The pains of public health
We tend to concentrate on grumbling about the shortcomings, yet the truth is we have one of the best public health services in the world. And it is free for users, with the bill being borne by the taxpayer. Those of us who from time to time use the service and have sampled public health abroad know more than others how good ours is.
That allows for the fact that Malta's public health has two major weaknesses - frequent delays in emergency treatment and long waiting lists. A third weakness relates to the number of beds relative to demand, even though efforts have increased to limit the number of social cases housed at Mater Dei. It is almost unbelievable that the new hospital has fewer beds than the old St Luke's, given the huge footprint it takes up and the massive cost incurred to complete it.
These three weaknesses are never far away from public discussion, usually on the basis of clients' complaints but also in the political context, with dissatisfaction expressed on both sides of the House, particularly regarding waiting lists. Lately the broader public health service has been in the news because of how much it costs the taxpayer.
The public airing relates to total cost, but can be divided under two main headings - the cost of provision of free medicines, and running the public hospitals. More than one government has attempted to address the two issues. To date, none has succeeded, not least because politics and political considerations tend to take over. Nowadays contributions from non-political quarters are helping to give better shape to the discussion.
Such contributions are mostly against in any way limiting the "free" aspect of public health provision. With that factor being a political football it seems unlikely that it will be vigorously tackled. Yet tackled it must be, because the allocation of funds that can be made out of the government's budget is not unlimited.
John Dalli, the minister currently in charge of public health, has shown every intention of tackling both the issue of free medicines and of running costs. For starters he has requested extensive studies to see how much each service truly costs. It is important to have such finely-worked-out calculations in hand, if only to enable users to appreciate how much it takes to provide them with the services they get for free.
It is very likely that any proposals which Mr Dalli draws up will encounter multiple hurdles when it comes to implementation. The first hurdles will come from within his own party. Few activists and MPs will be brave enough to endorse the full thrust the minister is likely to put forward.
Those hurdles surmounted with suitable compromises, there will be the opposition hurdles to navigate. The opposition is unlikely to agree to any curtailment of the "free" nature of the public health services. Oppositions, whichever parties make them up, will generally oppose. On its part the Labour opposition is unlikely to forget the obstacles from the Nationalist side to the Labour government's suggestion that dispensation of "free" medicines should be made against a token payment.
Political manoeuvring aside, the public health service has to be addressed in the round after serious critical analysis, both in the name of fairness and in particular to ensure it remains sustainable.
A convincing case can be constructed not to make medicines for chronic illness subject to a means test. At the moment such medicines are free for all those who are certified as needing them. Nevertheless there is also a strong case for some realistic measure to be introduced to cut out waste by ensuring that those suffering from chronic illness only receive medicine they truly need and in the amount they really require.
Introducing a token payment for each prescription would be one deterrent against unnecessary or over-application for these medicines.
It is not simply financially correct to cut out waste. Fiscal fairness demands it too. There is also the little matter of the massive bill involved, and the fact that the government tends to fall unduly behind in paying those who supply it with medicines, putting them in a tight corner at times with repercussions on regularity of supply.
Use of hospital services also has to be reviewed. Talk of health insurance opens up more controversy. Everyone who works in Malta makes a 10 per cent contribution out of capped pay, matched by employers and the government. Part of that 30 per cent contribution should go towards financing the public health service.
Does it? And to what extent? There is no way of telling, a gap that should be rectified without further delay. Then there is the matter of private health insurance, and how this relates to insured people who utilise the public, rather than private, health service. The insured are a low percentage of the overall population and nothing must be done to negatively affect those who cannot buy private insurance. Yet something has to be done.
The political discussion should not stagnate on maintaining the status quo. The clash and contrast of the ideas put forward should serve to bring about the best remedial action moving forward.
Without a sensible solution, to be subjected to the reality trials of time, the problem will simply be passed on to the next government, which will find itself mired in fresh partisan arguments when it tries to tackle it in turn. Meanwhile, sustainability will exert increased pressure to take remedial action. Postponing correct and fair action will only make for a bigger problem tomorrow.
