Updated: Health care reform launched: Patient registration scheme among key features
A registration system for patients with a family doctor is at the core of the much-awaited reform in primary health care, which was launched this morning and opened for consultation.
The reform revolves around the registration system with family doctors who will be their first point of contact for all their patients' medical needs.
A reform report announced by Social Policy Minister John Dalli points out that one of the problems in the current healthcare system is fragmentation and lack of continuity in patient care and says it should be a priority to create seamless and coordinated quality care services to ensure synergy between different services.
Patients will be free to choose their chosen care provider. With the patient's consent, the doctor will be able to access the patient's records, public laboratory and radiology investigations, prescribe from a pre-determined schedule of formulary medicines and refer the patient to out-patient appointments and day-care procedures.
While the patients will not have to pay for a registration fee, they will continue to pay the private doctor's fee. However, there will be a means-tested mechanism to identify those who cannot pay, and for whom the government will pay a fee.
Moreover, people with chronic diseases will be able to see their family doctor for follow-up care and repeat prescriptions, which will be subsidised through a reimbursement system.
Although the emphasis will be on the relationship between the patient and the family doctor, health centres will remain and they will be developed into hubs for primary and secondary care interventions at regional levels.
There will be three or four health centres in Malta and another in Gozo which will serve as a one-stop shop for community care and for specialised care for certain prevalent diseases and conditions.
They will also be equipped to treat minor but urgent conditions which might not be easily treated by the family doctors.
These regional centres will continue to see urgent cases who have not been referred by their GP, but non-urgent patient who go to hospital's emergency department without being referred may be sent back to either the regional centre or their doctor.
This is expected to relieve the pressure on the hospital Casualty Department, slashing the currently long waiting time and allowing patients to be better served within the community.
Moreover, clusters of district health clinics (bereg) will provide specific services and support to hospitals, family doctors and the community as a whole. While government family doctors can still continue to do private practice, they will not be able to enrol into the registration system.
Mr Dalli said the reform would enable Mater Dei Hospital to perform its proper function as a tertiary acute care hospital. The reform would relief Mater Dei Hospital from a lot of work which did not need to be done there.
Mr Dalli said the government would help the doctors set up the IT systems necessary to access records and would also be promoting group practices.
The consultation process will include a rage of meetings with workers and other operators as well as doctors and patients.
Parliamentary secretary Joe Cassar said a call centre with the number 188 had been set up for people to ask question or offer suggestions.
The consultation document is to be made available on sahha.gov.mt
31 Comments
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Edward Zammit
Dec 6th 2009, 12:24
@d.attard
The idea of young doctors supervised by older doctors is already in place, at tends to be least on paper. Supervision tends to be erratic and in some places non-existent, depending on the goodwill of the supervisors (who are paid anyway). Young doctors are often used as ''polyfillers'' and are often exploited. Btw. most young GPs are far better trained than certain older ''more experienced'' GPs. Better trained and in many cases, more dedicated, caring and hard-working.
Older does not necessarily mean better or more experienced.
Edward Zammit
Dec 6th 2009, 12:03
@Gerard Cassar
I am perfectly familiar with the primary healthcare system in Malta, both private and public, including the one at St.James, since I work in most of them (il-familja trid :) ). I understand your concern and I am not saying that you are wrong. The patient should be given acceptable choices. Unfortunately, most pharmacies offer small claustrophobic sub-standard clinics, with minimal facilities. A good clinic means huge expenses, so can't blame them.
I was referring to the UK system, when I mentioned that it is easier to change country. Our system is much more flexible, and hopefully will retain a good measure of flexibility, even after the reform. The patient deserves an excellent, affordable service while being allowed to choose.
As J.Debono said, registration will cause alot of problems, even if its done in good faith.
C Attard
Dec 6th 2009, 11:29
i AGREE WITH SUCH A SYTEM BEING PROPOSED. sOME PEOPLE ARE ABUSING THE SYSTEM. gETTING MEDICINES THEY don't really need. ther go to a health centre to measure their blood pressure or sugar 7 times a week and then eat and do whaterever they want. Some even go and as for a sick note without even knowing with what they are sick! just becuase they want to take a day off. Education should be the main focus so that this system will succed.
d.attard
Dec 6th 2009, 09:34
@Jason Debono,
the idea of having young doctors in a pool is to increase the capacity of the pool to visit all patients when asked to do so without shooting-up costs. young doctors may only stay in said pool for a limited amount of time before they move onto a better pool given their new-found experience. In this way, the experienced doctor can feel safe that his client-base will not be eroded.
