Please use this identifier to cite or link to this item: https://www.um.edu.mt/library/oar/handle/123456789/46215
Title: ESPN thematic report on inequalities in access to healthcare : Malta
Authors: Vassallo, Mario
Borg, Anna
Keywords: Health services accessibility -- Malta
Medical care -- Malta
Issue Date: 2018
Publisher: European Social Policy Network (ESPN), European Commission
Citation: Vassallo, M., & Borg, A. (2018). ESPN thematic report on inequalities in access to healthcare : Malta. European Social Policy Network (ESPN), Brussels: European Commission.
Abstract: Malta has a mixed healthcare system. The National Health Service (NHS) is provided by the state and is responsible for public service delivery. In parallel, the private sector provides services through a large number of clinics and a number of privately run hospitals. Between 2005 and 2015, the public share of health expenditure increased by more than one third, yet in 2015 the health expenditure in Malta remained below the EU average, both in per capita terms and as a share of GDP. Preventative, diagnostic, curative and rehabilitative healthcare services are available free of charge through Malta’s public healthcare system, funded through taxation. Inpatient medicines, and medicines listed in the government formulary for those suffering chronic illnesses, are available free of charge. Outpatients in low-income groups are also entitled to a restricted list of essential medicines and medical devices if they pass a means test. Free dental care is restricted to specific categories of people, whilst non-emergency dental care and optical services are means-tested. No qualifying period is required to access healthcare and in general patients are not asked to make co-payments or to pay any other charges. Some exceptional charges exist, as in the case of IVF hormonal treatment. Overall, the population coverage of the public healthcare system is high, comparing very favourably with other EU countries as documented through the EU statistics on income and living conditions (EU-SILC). There is also variability in reported unmet medical needs between those in the highest and the lowest quintiles of income. This suggests a not quite equitable access to services across all income groups. Due to the small size of the island and a good distribution of regional healthcare centres and other smaller clinics scattered around the country, there is no incidence of inability to access free healthcare services due to geographical reasons. Similarly, unmet needs for dental examination are very low. Waiting lists for inpatient care for a number of procedures, such as cataract surgery, have been reduced substantially in recent years and only 0.1 per cent of respondents reported unmet needs for medical examination due to long waiting lists. In contrast to this positive trend, outpatient waiting times are long and have been increasing; as at March 2018, on average patients across 18 departments at the Mater Dei Hospital had to wait for 40 weeks before being granted a first outpatient appointment. Similarly, data on pending unscheduled and scheduled interventions in the different specialities suggest long waits, especially in the orthopaedics department (220 days). Long and increasing waiting lists for some radiological investigations can also be noted at the medical imaging department. Malta’s challenges concerning healthcare access arise primarily because the same health consultants and specialists are allowed to provide services in both the public and privately run hospitals and clinics. This systemic feature severely limits the ability of health authorities to extend outpatient opening hours, and this situation is partially responsible for long outpatient waiting times. As a result, many believe that inpatient care in public hospitals is best secured by consulting specialists in the private sector first. This helps patients who can afford to pay for private consultations to by-pass, or at least minimise, their waiting times for inpatient care. This systemic feature of the Maltese healthcare system creates pressures for pensioners and families on low incomes who are in need of specialist care and who are not able to afford a private fee-paying consultation. When persons in these categories are prescribed medicines that are not listed in the government formulary their challenges become harder. Because of a lack of empirical research it is, however, very difficult to assess how big this group is: although out-of-pocket (OOP) expenses are reported to be on the high side (28 per cent of total health spending) and are nearly double the EU average (15.3 per cent). This puts Malta amongst the top third of countries with the highest rate of OOP spending. Malta has a mixed healthcare system. The National Health Service (NHS) is provided by the state and is responsible for public service delivery. In parallel, the private sector provides services through a large number of clinics and a number of privately run hospitals. Between 2005 and 2015, the public share of health expenditure increased by more than one third, yet in 2015 the health expenditure in Malta remained below the EU average, both in per capita terms and as a share of GDP. Preventative, diagnostic, curative and rehabilitative healthcare services are available free of charge through Malta’s public healthcare system, funded through taxation. Inpatient medicines, and medicines listed in the government formulary for those suffering chronic illnesses, are available free of charge. Outpatients in low-income groups are also entitled to a restricted list of essential medicines and medical devices if they pass a means test. Free dental care is restricted to specific categories of people, whilst non-emergency dental care and optical services are means-tested. No qualifying period is required to access healthcare and in general patients are not asked to make co-payments or to pay any other charges. Some exceptional charges exist, as in the case of IVF hormonal treatment. Overall, the population coverage of the public healthcare system is high, comparing very favourably with other EU countries as documented through the EU statistics on income and living conditions (EU-SILC). There is also variability in reported unmet medical needs between those in the highest and the lowest quintiles of income. This suggests a not quite equitable access to services across all income groups. Due to the small size of the island and a good distribution of regional healthcare centres and other smaller clinics scattered around the country, there is no incidence of inability to access free healthcare services due to geographical reasons. Similarly, unmet needs for dental examination are very low. Waiting lists for inpatient care for a number of procedures, such as cataract surgery, have been reduced substantially in recent years and only 0.1 per cent of respondents reported unmet needs for medical examination due to long waiting lists. In contrast to this positive trend, outpatient waiting times are long and have been increasing; as at March 2018, on average patients across 18 departments at the Mater Dei Hospital had to wait for 40 weeks before being granted a first outpatient appointment. Similarly, data on pending unscheduled and scheduled interventions in the different specialities suggest long waits, especially in the orthopaedics department (220 days). Long and increasing waiting lists for some radiological investigations can also be noted at the medical imaging department. Malta’s challenges concerning healthcare access arise primarily because the same health consultants and specialists are allowed to provide services in both the public and privately run hospitals and clinics. This systemic feature severely limits the ability of health authorities to extend outpatient opening hours, and this situation is partially responsible for long outpatient waiting times. As a result, many believe that inpatient care in public hospitals is best secured by consulting specialists in the private sector first. This helps patients who can afford to pay for private consultations to by-pass, or at least minimise, their waiting times for inpatient care. This systemic feature of the Maltese healthcare system creates pressures for pensioners and families on low incomes who are in need of specialist care and who are not able to afford a private fee-paying consultation. When persons in these categories are prescribed medicines that are not listed in the government formulary their challenges become harder. Because of a lack of empirical research it is, however, very difficult to assess how big this group is: although out-of-pocket (OOP) expenses are reported to be on the high side (28 per cent of total health spending) and are nearly double the EU average (15.3 per cent). This puts Malta amongst the top third of countries with the highest rate of OOP spending. Similar problems are also faced by third-country nationals who enter Malta legally but who are barred from working: they face more problems in accessing adequate health and follow-up care. There is no specific legislation which covers this group. Similarly, there seems to be a legal limbo in relation to how such people can access mental health services or expensive treatment for HIV. Such migrants may also face barriers to using health services due to lack of information, language problems and fear of being deported. Barriers for trans-gendered persons will soon be removed (June 2018) and specialised services such as hormone therapy and gender-affirmation care will start being offered free of charge.
URI: https://www.um.edu.mt/library/oar/handle/123456789/46215
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