That allows for the fact that Malta's public health has two major weaknesses - frequent delays in emergency treatment and long waiting lists. A third weakness relates to the number of beds relative to demand, even though efforts have increased to limit the number of social cases housed at Mater Dei. It is almost unbelievable that the new hospital has fewer beds than the old St Luke's, given the huge footprint it takes up and the massive cost incurred to complete it.
These three weaknesses are never far away from public discussion, usually on the basis of clients' complaints but also in the political context, with dissatisfaction expressed on both sides of the House, particularly regarding waiting lists. Lately the broader public health service has been in the news because of how much it costs the taxpayer.
The public airing relates to total cost, but can be divided under two main headings - the cost of provision of free medicines, and running the public hospitals. More than one government has attempted to address the two issues. To date, none has succeeded, not least because politics and political considerations tend to take over. Nowadays contributions from non-political quarters are helping to give better shape to the discussion.
Such contributions are mostly against in any way limiting the "free" aspect of public health provision. With that factor being a political football it seems unlikely that it will be vigorously tackled. Yet tackled it must be, because the allocation of funds that can be made out of the government's budget is not unlimited.
John Dalli, the minister currently in charge of public health, has shown every intention of tackling both the issue of free medicines and of running costs. For starters he has requested extensive studies to see how much each service truly costs. It is important to have such finely-worked-out calculations in hand, if only to enable users to appreciate how much it takes to provide them with the services they get for free.
It is very likely that any proposals which Mr Dalli draws up will encounter multiple hurdles when it comes to implementation. The first hurdles will come from within his own party. Few activists and MPs will be brave enough to endorse the full thrust the minister is likely to put forward.
Those hurdles surmounted with suitable compromises, there will be the opposition hurdles to navigate. The opposition is unlikely to agree to any curtailment of the "free" nature of the public health services. Oppositions, whichever parties make them up, will generally oppose. On its part the Labour opposition is unlikely to forget the obstacles from the Nationalist side to the Labour government's suggestion that dispensation of "free" medicines should be made against a token payment.
Political manoeuvring aside, the public health service has to be addressed in the round after serious critical analysis, both in the name of fairness and in particular to ensure it remains sustainable.
A convincing case can be constructed not to make medicines for chronic illness subject to a means test. At the moment such medicines are free for all those who are certified as needing them. Nevertheless there is also a strong case for some realistic measure to be introduced to cut out waste by ensuring that those suffering from chronic illness only receive medicine they truly need and in the amount they really require.
Introducing a token payment for each prescription would be one deterrent against unnecessary or over-application for these medicines.
It is not simply financially correct to cut out waste. Fiscal fairness demands it too. There is also the little matter of the massive bill involved, and the fact that the government tends to fall unduly behind in paying those who supply it with medicines, putting them in a tight corner at times with repercussions on regularity of supply.
Use of hospital services also has to be reviewed. Talk of health insurance opens up more controversy. Everyone who works in Malta makes a 10 per cent contribution out of capped pay, matched by employers and the government. Part of that 30 per cent contribution should go towards financing the public health service.
Does it? And to what extent? There is no way of telling, a gap that should be rectified without further delay. Then there is the matter of private health insurance, and how this relates to insured people who utilise the public, rather than private, health service. The insured are a low percentage of the overall population and nothing must be done to negatively affect those who cannot buy private insurance. Yet something has to be done.
The political discussion should not stagnate on maintaining the status quo. The clash and contrast of the ideas put forward should serve to bring about the best remedial action moving forward.
Without a sensible solution, to be subjected to the reality trials of time, the problem will simply be passed on to the next government, which will find itself mired in fresh partisan arguments when it tries to tackle it in turn. Meanwhile, sustainability will exert increased pressure to take remedial action. Postponing correct and fair action will only make for a bigger problem tomorrow.
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