An established doctor should not be too pre-occupied with loosing patrons even if most of these young ones, like in any other profession, would be go-getters.
Any visit would be as part of the pool and any info from said visit would go into whatever central informal system exsists as the established doctor would still be the doctor of said patient. If a serious situation arises from said visit, the young doctor would still be able to contact the regular family doctor for endorsement of action.
It appears that something similar is being applied at emergency when young doctors seem to work under some kind of central supervision presumambly done by other more experienced practitioners.
david jenkins
Dec 6th 2009, 08:18
"doctor will be able to access the patient's records,"!! How? when the records are still on paper? who is going to input all the hardcopy material onto the system for the doctor to access??
A. M Bartolo
Dec 6th 2009, 06:45
What shall we do in case of an emergency during Saturday & Sunday afternoons and public holidays ? In case of emergency case . Or if the doctor keeps on giving you ;
different types of medicines < for a very long time > and nothing helps out . And he won't 'refer you to hospital ?
I do not think that this is a good situation . You must open the public clinics day and night , in every town , village when the gp's are not available . We do not find the doctors neither on Wednesday mornings as they are off .
G Cassar
Dec 5th 2009, 21:02
In Gozo this system cannot be implemented as there is only two doctors who works solely as a private GP. All others work full time with the Gozo Ministry. Is all Gozo going to be registerd with these doctors? This is absurd.
Gerard Cassar
Dec 5th 2009, 20:44
Mr Zammit. In Malta people are used to see patients in a special part of a pharmacy. Going to a clinic one is charged for example Euros3.50 just to see a doctor (Ex. St. Mark), others charge more, for example if one where to go and see a doctor at St. James Clinic or Hospital, though most doctors serving there are specialists.
There are even others that have their office at home, so why make it compulsary for a doctor to be seen in a clinic. Pharmacies are in the neighbourhood clinics are not.
According to Mr Zammit, it will be easier to change country than to change doctor.
Then freedom of choice does not exist in matters of life an death.
Edward Zammit
Dec 5th 2009, 19:25
If its any consolation, even we GPs know very little about what is going to happen. The reform will take years to materialise and will encounter resistance from many sources. Financing state-owned clinics from our pockets will bankrupt us and it will have to be offset by impossibly high wages.
@M. Debono
My apologies for my phrasing. I did not want to belittle your understanding of the issue. The idea of registering with a GP or, better a Group practice, is to allow follow-up, and a better doctor to patient relationship. If you are not satisfied with your GP or GPs, you can appeal the decision (at least in theory). Btw. I am not taking sides. I agree with you that it is still vague and I hope for our sakes and the patient's sake, that it is for the better.
J. Debono
Dec 5th 2009, 19:07
@ d.attard
What you are suggesting is called a group practice.
It is a very good idea, that most doctors, given the right conditions and incentives, would be happy to work in.
However, well established doctors, are not going to hand over their hard earned clientele, to what you call 'rookie doctors'.
And unfortunately, this reform, does not give any incentives to doctors, to work in a group practice, though it has a whole chapter on group practice.
And there's the final problem - mentality of Maltese people!
Maltese people like to shop around regarding GPs, and many people love to have a second opinion. I am neither in favour nor against this - it is a fact, and this reform has an uphill struggle, when it suggested registration.
Ultimately the solution lies, not in registration, but as d.attard said, in group practices, and people registrating with a group practice, not one GP.
It would be wise for the government to try and find a way to increase group practices.
d.attard
Dec 5th 2009, 18:37
may i suggest that the proposal is fundamentally flawed. There are instances when it takes days to make contact with my doctor. moreover doctors need their own free time and time to travel. patient, on the other hand, often (not always) needs a doctor hey presto.
could the authorities perhaps investigae the possibility of having a pool of doctors that would include one's own doctor, to ensure that home-doctor service is available all the time. This pool may include a couple of rookie doctors who would work under the overall experience of the pool. I would expect doctor to guard their client-base jealously, yet a balance must be found.
