Introduction:
The General Healthcare System (GHS/GESY) in Cyprus was established to ensure universal access to healthcare services for all Cypriot citizens, regardless of their social or economic status. It was introduced through the General Healthcare System Laws, Law 89(I)/2001, and was implemented in phases, with the first phase commencing on 1 June 2019. The full implementation, which included coverage of all healthcare services, was completed on 1 June 2020. The GHS provides medical services to all permanent residents of Cyprus, covering them through social insurance and the system of contributions.
The Decision:
A recent ruling by the Administrative Court of Cyprus regarding prescriptions issued by doctors outside the GHS marks a significant development in the legal framework governing healthcare in Cyprus. Specifically, the Court examined the validity and acceptance of prescriptions issued by doctors who are not affiliated with the GHS and their ability to prescribe medications covered by the system.
According to the ruling, the Court concluded that the current legislation does not distinguish between doctors contracted with the GHS and those who are not, in terms of issuing prescriptions. The only distinction recognised in the law is between personal and specialist doctors, as outlined in Article 23 of the General Healthcare System Law of 2001 (Law 89(I)/2001). Furthermore, Article 22(2)(d) of the same law provides that the necessary pharmaceutical, medical technology, and healthcare products may be prescribed by a doctor who is not necessarily contracted with the Health Insurance Organisation (HIO), provided that the prescribed medicine is dispensed by a pharmacist contracted with the HIO.
Additionally, the Court found that the interpretation adopted by the HIO was incorrect, as it incorporated additional wording and combined different legislative provisions to arrive at an interpretation that was inconsistent with the plain grammatical meaning of the term “doctor.” The Court emphasised that if the legislator had intended to restrict the right to issue prescriptions for pharmaceutical products, this would have been explicitly stated in the law. Specifically, the Court noted:
“Nowhere is there an explicit requirement that medicines must be prescribed exclusively by personal or specialist doctors contracted with the Organisation, but rather by doctors in general. It is not permissible to add words to a legislative text, nor is it acceptable to alter the legislator’s intent to derive a desired interpretation when the grammatical interpretation does not support such a conclusion.”
In response to the argument made by the respondent Organisation’s legal counsel that the contested decision falls within the realm of private law, the Court disagreed, ruling that acts falling under its jurisdiction are those originating from a public law entity acting in pursuit of a public purpose. Accordingly, it clarified that under Article 3 of the General Healthcare System Law, Law 89(I)/2001, as it stood at the relevant time, the HIO is a legal entity governed by public law.
It is also notable that the applicant argued that if the Court rejected his claims and ruled that the relevant legal provisions required the prescribing doctor to be contracted with the GHS for the issuance of prescriptions for necessary pharmaceutical, medical technology, or healthcare products, then these provisions would be in violation of Article 28 of the Constitution, as they would create an unjust distinction among GHS beneficiaries. However, the Court did not proceed to examine this argument.
Conclusion:
This ruling significantly impacts the practical application of the GHS by overturning longstanding practices that restricted patients’ access to prescribed medication. The decision exposes a legislative gap, which may prompt Parliament to amend the law to provide clarity. Whether this interpretation of the law will stand or whether future legal or legislative action will reinforce GHS doctors’ exclusive prescription rights remains to be seen. In the meantime, the ruling introduces a new dynamic in the healthcare system, raising questions about its long-term financial and administrative implications.
Author:
Angeliki Flouri
Lawyer
angeliki.flouri@patsalides.com.cy