Strategy proposes fee for vaccine services

Parents would have to start paying for their children to be vaccinated if a proposed strategy for a patient registration system were to be approved.

Although the strategy, officially kept under wraps, does not make it clear whether the jabs themselves would have to be bought, patients would have to pay for the vaccination service, now given free at health centres.

The report, which proposes stopping the current health centre doctor service, was published by Labour Leader Joseph Muscat last night even if he had referred it to during a TV show on Monday.

The document says that all the population "would be obliged to receive and pay for their vaccines" from their registered care provider but adds that eligibility for free vaccination would be determined by the national entitlement policy.

"While in the future health centres may continue to provide an important vaccination service, especially for travellers abroad and other cohorts of the population, it is envisaged that most mandatory and voluntary vaccines would be administered by the registered family doctor," the report, drafted by the Patient Registration Task Force, says.

During Monday's TV show, Dr Muscat challenged Prime Minister Lawrence Gonzi to deny plans to charge for healthcare. Although Dr Gonzi was quick to deny any intention to introduce payment for healthcare services, the report speaks of "a departure from the concept of totally 'free' medical primary health care to one which is means tested".

Speaking in Parliament last night, Social Policy Minister John Dalli said healthcare practices had to change in order for the sector to remain sustainable. He said that nobody could define the term "free" and, yet, the demand for free health services continue to grow daily.

Addressing a press conference marking the third week of the MEPs election campaign, Dr Gonzi said yesterday the report was about proposals for primary health care reform.

"It is a report that seeks to provide family doctors with better facilities to do their jobs better such as giving them the possibility of accessing patients' records through a modern IT system. One of the recommendations in the report was to close health centres and concentrate on family doctors. The government disagreed with this advice," Dr Gonzi said when asked whether the government had discarded the report.

He said the government was having talks with family doctors on the matter. He insisted the opposition should not seek to politicise the health sector for political ends.

But during a debate in Żabbar last night, Dr Muscat said the report showed a clear departure from the promises made by the Prime Minister to keep healthcare free, which led him to win the general election last year.

Free healthcare, in fact, was a hot issue during the general election campaign, with Dr Gonzi saying that health services would be free as long as he remained Prime Minister. He had been faced with a similar report by then Opposition Leader Alfred Sant.

Dr Muscat insisted that this latest report was discussed at very high levels, including Cabinet.

Questions sent to the Social Policy Ministry on Monday remained unanswered.

The report looks in depth at a patient registration system, which will make family doctors the "primary gatekeepers" for access to healthcare services, except in emergencies.

Although no fee is incurred to register with a general practitioner, patients will have to see a private doctor, at a fee which remains unregulated by the government, since the free health centre doctor service will no longer be available. Means testing will determine who is exempt from the fee, which would in turn be paid by the authorities.

"The current strategy does away with the expectation that the state needs to directly provide a family doctor service and instead creates the current environment and conditions for the already well established private primary care sector to consolidate itself and thrive."

The report says the government would start discussions with the insurance sector with the aim of mainstreaming insurance medical coverage for the general population.

"This is especially relevant to provide insurance cover for basic primary healthcare and for out of hours urgent care," it says, adding that this would be supplementary and additional to the statutory insurance/tax system.

The strategy says that family doctors operating within this system would have direct access to patient medical records and government laboratory and radiological investigations and can even make direct bookings for outpatient appointments.

Health centres would evolve into four regional hubs in Mosta, Żejtun, San Ġwann and Żebbuġ, which would provide specific specialised services and support to hospitals and registered family doctors. However, the first point of call for patients needing urgent care would be the family doctor, who would have to provide around-the-clock coverage.

The report underlines that patients would only be referred to the four "medical centres" or hospital's Emergency Department if the family doctors cannot give the care themselves.

Moreover, patients who are found not to need hospital treatment would be referred back to the medical centre or their family doctor.

Referring to health centres, the report says these would serve as "regional centres of excellence" and fitted with the needed equipment to carry out "certain investigations and specific day care interventions". This would only require "a handful" of the currently employed health centre doctors with the others who do not opt for private practice being deployed elsewhere.