M. Debono
Dec 5th 2009, 18:37
@ Edaward Zammit
I have read the document before I commented,
and basically the reform is the status quo, but with the difference that now you have to register with a GP, instead of just going to a GP.
As I said, this is NOT a reform, but a consolidation of the status quo.
@ Edward Zammit
Can you tell me one incentive in the reform, for GPs to work as a group practice??
Who's going to pay for the clinics?? The GPs? If yes, I think they would prefer to see people in a pharmacy, then spending thousands of Euros, to basically give the same service.
Edward Zammit
Dec 5th 2009, 18:17
My apologies. ''No, a specialist from another field cannot be selected by a GP.'' should read ''No, a specialist from another field cannot be selected as a GP.''
Thanks and sorry.
Carmel Saliba
Dec 5th 2009, 18:06
Who will be responsible in running this service in Gozo - The Health Division or the Gozo Ministry?
Edward Zammit
Dec 5th 2009, 17:47
Please read the document before commenting. Having said that details are still sketchy, but the main ideas are that: public healthcare will still remain free of charge, but you can opt for a private GP whenever you want; GPs will be encouraged to work in group practices, so at least one of them will be available whenever the patient requires assistance. They will use clinics, not pharmacies. In the UK, if you want you can change your doctor, but it would be easier to change your country.
@Gerard Cassar
Just to correct some misconceptions, most GPs are now Specialists. Soon ALL GPs will be Specialists. In addition, it does not make sense to select a specialist from another field as a GP, as he is not trained as a GP. So, in answer to your question: No, a specialist from another field cannot be selected by a GP. However, you can choose any Specialist GP you like.
@Gerard
J. Cardona
Dec 5th 2009, 17:39
Is anyone thinking about continuation of treatment within the community, rather than criticizing the document, with usual pessimist comments?!
J.Tonna
Dec 5th 2009, 17:39
One should thank all those who are submitting 'constructive' criticism, which I understand will be heeded by those promoting this new scheme.
As for those submitting 'destructive' criticism all one has to do is to hit the delete button.
V Battistino
Dec 5th 2009, 15:58
As usual...so many experts giving their opinion on a simple sketchy newspaper coverage of a press conference...just take your time to go through the document, understand it well and then comment.....it has taken experts months and hours of negotiations....and anyone dares to comment within hours that this is launched.....some people are really impossible !
As for John Dalli becoming Commissioner......well, as if these reforms are borne, bred and pesented by one person....it is a team effort and the politician is just the instigator....
M. Debono
Dec 5th 2009, 15:56
@ D. Xerri
When EFA promised doctor of your choice, it was meant to be free.
We already have the doctor of out choice, we pay but we can go to any GP we want to go.
What Dalli is trying to do is 'force' us to go to the same GP - as we are now 'registered' with this GP! What a reform!!
Dear Minister Thanks but no thanks.
Let me give you an idea. Why don't we do the registration like it is done in the U.K., Italy, Ireland etc. :-
We register with a GP, You pay the GP for every patient registered with him, and we don't pay the GP. From where to get the money? - Close Health Centres, and channel the same money to the private GPs.
M. Debono
Dec 5th 2009, 15:17
If I am understanding correctly
1. We can choose any private doctor where we can register ourselves and we are still going to pay if we go to a private GP
2. Health Centres will still remain open - therefore we can still go to a health centre
3. Bereg will still remain open
4. For a referral to MDH we still need a paper from our GP
Emmm. Is this called a reform??
What exactly is going to change?? except for the registration scheme??
Does it mean that if I want to change my GP, I cannot do so because I am already registered??
The train is moving at last, backwards, but at least moving!!
Gerard Cassar
Dec 5th 2009, 14:53
And those who don't have a family doctor will they be compelled to chose. There are surely a number of families who don't have a family doctor. They just go to the first that comes to their mind, and don't mind to pay what he asks.Shall we now be compelled to always contact the same doctor even if he does not appear to be efficient enough. We shall now chose one once and for all. Is it so?
Notwithstanding everything there should always be a substiute because what we are going to call family doctor will not be able to see all those who need him, and besides he has his own days off, such as Saturdays, Sundays, feast days. Shall it be valid to have a selection of family doctors not just one.
