Public health, health policy and health systems organisation
Scope
The domain tests how public health functions are organised, financed and governed, and how policy instruments shape equity and access. Cyprus-specific structures are fair game.
Core rules
- Essential public health operations include surveillance, health protection, health promotion, disease prevention, workforce development and emergency preparedness.
- Health systems are analysed through six building blocks: service delivery, workforce, information, medical products, financing, and leadership and governance. Universal health coverage means access to needed services without financial hardship, not necessarily zero cost at the point of use.
- Financing models differ: Beveridge (tax-funded, government providers), Bismarck (social insurance contributions, multiple payers), national health insurance (single payer, mixed providers) and out-of-pocket. Provider payment methods - capitation, fee-for-service, diagnosis-related groups, salaries - create different incentives.
- Cyprus introduced the General Healthcare System (GESY) in 2019, administered by the Health Insurance Organisation (HIO), with the State Health Services Organisation (OKYPY) running public hospitals. Enrolment gives access to a personal doctor who acts as gatekeeper to specialists.
- Health in All Policies and health impact assessment embed health considerations in transport, education and taxation. Equity means fair distribution; equality means equal distribution. The inverse care law states that services are least available where need is greatest.
Worked example
A ministry proposes user fees for primary care visits to reduce frivolous demand. Applying the framework: fees shift costs to patients, deter the poor and chronically ill, and may increase emergency use. A better policy package is capitation with quality bonuses for personal doctors, exemptions for low-income and chronic disease groups, and investment in out-of-hours primary care. The reasoning links financing to incentives and equity, not just revenue.
Traps
Do not equate universal coverage with free care; do not confuse the HIO with OKYPY; do not describe health policy as clinical guidelines; do not assume gatekeeping always reduces costs without access safeguards.