Executive Summary
Market Entry
Current Market Trends
Best Prospects
Market Size
Main Competitors
Current Demand
Registration Process
Reimbursement
Barriers
Procurement and Tenders
Local Associations
Government Links
FAQs
U.S. Commercial Service Contact Information
Tab Options
Executive Summary
Market Entry
Current Market Trends
Best Prospects
Market Size
Main Competitors
Current Demand
Registration Process
Reimbursement
Barriers
Procurement and Tenders
Local Associations
Government Links
FAQs
U.S. Commercial Service Contact Information
Executive Summary
According to Bloomberg’s 2019 edition of the Healthiest Country Index, Cyprus ranked the 21st healthiest country globally and 24th out of 195 countries in the Healthcare Access and Quality Index (HAQ) for access to quality health services. The first National Health System (NHS) in the Republic of Cyprus (ROC) was implemented in two phases. Outpatient services launched on June 1, 2019, and inpatient care services launched on June 1, 2020. The NHS aimed to modernize and upgrade the healthcare sector into a more transparent and efficient system, reduce government expenditures and introduce competition into the sector. This could open new commercial opportunities for U.S. health-related products and services. The ROC has a small but vibrant health care sector, and it is open to imported health-related products and services based on EU regulations. The ROC does not have a domestic medical equipment manufacturing sector and is entirely dependent on imports of which 75 percent are from other EU countries. It does, however, have a large manufacturing industry for generic pharmaceuticals that welcomes U.S. products and equipment.
Prospects are less promising in the area administered by Turkish Cypriots. The self-proclaimed “Turkish Republic of Northern Cyprus” (“TRNC”) is not recognized by the United States or any other country except for Turkey. “TRNC” health “authorities” have sought to harmonize the healthcare market “regulations” with EU standards, but the market is largely isolated from the ROC and EU and heavily dependent on imports from Turkey.
Pandemic Effects
The first phase of the implementation of the NHS began just before the outbreak of the pandemic in Cyprus in March 2020, which expanded health services to combat the COVID-19 crisis. The ROC funded new hospital wards to accommodate COVID-19 patients, ICU units increased their capacities, and public hospitals leveraged private doctors and hospitals to provide treatment for other routine incidents.
The ROC imported medical equipment and consumables to support COVID-19 treatment, and the Ministry of Health (MoH) established a central committee for the management and coordination of the country’s supply and demand. Despite these changes, there are no substantial drawbacks to the system or any backlogs for medical device registrations.
Market Entry
As a member of the EU, the ROC’s legislation concerning medical devices complies with the following EU directives: active implantable medical devices 90/385/EEC , medical device 93/42/EEC and in-vitro medical devices 98/79/EC as well as all the supplemental EU directives from past years. Medical trade is duty-free within the EU, as are most of the products coming from non-EU countries. Manufacturers from non-EU countries must identify an EU-based authorized representative unless the manufacturer has a registered business in the EU. The representative serves as the point of contact for the appropriate authorities in Cyprus and can serve purely as an administrative agent or as an importer/distributor. A product for final sale or use in Cyprus should be marked with the “Conformité Européene” (CE) identification. To affix the CE mark, the device must conform with the general requirements contained in the first annex of the three directives on medical devices. If a medical device is correctly marked as CE, it does not need additional approval or certification to be marketed throughout the EU. Furthermore, depending on the medical product, additional requirements may be in place relating to the language of the device information. See the latest National Trade Estimate Report on Foreign Trade Barriers for more on compliance with EU standards and conformity assessment procedures.
In the areas administered by Turkish Cypriots, “TRNC” health “authorities” have sought to harmonize “regulations” with EU standards, but the market is largely isolated from the EU and heavily dependent on imports from Turkey.
Current Market Trends
The NHS provides universal coverage for all ROC residents, including Cypriot and EU citizens, third country nationals, and migrants.
