03/08/2026
🏥 A timely WHO/ European Observatory report on ΓεΣΥ - Οργανισμός Ασφάλισης Υγείας GeSY - and some thoughts on what comes next
The new report on strengthening primary healthcare in Cyprus comes at exactly the right time. It acknowledges GeSY's major achievements in expanding access and reducing financial barriers, but also turns the discussion to the next phase: how to improve quality, efficiency and long-term sustainability through a stronger primary healthcare system.
Many of its recommendations are not entirely new. Several reflect principles that formed part of the original philosophy and architecture of GeSY or ideas that have been discussed, promoted—and at times actively debated—throughout its implementation.
Their value lies not necessarily in their novelty, but in bringing them together within a coherent, evidence-based framework informed by international experience.
💭 Perhaps the most important message, however, is that the themselves are only half the story.
The real challenge is .
The report identifies several important prerequisites, while others are mentioned only briefly or remain implicit. Reading it in the Cypriot context therefore requires us, to some extent, to read between the lines.
Here are a few reflections.
📊 1. Aligning incentives and measuring performance
The report recommends a blended payment model for Personal Doctors, combining capitation, targeted fee-for-service payments and pay-for-performance.
A particularly important distinction is between process indicators (e.g. preventive care, chronic disease management) and outcome indicators, recognising that meaningful performance measurement depends on robust health information systems, appropriate risk adjustment and clinically relevant indicators.
👉 Performance-based payment is only as good as the quality of the data behind it. Reliable indicators, routine evaluation and locally generated evidence are not technical details—they are fundamental prerequisites for reform.
👨⚕️👩⚕️ 2. Investing in primary care capacity
The report emphasises manageable patient lists, multidisciplinary teams and continuing professional development.
🔹 Patient lists: This recommendation is likely to reopen an important discussion. Interestingly, the original philosophy of GeSY envisaged smaller patient lists that would allow sufficient time for prevention, continuity of care and chronic disease management.
During the design of GeSY, however, the medical profession strongly lobbied for substantially larger lists, and it is reasonable to expect that any attempt to revisit this issue may once again encounter resistance.
👉 Ultimately, optimal list size should be determined by evidence on quality, accessibility and sustainability—not remain fixed through historical compromise.
🔹 Multidisciplinary teams: The report rightly highlights multidisciplinary primary care teams.
This has been discussed for years, yet implementation remains limited.
Nurses in particular continue to be significantly underutilised despite the strong international evidence supporting their role in prevention, chronic disease management, patient education and care coordination.
Importantly, this is not simply a workforce shortage issue. It is also about how professional roles are organised and utilised within GeSY. In fact, if multidisciplinary primary care were implemented as envisioned, current workforce shortage estimates would probably prove to be underestimates.
It is also worth reflecting on why previous incentives encouraging multi-doctor practices achieved only limited uptake. Understanding why organisational reforms fail may be just as important as designing new incentives.
🔹 Continuing professional development: Although CPD has now been institutionalised, implementation is still evolving.
The challenge is no longer simply providing educational activities, but ensuring they address genuine practice needs—and perhaps even more importantly—cultivating a culture where lifelong learning is viewed as part of professional excellence rather than merely another regulatory obligation.
📈 3. Quality-driven contracting
Quality-based contracting may ultimately prove to be one of the most transformative—but also one of the most contested—recommendations.
Resistance from parts of the medical community should not come as a surprise. This is precisely why Recommendation 1 is so important.
👉 Without transparent, clinically credible and widely accepted performance indicators, quality-driven contracting simply cannot work.
Performance measurement is therefore not another recommendation—it is the prerequisite upon which selective contracting depends.
🤝 4. Realigning patient expectations and supporting shared decision-making
The report recommends strengthening public understanding of the role of Personal Doctors and developing decision-support tools.
Public awareness is undoubtedly important. However, previous campaigns have tended to focus almost exclusively on changing patient behaviour.
Patients matter—but healthcare professionals arguably shape the system even more. Referral patterns, continuity of care and the way patients navigate GeSY are strongly influenced by clinical practice. Sustainable change therefore requires behavioural change on both sides of the consultation.
Equally welcome is the emphasis on decision aids. These are far more than informational leaflets. They help patients understand benefits, risks and trade-offs, allowing them to participate meaningfully in decisions about their care.
At the same time, shared decision-making should not be viewed simply as educating patients. It represents a fundamental shift in professional practice, requiring new communication skills, a different consultation style and a genuine partnership between clinician and patient.
👉 Decision-support tools and professional training therefore go hand in hand.
🎓 One area that deserves even greater attention
Perhaps the one issue that deserves even greater emphasis than it receives in the report is the role of the academic and public health community.
Reading the recommendations together, it becomes clear that has a much broader contribution to make than conducting Health Needs Assessments.
It can contribute to:
✔️ Developing and evaluating performance indicators
✔️ Workforce planning
✔️ Designing and evaluating decision-support tools
✔️ Developing and evaluating public awareness campaigns
✔️ Supporting continuing professional development
✔️ Evaluating reforms as they are implemented
✔️ Training future healthcare professionals to work effectively within an evolving health system.
These are not isolated research projects. They are continuous functions of a learning health system.
Many of these evidence needs are highly local and operational. And here is the catch:
■ They are unlikely to be addressed through competitive international research funding alone, while the organisations responsible for planning and purchasing healthcare understandably have limited internal research and analytical capacity.
■ At the same time, Cyprus still lacks clear and institutionalised mechanisms through which public organisations can routinely collaborate with the academic and public health community through commissioned research, evaluation, implementation support and professional education.
❗️❗️❗️Strengthening this research–policy may ultimately prove just as important as any individual reform proposed in the report.
While the report rightly recognises the value of collaboration with the academic and public health community, this remains largely implicit.
Research continues to be treated as an activity that supports the system from the outside, rather than as an embedded function of the health system itself.
Likewise, collaboration with academia appears more as a wish than a strategic plan. There is little discussion of how such partnerships should be organised, governed or sustainably funded, despite the fact that many of the report's recommendations—from performance measurement and workforce planning to decision-support tools, training and evaluation—depend on precisely this type of collaboration.
If Cyprus is to develop a genuinely learning health system, the research–policy interface must move from the margins to the centre of health system governance.
💡 Final thought
Overall, the report suggests that the next phase of GeSY is less about introducing new ideas and more about implementing well-established principles effectively.
Reliable data, meaningful performance measurement, multidisciplinary primary care, shared decision-making, continuous professional development and systematic evaluation are all interconnected.
👉 The challenge for Cyprus is no longer deciding what needs to be done. It is creating the institutional capacity, partnerships and culture that will allow these reforms to be implemented, evaluated and continuously improved.
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