Fresh and saltwater pools, whirlpools, saunas, steam rooms and hammams, are all present in abundance in hotels around the island for the growing number of wellness orientated and health-conscious tourists.
Investment in both medical and wellness tourism continues to be a serious opportunity for investors, as this sector has been earmarked by the government as one with immense development potential with growing demand from European tourists. According to the state's strategic report, the development of wellness centres should be considered an integral element of future new resorts or added to existing assets in a bid to upgrade and enhance their value proposition. This is also highlighted through TourInvest, a specialised unit operating under the auspices of Cyprus’ investment promotion agency Invest Cyprus, and aimed at promoting tourism-related investment opportunities on the island.
Medical Cannabis
An interesting initiative is Cyprus’ plans to introduce the cultivation and trade of medical cannabis. Apart from the benefits it would bring patients – a number-one priority – it can also boost the economic development of the island, as well as attract significant foreign investment for the entire production chain.
In February 2019, Cyprus took a step forward and passed a law allowing for and regulating the cultivation and distribution of medical cannabis. Initial plans outlined three licenses will be granted to private companies at a cost of €500,000 each for 15 years to grow medical cannabis and distribute it to pharmacies. The annual cost of renewing the license was €30,000 however there has been a call for re-examination of the fees with other options being touted such as a percentage of revenue due to the high profit margins the business is expected to yield. As the law is still relatively new, MPs and stakeholders continue to be involved in the improvement of the legislation, which was amended with regulations in August 2020.
The law regulates the import of cannabis seeds and plants, the cultivation, production, import and export of pharmaceutical cannabis and its use for research for medical purposes. Medical cannabis is available with prescriptions and in the long-term, the move is expected to put Cyprus on par with many other states such as Israel and Germany, where medical cannabis has been legalised and offers patients more options for treatment, though the law stipulates the drug can only be offered after all other available options have been exhausted. North American-based company Tilray has already announced it has been cleared for distribution of cannabinoid formulations for patients in Cyprus and Israeli producer Panaxia made its first delivery of medical cannabis to Cyprus in March 2021.
Medical Research and Education
The Cyprus education and research sector has a significant boost over the last few years. The establishment of medical schools on the island was a strategic move in the ongoing process of improving the sector, as well as fostering international research and innovation. Today, Cyprus has three medical schools – one public and two private – all of which are affiliated with hospitals throughout Cyprus and with prestigious international medical institutions, such as St George’s Hospital (University of London), Barnsley Hospital NHS Foundation Trust as well as other medical centres and hospitals in Greece and Germany.
Over the past three decades, Cyprus has made highly commendable achievements in the fields of medical research and innovation. Pioneering research work has been undertaken at the Cyprus Institute of Neurology and Genetics, which developed a ground-breaking, non-invasive prenatal test for Down Syndrome. And in 2017, doctors at the Institute discovered a genetic mutation, which is common only in Cypriot families, that is responsible for most cases of hereditary breast and ovarian cancers on the island. Research in the biomedical field has also had a remarkable increase, especially in the field of genetic diseases, hereditary cancer and biotechnology. These ambitious research projects, funded by both local and foreign sources, but mostly through the EU, resulted in data and new knowledge benefitting both the local and international community.
In 2017 a new strategy was also drawn up to deal with diabetes, another growing disease on the island. The strategy plans for the development of a central research body on health issues and a central research database connected with other European international centres.
This kind of top-quality academic work in Cyprus is evidenced by the securing of important European funding such as Horizon 2020, hundreds of high-impact publications in international peer-reviewed journals and invitations to present their work at major medical conferences around the world.
A Healthy Future
Cyprus’ formidable private healthcare sector now complemented by a new and streamlined national health system is sure to bring much-needed modernisation to the overall sector. This upgrade and razor sharp focus from the government in achieving an efficient and productive industry will ensure equal competition between private and public health providers and attract new investment in the health sector – be it in tech solutions, research or world-class medical facilities.
As with most countries in the world, the coronavirus pandemic will inevitably have an impact on progress as the global economy grapples with this new reality. However, Cyprus is well equipped to tackle challenges thanks to its vast pool of medical professionals and facilities as well as its education and research institutions. There continues to be much untapped potential in Cyprus and investors and innovators should keep a keen eye on the country to capitalise on opportunities in the health and medical landscape.
For more information, contact Cyprus' investment promotion agency, Invest Cyprus.
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October 2022
