The Health Ministry is still updating its proposals on primary healthcare reform, four months after the Prime Minister said the controversial plans were going back to the drawing board.
"Internal discussions are under way and the ministry is analysing the feedback and the proposals received during the consultation period," a spokesman said.
He did not say when the updated version might be ready, insisting it was "far from straightforward" to reconcile the alternative proposals made by different stakeholders and meet everyone's expectations.
In March, Lawrence Gonzi said that some of the primary healthcare reform proposals, especially those that received "immensely negative feedback", would be changed.
One of the proposals was to have patients register with private family doctors, who would then be able to access their medical records and test results, prescribe some free medicine and make appointments for outpatient services and day care procedures.
Aspects of the reform launched earlier this year elicited diametrically opposed reactions from two doctors' organisations and were also shot down by some government MPs. One backbencher, Jean Pierre Farrugia, a doctor by profession, even threatened to vote against the proposals should a Bill be presented in Parliament.
The Health Ministry said it had received a lot of feedback, which was "rigorously analysed" in a bid to come up with an updated version of the reform.
"This feedback has shown that, while the vision and underlying principles of the reform were hardly disputed, the way these should be attained raised issues of concern which were, at times, conflicting," the spokesman said, adding there was also general agreement that some form of change was necessary.
Although the ministry was not yet in a position to say when it expected to conclude the internal review, the spokesman said the health authorities had already introduced some elements of the reform deemed to be of top priority by doctors.
One of these changes was an extension of the list of laboratory investigations for which doctors in private practice could refer their patients directly to the public sector. As from June 1, this list includes thyroid function tests and prostate-specific antigen tests for patients suspected to be suffering from any disorder of the prostate and for men who have a strong family history of prostate cancer.
"The ministry will also shortly be in a position to introduce the first digital radiography service in the public primary health care service," the spokesman said.
The updated reform document would also include timeframes for phasing in the changes.
"The reform will have to be implemented in a phased approach with policy and implementation being developed simultaneously in an incremental fashion," the ministry said.
When speaking in Parliament earlier this year, Dr Farrugia argued that the proposed system would prompt family doctors to raise their fees because they would be flooded with work. Moreover, he said, the system would basically introduce a form of payment on health services, which, to date, were free. In this respect, he echoed the Labour Party's argument that the reform would spell the end of free healthcare.
Health Minister Joe Cassar is insisting that health centres would remain free of charge and people would still be able to walk in and get treatment.
The Association of Private Family Doctors supported the reform as proposed, pointing out it would give its members more power to treat patients in the community. However, the Medical Association of Malta, which represents health professionals more generally, was critical, primarily because doctors who work for the government would not be able to register.