'Continuity of care' at core of health care reform

Malta’s sexual health policy will be published soon but the government needs to ensure there is the proper infrastructure for its implementation, the Parliamentary Secretary for Health, Joseph Cassar said.

Dr Cassar, who was being interviewed by di-ve.com editor Vanessa MacDonald, spoke about the reform in primary health care, saying such a reform was imperative especially for continuity of care and the building of a relationship between doctor and patient.

He explained that most people had their private family doctor and those who could not afford to pay used health centres. But the biggest flaw of health centres was that they did not offer continuity of care. This did not solely revolve around access to records but also on the relationship between doctors and patients.

As part of the reform, people who have financial difficulties will be subsided to also have a private family doctor, Dr Cassar said.

Health centre walk-ins would remain free of charge, he said, but they were not the preferable health care system because of the lack of continuity of care.

Dr Cassar said that general practitioners did not want to be government employees and with the 70 doctors currently working in health centres, it was not humanely possible to have the whole population registered with them.

This system was shot down in the 1987 -1992 legislature and it would have been ridiculous to go into it again.

Dr Cassar admitted that any change brought with it a degree of anxiety but said that if primary health care was not reformed there would be big problems within a few decades caused by poor lifestyles. Such problems would include obesity and diabetes.

The Labour Party’s main spokesman on health, Michael Farrugia, said that one of the mistakes over the years was that while Mater Dei was being built, health centres were not improved but allowed to deteriorate.

He asked what options there would be for people who preferred to go to health centres instead of having their own GP.

Dr Farrugia accused the government of introducing a system whereby people would have to go to a GP and pay for the service.

Dr Cassar pointed out that district health offices would remain free and would continue to offer certain services, such as blood pressure monitoring.

The government, he said, was embarking on a project that would make it easier for very expensive drugs to be given to patients free of charge.

He said that the government was considering new ways to define those should be entitled to certain medicine.

It was working to optimise Schedule Five, which was a list of chronic disease for which free medicine was given to patients. There was also a need for a good means testing system for people under a certain income threshold.

He said, when asked, that a medical consultation at health centres during the day cost the state €5 to €6, at night €20 to €36.