Editorial

Our latest public opinion survey focuses on the health service and how it is perceived. Its results should also be read together with the comments made recently by Health Minister Louis Deguara, who also gives us a follow-up interview in this issue.

Over 81 per cent of those surveyed said they are generally happy with the health service but significantly, while the fact that hospital services are adequate is given as the major reason for this satisfaction, the existence of free services and medicines is an important consideration leading to this positive assessment.

The "free" service and the "free" medicines in fact highlight one of the major problems currently facing the health service. This is how to continue to provide the best possible service in the face of ever-spiralling costs of medicines, equipment, and labour.

The new Mater Dei Hospital, offering state-of-the-art medical treatment and equipment, and the maximum comfort for patients, represents not only a massive Lm100 million in capital expenditure (at least), but will also cost millions every year in running costs. And with ever-rising costs in the medical field, the strain on the national budget - where the deficit, we were informed last week, stands at Lm127 million so far this year - can be imagined.

Obviously, a government which believes in solidarity, and which tried to outdo its Labour competitor in ever more generous social welfare in the past, will ensure that those without resources and with the lowest incomes continue to benefit from free health services and free medicines.

The question is whether those who can afford to pay, and who continue to make use of the public health service in large numbers - as evidenced by the results of our survey - should still be entitled to them, even while contributing to the service through taxation.

The fact is that private medicine, the alternative to public health care, again according to the findings of our survey, is perceived to be expensive, with a large majority of those interviewed suggesting it be tax-exempt, since recourse to private medicine lessens the pressure (and therefore the expense) on the service provided by the government.

But Dr Deguara is right to point at other problems in the health service, whose running is contributing mightily to the ever burgeoning government expenditure. Foremost among these is a more rational, possibly optimal, use of human resources; flexibility is essential in hospitals and health clinics in order to give the public the best possible service. There is no longer any room for outdated trade union practices and rigid stances which can only be counter-productive, not least to the very members whose interests trade unions seek to defend.

The keynote must, in any case, be "value for money". The Prime Minister had described the new Mater Dei Hospital as the government's "millennium" gift to the Maltese people. It is an expensive gift, but in the final analysis, except for some financial assistance from the Council of Europe towards its setting up, it is one which the Maltese people will have to pay for themselves, and particularly for its running costs. Guarding against waste in the new hospital should therefore be a priority.

It is also logical that, although all citizens are expected to contribute to government services according to their means through income tax and other fiscal measures, any services should be paid for mainly by those who use them.

It would not be a bad idea for Government to embark on a truly educational campaign and make people aware of what the real costs of hospital care, treatment, equipment and services - not to mention medicines - are, even if no charge is actually levied.

Such awareness must be created as a prerequisite for the elimination of waste and gross misuse of public funds not only by users, but also by those professionals who cavalierly prescribe treatment and medicines.

Dr Deguara tells us that his ministry has now put together "an extensive and far-reaching reform proposal" for the health service, which is being submitted to the Cabinet for approval. Here again, those most closely involved - doctors, nurses, other hospital staff, trade unions, and of course users, i.e. the general public - must be made aware of how the problems are to be tackled and why the solutions proposed are in the best national interest.