The NHS has introduced more competition in the healthcare sector, potentially creating opportunities for U.S. companies to establish or expand their share of the market. Potential opportunities include applications for electronic medical record systems and business intelligence for health, and knowledge management.
The NHS covers exams by general practitioners and specialist doctors, lab tests, pharmaceuticals, inpatient and outpatient hospital care, medical rehabilitation, preventive dentistry, and other medical services.
The NHS has introduced a new single insurer, the Health Insurance Organization (HIO). The HIO is funded by contributions from employers, employees, other income-earners such as pensioners or property owners receiving rental income or government assistance. The burden of paying for health insurance is now distributed across multiple parties and is expected to reduce direct government spending on healthcare. It has, however, created disincentives for individuals or companies to pay for additional private insurance. Health spending in Cyprus is relatively below the EU average, at €1,881 euro per capita in 2019, compared to the EU average of €3,523 euro per capita. The approved health care budget for the MoH for 2022 is €1.0 billion ($1.05 billion), an increase of 2.1 percent over 2021.
The ROC’s National Recovery and Resilience Plan for the period 2021-2026, funded partially by the European Union (EU) Recovery and Resilience Facility and ROC national budget, plans to increase investment in healthcare. The plan includes upgrading public and private hospitals for approximately €46.1 million ($49.5 million) and updating the healthcare information system for approximately €5.7 million ($6.1 million).
Best Prospects
Republic of Cyprus:
A new tender for healthcare-related IT services will likely be announced in early 2023. The tender, worth over €30 million ($32 million),will be to design and implement the “Electronic Health Care Record for all Citizens” for the Cyprus National eHealth Authority.
One major tender for the implementation of the NHS scheme is currently in progress, namely the “ROLLOUT of Integrated Health Care Information System (IHCIS)” which calls for health care information systems, business intelligence for health, electronic content management, and decision support and knowledge management. Tools will include software and hardware devices as well as equipment.
Area Administered by Turkish Cypriots:
Medical devices, medical disposables, and medical equipment are developing markets in the area administered by Turkish Cypriots.
Market Size
Healthcare spending (including investment)
As percent of GDP:
7.01 (2019) (source )
… of which spent on inpatient services (including rehabilitative care):
€445.71 Million (2019) (source )
… of which spent on pharmaceuticals/consumables:
€248.64 Million (2019) (source )
… of which spent on outpatient services:
€426.22 Million (2019) (source )
Hospitals, Procedures, Healthcare Professionals
Number of hospitals
…Public:
8 district and 38 rural (source )
…Private:
73 (2018) including private clinics (source )
Number of hospital beds:
2,909 (2018) (source )
… available beds per capita:
299 (2018) (source )
…of which in general hospitals:
1,601 (2018) (source )
…of which in specialized clinics and rehabilitation centers:
1,398 (2018) (source )
Number of surgical procedures:
34,364 (2018) in public hospitals (source )
…of which:
26.8% General Surgery (2018)
…of which:
18.6% Ophthalmology (2018)
Physicians:
3,544 (2018) (source )
…of which surgeons:
968 (2018)
…of which internists:
912 (2018)
…of which pediatricians:
256 (2018)
Dentists:
965 (2018) (source )
Demographics
Population:
1.295 million (source )
Life expectancy men/women:
male: 80.4 years (2020) female: 84.4 years (2020) (source )
Infant mortality rate:
8.36 per 1000 live births (2022) (source )
Percent of population older than 65:
12.97% (2020) (source )
…projection, 2030:
18% (2019) (source )
Annual deaths
5,963 (2018)
…caused by heart disease
1,784
…caused by malignant neoplasm
1,435
…caused by COVID-19
1,079
Prevalence of Diabetes
8.6% (2021) (source )
Sources: Eurostat, WHO, Cyprus Statistical Service, UN, CIA World Factbook, European Commission
Main Competitors
U.S. exporters’ main competitors in the ROC include companies from Germany, Netherlands, Greece, and Belgium. Other competitors include Italy, United Kingdom, France, Switzerland and China. Turkey is the only significant foreign market participant in the areas administered by Turkish Cypriots.