Could a specialist be selected as a family doctor.
Specialists with their exhorbitant fees 60 Euros per visit will surely not be chosen as a family doctor but others more moderate could be opted by a family Is this allowed?
Will family doctors continue to see their patients in a pharmacy .
Will people be allowed to attend at any doctor at whatever pharmacy they like.
Sergio Galea Vincenti
Dec 5th 2009, 14:30
Erm.... Can someone provide a direct link to the report as the sahha.gov.mt does not seem to be updated!
Ray Buhagiar
Dec 5th 2009, 14:00
This reform requires an efficient IT Network and excellent communication. In the end it does require a mentality change. Malta is the only country in Europe where if one suffers from backpain will consult a neurosurgeon. Will this be allowed in the Health Reform?
D. Xerri
Dec 5th 2009, 13:36
If You all remember well way back in the 90`s we were promised by Dr E.Fenech Adami - It-Tabib tal-ghazla tieghek ! So I assume its 20 years late maybe Imma Nsomma - U Iva 10 Miljuni l`hemm u 20 sena l-ghawn kif diga smajna hux under GonziPN Kollox Possibbli mid-dehra minbarra dak li suppost isir jew diga suppost sar. And Mr g. c. Forte you are sure Mr Dalli will handle this one good - Dont You know Mr Dalli will be NO LONGER handling the Health Dept and is going to take the place of Mr Joe Borg ? We dont even know WHO will be the new Minister of Health ahseb u ara kemm Mr Dalli will handle this one good ! Im beginning to truly beleive the current government`s medicine of alienation of this nation is working perfectly well !
g.c.Forte
Dec 5th 2009, 12:17
I do not like to be naive,but I wish to ask. A. Everybody even those on social benefits,has to have a family doctor, when we all know that " certain doctors "wants to be rich in one year. I am sure that they cannot afford to have and pay a Dr., when considering that even for a simple medical certificate, they charge you 5 to 8 euros. I am not generating here, because you find Doctors who have a heart. (luckily we have lot of them ). B. There are cases that the doctor and the patient create a family friendship, and there were the abuses starts, because the Dr. approve any kind of medicine, even that the patient does not need them, but he brings the medicine for a friend. Anyway,I agree that a reform should be introduce,and I am sure that Minister Dalli will handle this one good.
John Camilleri
Dec 5th 2009, 12:02
If some Health Centre's doctors would not go to sleep during their night duty and nurses extend their roles in the health centre we would see an improvement in the health care system. We could give short courses to these nurses how for example apply a plaster to a patient so that he is not sent to Mater Dei for review of x rays and plaster.
Joseph Abdilla
Dec 5th 2009, 11:58
Let me see if I understood this right - we will not pay for the doctor registration, but we will pay our doctor, like we do now?
I assume service at the health centres will remain free, right? Will health centre doctors also call at home if required
Peter Murray
Dec 5th 2009, 11:56
Couple of issues not clear.One being is that whereas a patient is free to choose their care provider is a Doctor unilaterally compelled to accept a patient and further must he/she continue to include said patient on their enrolment list sine die?
Also Mr.Dalli stated" the reform would enable to relieve Mater Dei from a lot of work which does not need be done there".Does this include the issuing of invoices for discharged patients or is that considered essential,or perhaps issued elsewhere by another department?
V. Zahra
Dec 5th 2009, 11:50
What happens when a doctor has too many registered patients? And will the doctor be obliged to see patients round the clock?
Will the pharmacy of your choice scheme be extended in parallel?
j.f.Vella
Dec 5th 2009, 11:47
Let's hope the reform works, it is sorely needed. We also need more doctors in health centres. People will stop going to Casualty at Master Dei if they are well served by their family doctors or at health centres.
M Mifsud
Dec 5th 2009, 11:40
Jekk nigbdu habel wiehed naslu. Tajjeb wiehed jaghti suggerimenti imma irridu nevitaw tfixkil bla bzonn, wara kollox, hemm sahhitna u sahhet uliedna fin-nofs. L-Oppozizzjoni ghanda taghti sehem shih f'dan il-process. Hemm probabilita' li tkun hi qeghda tmexxi l-pajjiz meta s-sistema shiha tidhol fis-sehh.