The feasibility of introducing user charges at Zammit Clapp Hospital.

Abstract

Economic, demographic and technological pressures have led to increased demands upon health services and the need to contain spending on healthcare. Like other developed countries, Malta is facing pressures of sustaining escalating healthcare costs. The purpose of this management project was to explore the perspectives of stakeholders regarding the concept of charging users for public healthcare services and the feasibility of introducing user charges for services provided to inpatients at Zammit Clapp Hospital (ZCH). A combination of qualitative and quantitative methods was utilised. Interviews were carried out with a representative of a non-governmental organisation and six key informants at corporate level in the fields of health policy, social servIces, finance, economics, and hospital management. Structured questionnaires were collected throughout March 2003 from 106 in-patients (n=139) and from 101 of their informal carers who were recruited on informed consent and set inclusion criteria. Patients and carers were asked about charging users for public healthcare services; the willingness to pay part of the cost incurred by ZCH to provide services and knowledge of the daily cost of care. 67% of patients, 58% of their informal carers and all key informants agreed with the concept of paying user charges for public healthcare services. Although 75% of patients and 77% of carers were willing to pay part of the costs of services provided at ZCH, a much lower ability to pay resulted. More than 92% of patients and their carers lacked knowledge of the daily cost of inpatient care. According to interviewees, the current system of funding healthcare was insufficient or created excess demand that would be better rationed if a price were charged. Income-related charges were considered acceptable for most healthcare services. Findings also indicated that the system that would introduce user charges for public healthcare services would have to follow a top-down approach directed by government since it entailed restructuring of the system financing healthcare. As a public hospital, ZCH would therefore have to follow decisions taken centrally related to charging users for services provided. Among options of user charges considered, introducing a charge per bed night for the package of care provided was recommended as the most feasible to implement because of its potential of generating revenue and since it supported equity principles by exempting patients eligible to Free Medical Aid. Preserving social solidarity in terms of equity of access was considered fundamental to the reform process that would introduce user charges for public healthcare services in Malta.