Deguara defends cost of new hospital

Health Minister Louis Deguara yesterday defended the cost of the new hospital, saying that at Lm200 million the bill was reasonable and not far from estimates made by the Labour government, when everything was considered.

Dr Deguara was concluding the debate in parliament on the financial estimates of the Ministry of Health.

He said that the government's policy was to ensure that health services were sustainable and that there was solidarity and subsidiarity. The budget had included difficult decisions with this aim in mind.

Much progress had been made in the provision of health services worldwide, but there was a cost. People were living longer and pressure on health services, and their sustainability, was rising.

Services given from Maltese hospitals in 2002 at a cost of Lm85 per bed totalled Lm20 million last year. In all, hospital services, including operations, cost Lm41 million. Yet investment was continuing, such as the recent commissioning of new MRI equipment.

But one needed to be cost-effective and the people should be asked to help set priorities and be selective. Was it social justice that persons with depression received no free medicines while those with a yellow card took whatever medicines they needed, whatever their income? Was it right that diabetics, who were holders of the pink card, were also eligible for the handyman service? Clearly there was a need for change for a fairer system to be introduced.

The Maltese government had been speaking of the healthcare problems since 1995 and had been taking measures to reduce costs. It was no surprise that some people opposed change which instilled greater accountability. In the medical stores, after a computerised system was introduced, the number of items issued fell by 18 per cent.

As from next month a new computerised system would be introduced gradually in St Luke's Hospital whereby every item that was ordered was audited and accounted for until its use.

With regard to health centres, it was worth pointing out that in 1997, according to a study commissioned by the Labour government, only seven per cent of the work done by health centres was carried out at night.

The report recommended a redistribution of doctors to reflect the workload and an evaluation of the cost-effectiveness of keeping health centres open at night. The report even mentioned the centres which could close at night. The then government had not had the courage to take the decisions which needed to be taken. This, however, was what the present government was doing, so that more manpower and resources would be made available to patients when they were really needed.

Dr Deguara said the decision to build a new hospital was a courageous one that was needed because facilities at St Luke's could not be developed much further. A report commissioned by the Labour government in 1998 had assumed the cost of the new hospital would be Lm100 million, excluding medical equipment, IT and furniture. The final cost would not have been far from the Lm200 million figure being given by the present government for a better-equipped complex. Replying to a comment by Dr Farrugia, Dr Deguara said any cases of bad workmanship at the new hospital had to be rectified by the contractors at their own cost, as laid down by the contract.

Dr Deguara said the delays in the granting of the contract for medical equipment had put back the opening of the new hospital by two years, and two other major contracts, for IT and for furniture, still had to be awarded, and however the tenders were processed, they would still be contested.

Referring to criticism over the opening of new pharmacies, Dr Deguara said there were 300 pharmacists who were pleading with the government for the opening of new pharmacies.

As for the fact that the system for the free distribution of medicines through pharmacies had not been introduced, Dr Deguara said the government was going to be billed Lm5 per patient per month or Lm2 per prescription, something which was unacceptable.

Near the end of his speech Dr Deguara said both the government and the opposition should work together for the benefit of the people. Nationalist and Labour governments had together built the health service and they should work together to continue to improve it and ensure its sustainability. The government remained committed that the changes it intended to bring about would be introduced after talks with all concerned.

Earlier in the debate, Mario Galea (PN) said the health service was undergoing a restructuring aimed at ensuring that maximum use was made of its limited resources.

PN governments had always been generous in the provision of health services. In 1997, when Labour left office, syringes were still boiled at hospital. Now facilities were second to none. The infant mortality rate, one of the yardsticks of health service quality, was the lowest in Malta, compared to EU accession countries.

Costs had spiralled, but there was a lot to show for this spending. Expenditure on free medicines had risen from Lm6 million in 1996 to Lm19 million this year. So was it wrong not to give free Panadols to people who declared an income of Lm15,000? And did this country need a general hospital and eight health centres opening round the clock? He did not think so.

The opposition, while criticising the government, was not saying what its plans were and how it could ensure the sustainability of the health service.

Nationalist MP Michael Gonzi said the government wanted to ensure that the country would be able to keep up with progress in the health sector well into the future. There were diseases for which there was currently no cure but for which there could be a cure in a few years' time. The country had to be ready for reforms, especially when it depended on human resources for its income.

Through reforms, he said, a balance had to be sought between equity, quality and efficiency for effectiveness to be retained.

Dr Gonzi paid tribute to the work of the Health Promotion Unit, saying its effectiveness could be seen by the fact that food-borne diseases were now more common in homes than catering establishments.

Statistics, he said, reflected the high standard of medical care in Malta. While the incidence of certain diseases in Malta, such as lung cancer, was lower than the European average, the incidence of other forms of cancer, such as breast cancer, was higher. The mortality rate of bypass heart surgery in Malta was 0.65 per cent, comparing well to that of 2.3 per cent in Italy.

The incidence rate of tuberculosis among the Maltese population was among the lowest in a global perspective. But there was an association between the disease and HIV, and one had to be careful because people in whose countries this disease was endemic were visiting Malta more frequently.

The government's challenge, he said, was to guarantee this quality of life to future generations. People were now living longer and as a result all countries were reforming their health systems, and Malta could not be an exception. It had to reduce waste and increase efficiency.

Turning to the provision of free medicines, Dr Gonzi pointed out that changes would come about only after talks with interested parties. There was no doubt that one could not be means tested before receiving medicines for major diseases such as leukemia, for which medicines were extremely costly. But it certainly did not make sense for one to get free medicines which were not directly linked to the chronic illness one was suffering from.

Although taxes were being paid for the health service, the cost of most services was higher than the taxes one paid. The disposables required for an angiogram, for example, cost Lm600 and 18 angiograms a day were carried out. Many services could not be paid by individuals, and this was where the concept of solidarity came in.