Current Demand
Current demand includes laboratory equipment, healthcare equipment and services for diseases such as nervous, breast cancer, nephrological, orthopedic and cardiovascular, and pharmaceuticals and pharmaceutical manufacturing inputs.
Cyprus does not have a domestic medical device manufacturing industry and all medical devices are imported. As per the Cyprus Statistical Service, imports of medical devices (HS 9018) into Cyprus reached €61.5 million ($72.6 million) in 2021. Approximately 75 percent of medical devices were imported from EU countries, although this included non-EU manufactured medical devices re-exported from EU countries to Cyprus. The rest were imported from China, Korea and other non-EU countries, including the United States, which accounted for around two percent of the total.
The “TRNC” healthcare market is underdeveloped. Most of its imports, including medical devices, are from Turkey. Turkish Cypriot health “authorities” attempt to harmonize health “legislation” with EU standards. They follow World Health Organization international health regulations and have worked with counterparts in the ROC to address global issues such as Ebola and COVID-19. Turkish Cypriots have received significant medical supplies and vaccines from Turkey during the COVID19 pandemic, however the ROC and EU also provided COVID-19 vaccines and needed medical equipment.
Registration Process
As a member state of the EU since 2004, Cyprus has adapted its national legislation to abide by EU law. In accordance with relevant legislation, the authority for the implementation of regulations related to medical equipment is the Medical Devices Competent Authority of Medical and Public Health Services. The duty of the Competent Authority is the development and operation of all necessary mechanisms so that medical devices are correctly registered and safely placed into the Cyprus market. The medical device sector includes a wide variety of products ranging from bandages and syringes to more sophisticated products which incorporate advanced technologies such as nanotechnology and tissue engineering. Please refer to the “Market Entry” above for a full explanation of the registration process.
Reimbursement
Cyprus’ health care system is split into the public and the private health care sectors, and 100 percent of the ROC population relies on the public health system, the NHS. There are no barriers to citizens to use the public system. Private doctors, hospitals, labs, and other service providers that join the NHS agree to a fixed schedule of reimbursement rates. The NHS has significant bargaining power in setting those rates.
NHS revenues come mainly from the contributions citizens pay through annual taxes. Employees, pensioners, income earners and government officials contribute 2.65 percent of their monthly income, while employers contribute 2.90 percent, self-employed 4.0 percent, and the state 4.70 percent. Cypriots do not pay when they visit their General Practitioner (GP), however, they pay six euro when they visit a specialist doctor, one euro and an additional minimal fee for each pharmaceutical product and lab test, and ten euro for each radiology exam.
The private health care sector is funded through voluntary health insurance schemes and out-of-pocket payments made directly to medical practitioners, private hospitals, and clinics that are not members of the NHIS.
Barriers
There are no restrictions on imports in Cyprus, as long as they comply with EU regulations. The import climate is open to innovative, high-quality equipment.
Procurement & Tenders
The Republic of Cyprus announces all tenders through the Ministry of the Treasury’s Public Procurement Directorate at https://www.eprocurement.gov.cy/epps/home.do .
The procurement website also provides FAQs on how to register an organization and submit offers.
The following links list global tender opportunities including Cyprus:
http://www.tendersinfo.com/global-cyprus-tenders.php
http://www.medicaltenders.com/medical_tenders_cyprus.htm
Local Associations
Cyprus Association of Importers of Medical & Scientific Instruments:http://saieek.com/index.php/en/
FAQs
1. Are there visa requirements for U.S. citizens to travel to Cyprus? 2. How can I start business in Cyprus? https://cy.usembassy.gov/business/getting-started-cyprus/ 3. How can I connect to Cypriot importers? https://cy.usembassy.gov/business/services-u-s-companies/ 4. Are there any barriers on imports?
U.S. Commercial Service Contact Information
Name: Anna Agrotou agrotou@state.gov
