Although the degree of health expenditure is usually determined by the economic performance of the country making such expenditure, the impact the healthcare sector has on the economy must not be underestimated. As the nation continues to endure the economic burden of preventable illness and death, cost-effectiveness analysis has been introduced as a method of determining correct utilisation of financial resources in healthcare provision.
In his book You And Your Doctor (2006), Pierre Mallia opines that "It is not enough for governments to treat diseases successfully; they must strive to prevent them. Prevention is the speciality of the family doctor". Aggressive health promotion and prevention campaigns that keep people out of hospitals and prevent chronic illness (such as high blood pressure and diabetes) substantially reduce healthcare costs in the long-run. Prevention itself, is an expensive venture but it is indispensible considering today's aging population. The long-term cost savings through preventative care are imperative to maintaining the healthcare system, which will, over time, undoubtedly become more expensive to run.
Healthcare is a finite resource that must be distributed in the best manner to safeguard and promote the population's health. While it is the government that makes the value judgment on distribution of healthcare to its citizens, one cannot dismiss the fact that it is the tax payers' money that is ultimately spent. It is therefore in the patient's interest that adequate healthcare reform measures are introduced without delay. This is envisaged to take place through the enactment of subsidiary legislation under the Healthcare Act, as proposed in the in the consultation document Strengthening Primary Care Services; Implementation of a Personal Primary Healthcare System in Malta, which is expected to be re-issued in March.
Health IT and the creation of an electronic patient register would lead to a reduction in medical errors and treatment duplication, but it would also facilitate national health promotion and education campaigns, vaccination and screening programmes and chronic disease management through improved data compilation and analysis. Continuity of care must be strengthened through more integrated collaboration between all healthcare professionals. It is additionally just and equitable that patient representation groups have a voice in resource allocation and that the healthcare expert-teams are multi-disciplinary, bringing together different healthcare professionals, economists, statisticians and legal professionals.
Although healthcare is a finite resource, basic healthcare cannot and should not be rationed to such an extent that it is prohibitive and forces patients to seek private medical care. It is illogical for the tax payer to wait over two months for a 10-minute dermatologist appointment. It is irrational for a patient to have to wait so long for reparative knee surgery that knee replacement becomes necessary, thereby skyrocketing the cost of the surgery.
Waiting lists could very well be cut through greater consolidation of healthcare services and by granting doctors proper access to public laboratory and radiology investigations and individual patient records. The year 2009 saw an increase of 2,768 surgeries over 2008. However, statistics published last June reveal that 22,621 patients were still on the waiting list - with 10,000 patients waiting for orthopaedic surgery including knee and hip replacements. As recently as last month, a total of 5,735 people were awaiting a cataract operation.
Failure to properly implement adequate reform measures will not only negatively affect the Maltese patient but will, undoubtedly, impact the Maltese economy.
At present, our country is - to use the technical phrase - losing out on some serious cash. The medical tourism industry is said to be worth $60 billion, a niche which is largely benefitting countries like India, Singapore and Thailand. Many surgeons in these countries have undergone world-class training and several hospitals are accredited by international organisations, assuring overseas patients that their treatment will be of an internationally-recognised standard.
A decade of European Court of Justice rulings establishing the right of patients to access healthcare services in other member states (with the cost being borne by their own member state) has created a European healthcare market. Malta cannot hope to benefit from this until it steps up its efforts to provide more expedient care to its own citizens and reduces its domestic health inequalities.
The author is reading for a doctor of laws degree at the University of Malta, with a special interest in health law.
anthiazammit@gmail.com