Photo: Chris Sant Fournier

Malta has always enjoyed a high standard of medicine in spite of relative underfunding of State health. As in some other countries with State health care, funding has not caught up with our increased health sector demands as a result of population increase, longer life spans and advances in medicine.

It is clear that more hospital beds and staff are badly needed. The government has now had seven years to invest realistically in Malta’s future health and in new hospitals little has been done beyond creating a new ward at Mater Dei and finishing off the oncology hospital.

All that has happened is the signing of an agreement by government to handsomely  reward  a commercial company  to do what we could have done competently ourselves at a lower cost. For reasons set out below, this is the wrong choice which has set our State health care on course for disaster.

Our health service is based on the British, Canadian and Scandinavian model, namely:  patient-centred care with access to treatment for everyone regardless of their means or circumstances. We have maintained a high professional standard of professional care despite continuing pressures from inadequate funding and shortage of beds.

This is witnessed by a regular stream of published letters expressing gratitude for first-class treatment at our hospitals. Now it seems as though all of this stands to be thrown away.

The health service saga has been unfolding before us over the past months.  Instead of allocating more public funds to State health, a sector which should receive the highest priority, our government has pursued Malta’s new money-status game and plunged our State health service into a vortex of big business.

Our State health has now become a saleable business commodity for lucrative deals between heavyweight commercial enterprises.

It started many months ago with selection of a preferred bidder for a ‘public-private partnership’ in our health provision. Vitals Global Healthcare (VGH) with no experience in health care was selected.

The public was later informed (November 2016) on the management structure of VGH in a turgid news item which seemed to have been copied directly from a glossy VGH brochure into a government press release.  By this time the red lights should have started flashing, but it was all so cleverly packaged that nobody was particularly perturbed.

This concession of a large part of our health sector to VGH has now become a multi-tentacled Frankenstein over which we have little control.

The ink had barely dried on the original contract with VGH when we learned that VGH intends to sell its concession for running the St Luke’s, Karin Grech and the Gozo hospitals to an American operator, Steward Health Care.

This new operator was desperately tweeted as “the largest private healthcare operator in US” which “chose Malta for its first international investment” and “a vote of confidence in Malta by another major US firm”. VGH was headed by a CEO, Armin Ernst who, it seems, has now crowned himself as president of Steward Healthcare International.

This concession of a large part of our health sector to VGH has now become a multi-tentacled Frankenstein over which we have little control

All along, details remained shrouded in governmental stone-walling with conflicting messages and nobody prepared to hold themselves accountable or to assume responsibility for providing information.  People are now starting to wonder whether the original contract and the latest sale of the concession to Steward is  tainted with illegality as a result of the payment of kickbacks, that we are being ripped off, involvement of insider dealing,  etc.

All the foregoing raises important questions: was the original deal with VGH made in a purely speculative manner? Why was there no prior high-level consultation with our health carers?   Was research conducted into the experience of privatisation of State health in other countries?

Arguments in favour of privatisation of State health have been largely driven by inadequacy of public-sector capital resulting in a misguided “privatisation or bust” attitude based on reasoning that is ideological  rather than practical. The usual insular excuse was invoked that “only the private sector is efficient and can manage services well”. This is certainly not true in the case of our health system.

No matter how one looks at it, there is no escaping that fact that concession of a significant part of our health service to a commercial concern will be a disservice to the public. The experience in other countries has been negative. The crisis that resulted out of health privatisation in Germany (Hamburg) and the UK was described in this newspaper (December 31, 2016, February 8, 2017).

Privatisation is incompatible with the concept of a State health service; UK senior politicians admit that a model based on business experience (as in the Thatcher years) is quite incompatible with a State health service. It has been described as “far too radical an experiment that could go catastrophically wrong”.

The only “real thing” about Steward Plc will be the profit margin that has to be reached to satisfy shareholders. When State health is privatised, quality of care suffers because lower priority is allocated to patient care by virtue of the profit-driven nature of commercial companies.

Staff is reduced to a minimum to make savings and unprofitable health departments are decommissioned to improve return. Profits are augmented by overcharging the State for outsourced services once the contract is signed.

The high cost of outsourced care could result in cost-cutting in government-funded health resources which ultimately leads to discrimination against the old, the poor, the disabled and the chronic sick because they are expensive and occupy hospital beds for too long.

At a moral level, the experience was that health care was dehumanised and robbed of compassion.

Ultimately, we the taxpayers will be the losers because costs will exceed the amount it would, in the first place, have cost the State to invest in health care from public funds in the long term. Now that contracts have been signed, we have laid ourselves at the mercy of commercial interests where profit over-rides patient care.

Privatisation of health is emblematic of a “failure of health policy which obliges hospitals to work for profit”, a situation where “things become terribly opaque and dishonest; a way of hiding obligations”.

This is exactly where we are heading.

The different settings of health care funding

(a) A State-funded health service as in Malta, Scandinavia, Canada and the UK.

The UK NHS was introduced in 1948 and, about 30 years later, in Malta. These are State-funded. The objective of the NHS healthcare system is free health care irrespective of patient circumstances. Though not explicitly stated, this applies also to Malta.

(b) A (national) insurance-funded service – as in Germany, France.

Roughly, in this system, the patient pays for treatment and the State re-imburses him.

c) No State-funded health service – as in US, Switzerland.

In Switzerland everybody is responsible for being insured for health expenses. Though treatment is given in a State (usually university) hospital – there is no guarantee that it will be given and treatment may be withheld in private hospitals until the patient provides proof that he can pay.

d) A (voluntary)  health insurance-based private health service separate from any State-funding which entitles the patient who takes out health insurance to claim refund of  expenses from  the insurance company.

George Debono is a retired doctor with a research background and a special interest in health and environment matters.