Few people doubt that healthcare reform is one of the most daunting structural issues the country faces in the coming few years. An ageing population, insufficient investment in modern healthcare facilities, lack of effective healthcare management, shortage of qualified care professionals and a flawed financing model are some of the issues that need to be addressed with urgency if the country’s ‘free’ health model is to survive.
Some tactical moves are being made to address these major challenges but many users of the public healthcare service argue that policymakers are just nibbling around the much-needed reform priorities. The latest initiative is the decision by Health Parliamentary Secretary Chris Fearne to give local councils “clearance to run a health clinic for the community”.
The Żurrieq council will be the first to experiment with this concept and the parliamentary secretary says he believes in this project because a health centre run by a local council “is in the centre of the community”.
There is no doubt that “a lot of diseases, especially chronic ones, can be prevented through a healthier lifestyle”. This reality needs to be addressed with determination. But what many healthcare professionals are asking is whether local councils have the management experience to run health clinics.
Even if they had to be allocated the funds and the qualified people needed to run the existing 54 health clinics effectively, one needs to ask whether resources are being fragmented when economies of scale would justify better equipped but fewer health centres that serve more than one town or village.
Mr Fearne insists that “we are strengthening our services in hospital and also bringing them close to the community”. This is what really needs to be scrutinised. What plans are being made to deal with age-related health issues like dementia, loss of ability to live independently because of old age morbidity and the financing requirements that need to underpin a sustainable healthcare strategy?
It is almost tragic that, so far, there has not been a bipartisan approach to strengthening health services in a meaningful way.
It is all well and good to offer “one-to-one sessions dealing with health promotion and education” in health centres run by local councils. But this project could be a tactical red herring if it is not part of a comprehensive strategy aimed at making the country’s free health system financially and socially viable in the long term.
Both main political parties repeat the mantra that government healthcare will always remain free. This is increasingly becoming a political delusion that, in the long term, will shortchange the users of the public health system. We already face a situation where we do not have enough hospital beds to deal with patients needing hospital treatment. Similarly, we have a situation where public care homes for the elderly cannot take on many more residents.
The rationing of medical services is a reality that needs to be addressed as urgently as humanly possible.
Improvement in hospital management and strengthening of primary care services are important tactics that are being addressed. However, on their own they will not eliminate the structural weaknesses that exist in the national health system. We can continue to kick the can down the road hoping that someone in future will have the courage to bite the bullet.
But nibbling around the edges of healthcare reform is not the stuff that good leadership is made of.