Pressure ‘to cut’ waiting lists

New EU rules allowing people to seek free medical assistance overseas would put pressure on the government to reduce hospital waiting lists, Malta Medical Association general secretary Martin Balzan said.

According to an EU directive, which must become part of Maltese law by October 2013, the government will pay for overseas treatment if certain criteria are met.

The health authorities will have to allow such treatment abroad when a patient is entitled to health care that cannot be provided within a time-limit that is medically justifiable, as could be the case with long waiting lists.

Figures released in Parliament last month showed there were about 13,502 pending operations at Mater Dei Hospital.

The longest list was for the removal of cataracts, with 4,752 surgeries waiting to be done. There were 1,748 cardiac interventions still to be carried out.

Dr Balzan explained that since the government would want to have control over its budget it would be in its interest to cut waiting lists to avoid paying for overseas treatment or face litigation similar to that concluded last week.

The appeal court has just confirmed a judgment handed down in November 2008 which ruled that the authorities’ refusal to cover a diabetic patient’s treatment abroad was in violation of EU law. The case was instituted in 2004 by Daniel James Cassar against the Chief Government Medical Officer and the Director of Social Services.

Mr Cassar had required surgery but the government refused his request for this to be done overseas on grounds that it did not form part of the publicly-funded health care services package. In the circumstances, he had to undergo a kidney transplant in Pisa at his own expense, spending over €74,000 on the operation. His mother was the kidney donor.

The court found that, had such surgery been possible in Malta, he would have had the same operation performed free of charge. So, being a person entitled to free medical treatment in Malta, Mr Cassar was entitled to the treatment he sought.

The court also ruled that the same applied if “the waiting time imposed on the person concerned exceeds the medically acceptable period in the particular case”.

A spokesman for the Health Ministry said the ministry had “taken note” of the judgment. She said Malta was working to bring into force the EU directive on cross-border health care. But this did not mean that anybody who decided to take treatment overseas would automatically be entitled to reimbursement from the government.

According to the EU directive, the health authorities would only be able to turn down a request for treatment abroad if the intervention, or the health care provider in question, is deemed to present a risk to the patient or if appropriate health care can be provided at home in good time. The directive leaves it up to each member state to define what is meant by a medically justifiable time, depending on a patient’s medical condition and particular circumstances.

According to the directive, while patients will have to fork out travel and accommodation costs, they will be eligible to a refund on the medical costs worked out on what the same operation would cost in Malta. If the cost of the operation abroad matches the tariffs established by the authorities locally, the patient would get a full reimbursement.

The Health Ministry spokesman said the government “has taken several steps to strengthen its administrative procedures” through the setting up of the Treatment Abroad Committee and had signed a memorandum of understanding with the Italian Ministry of Health in order to widen access to organ transplantation.

According to the committee’s website, it evaluates referrals on certain criteria that include whether the service can be provided locally and whether it forms part of Malta’s health care package.

The committee was criticised by the appeal court, which noted that the public was not aware of the treatments featured in the list of health care treatments that can be publicly funded.

The Labour Party spokesman for health, Marie Louise Coleiro Preca, said the judgment was “definitely good news” to people suffering from serious medical conditions and who hoped to find treatment elsewhere if not available in Malta.

“The government will have to make an immediate rethink of how it can cope financially with this new episode in Malta’s medical history... The government should have dealt with such possibilities before as it was shameful that Maltese people who could find hope of resolving their serious medical elsewhere for many years have been left completely on their own to manage, many a time, very difficult situations,” she said.