An excellent health service

I was worried recently by a comment made en passant that health services are deteriorating. I was annoyed especially that the declaration was made in a sort of axiomatic way, therefore needing no proof or justification. In fact, nothing is so far from the truth. The service has been improving over the years and is still doing so. The sheer truth is that despite the increase in existing services as well as in totally new ones, in quantity as well as in quantity, supply is falling behind demand. This is not a local happening only. It is due to various reasons which we will look at later. This is why I have put it more than once on record that we have to watch out unless we want our health system to become unsustainable.

Our health system is well, thriving and still advancing, despite growing pains. Not because it is certified by the World Health Organisation, placing the system fifth in the world overall and second as far as efficiency goes. Neither because we have been placed 13th in a list comprising the EU 25 and Switzerland, a report which, in spite of using parameters different to those used by WHO, praised our health system for its generosity though found patient empowerment wanting. Nor because numerous Maltese and, especially, foreigners take the trouble to write praising the service they receive at St Luke's Hospital and comparing it favourably with the service they receive at home. In fact, most of our detractors think otherwise once they make use of our hospital. I propose to back the above statement by hard facts, even at the expense of somewhat boring readers with figures.

The priority given to health by the Maltese people is witnessed by the fact that we spend 9.6 per cent of our GDP on health, surpassed only by Germany and France at 10.9 per cent and 9.7 per cent respectively in the EU. The lowest figure is 5.1 per cent. Recurrent health expenditure has increased from Lm45.7 million in 1995 to a budgeted Lm101million in 2006. Government expenditure on medicines has gone up from Lm6 million in 1995 to Lm20 million this year. One may well ask if this increase is justified by health outcomes. Is the system riddled with wastages?

The thousands who have been given a new lease of life are our main witnesses of the vindication of our investment in our people's health.

Anecdotal evidence has it that there is wastage in our system of free medicines. Though we should work harder to stamp out all waste, pilfering and access to free services by those who do not deserve them, deeper verification proves that there is no rampant wastage. In fact, the steepest increase in our medicines bill is due to disposables related to ever more sophisticated operations performed in our hospitals. The increase is also attributed to the high inflation in pharmaceuticals especially innovator drugs, throughout the whole world.

We are sure that other problems particular to our local situation will be overcome in the coming days. But those who affirm that the solution to health sustainability lies in merely cutting on waste are kidding themselves or pulling wool over our eyes. In fact, as has already been pointed out above, the WHO classified us second for financial efficiency. It's heartening in this respect that the Labour opposition is now playing down this tune and are admitting that there is a real threat to health sustainability.

Where is all this money going? Operations have risen from 22,000 in 1995 to 29,000 in 2005. Rather than be impressed by the 30 per cent increase, were one to delve deeper one would rather be electrified by the range of new and ever more sophisticated interventions that has not only added years to life but added life to years.Concurrently laboratory tests increased by 65 per cent between 2000 and 2004. CT scanner tests have shot up by 95 per cent. MRI tests have grown from scratch to 5,350 in 2005.

This advance is not restricted to cardiology, neurology and orthopaedics only. A spectacular improvement can be witnessed in most disciplines. Many conditions which were not previously treated became curable and, hence, the increase in expectations and demand.

Our very success has created new challenges. Hence, our waiting lists which we will partly overcome thanks to the enhanced capacity and improved quality of equipment provided with the opening of the new hospital as well as the planned rationalisation of our health delivery services institutions. As an example, the new CT scanner intended for Mater Dei Hospital but already being used in St Luke's has quickened the speed of a test from 30 minutes to three minutes per test.

It is also being said that our health system is facing a crisis due to a rampant brain drain. It is true that we have a problem with retaining junior doctors. It is claimed that this is due to the poor conditions doctors are being offered. On the other hand our young doctors have always gone abroad, mainly to the UK, to specialise.

Several have advanced so much that they made us proud in many hospitals abroad. Many returned and took up senior posts at our hospitals. In fact, the high level of our health outcomes is attributed largely to our consultants who have returned enriched by their specialisation and experience abroad.

We have increased the number of consultants from 74 in 1995 to 135 today. But the numbers cannot go on expanding. In almost all disciplines we are on a par with recommended ratios in the EU. Junior doctors know that their career prospects are limited in Malta and that is why they are taking training posts abroad.

But one may justifiably ask what has caused this shortfall between the spiralling demand and finite supply. The number one factor is the demographic shift and today I limit myself to this factor.

Life expectancy at birth has increased from 67.5 years for males and 77 years for females in 1967 to 77 years and 81 years respectively today. At the age of 60 years life expectancy in 2003 was 22.89 years for women and 19.74 years for men. This is among the highest in Europe. This improvement is causing a double strain on our resources, which we will face gladly but responsibly.

Not only Maltese society has to provide long-term care for an ever-increasing number of elderly but it is well documented that the elderly make use of health services far more than the young and the middle aged. On average, Lm800 are spent annually on every 80 year old against Lm100 on every 40 year old at St Luke's Hospital. In fact, we have long waiting lists mostly in the case of degenerative diseases associated with old age.

This is the main challenge for the foreseeable future, a challenge which we must overcome in the interests of our senior citizens to whom we owe so much.

Dr Deguara is Minister of Health.