The new Mater Dei Hospital CEO was spot on in stating: “It is difficult to say how long we can sustain free healthcare. It all depends how long government finances can carry it, and as time passes it’s going to become more expensive. The sooner we start to address the situation the better.”
By noon on the Sunday those comments were published, any internal political party discussion to change the status quo had already been prejudiced. The opposition leader stated that healthcare would always remain free under a Labour government and in no time the Prime Minister rebutted that health services would remain free for everyone.
The Labour opposition had already lambasted outgoing Central Bank governor Michael Bonello when he advocated means testing last November: “The priority of the welfare state should be to provide equal opportunities for all, but a safety net only for those who need it most. Universality – dispensing free goods and services to all irrespective of income – is a wasteful and unaffordable principle.”
As things stand whoever pays NI contributions is entitled to free state health services and only urgency based on clinical judgment can prioritise a case.
Joseph Caruana also said: “There is enough work to be done here and in private practice for those people who choose to do both. I am focusing on ensuring doctors give me what is expected of them in the contractually agreed period.”
In reality, St Philip’s Hospital has closed down and consultations in the private sector are mainly intended to fast track gridlock at Mater Dei, private health insurance coverage paradoxically encouraging more to do so even in uncomplicated, non urgent one-off treatment.
This expenditure is a burden on the uninsured. I have repeatedly suggested that the government considers giving tax rebates to private health insurance users who manage to avoid using Mater Dei as this seems to be the only way to break this vicious iniquitous circle.
That 5,000 patients awaiting cataract surgery at Mater Dei can now have it done through public funds at St James and St Anne’s clinics on a first come, first served basis is long awaited progress that will also allow theatre time and staff at Mater Dei to tackle the other 9,000 pending operations.
Let it be clear that the main concern should undoubtedly be the waiting time to be seen by a specialist as an outpatient where throughout 2010 outpatient attendance at Mater Dei reached the half million mark with over 1,000 new cases referred up to last October still having to be seen this year.
As most OECD countries have been endorsing as major policy objectives the reduction of inequalities in health status and the principle of adequate or equal access to healthcare based on need, it is about time the political class here focuses on equity in health matters. Moreover, if retirement age is to eventually depend on life expectancy, this just cannot vary extensively according to geography or socioeconomic groups.
A case in point is the inaptness of taking four years to roll out the Pharmacy of Your Choice only in the more affluent regions of our islands. While offering free medicines for defined chronic condition/s, irrespective of income, even if they cost a pittance, just around the corner and at the beck and call of residents up north, others often have to buy from their own pockets as stocks run out.
The CEO also said: “Today, our data states 35 per cent of patients who come to Accident and Emergency did not need to come to hospital and they could have solved their problem by going to a GP or a health centre.”
Ever since the primary health care reform proposals were launched in December 2009, private GPs remain without basics – IT accessibility to their patients’ hospital records and human re-sources to pool into group practices.
The government should also be focusing on how to ameliorate polyclinics to serve as centres for the treatment of minor yet urgent conditions that may not be easily treated by the family doctor in the clinic or at home, but which do not need hospital services. A positive step was the extension of availability of X-rays in two health centres. Not so the squeezing of 1,000 appointments in a week’s schedule reduced by seven hours in Hamrun, Marsa and St Venera, just to mention three localities in my constituency.
In the midst of a global financial crisis, to avoid a double dip, there should be a joint agreement across party lines to reduce public expenditure particularly by discontinuing universality. Considering health to be a top priority, one would settle for avoiding escalating costs but strengthening equity. A micro island state should have evolved this much since independence.
Dr Farrugia is a general practitioner and Nationalist MP.