Call for more collaboration between state and private hospitals

The government could net up to Lm6 million a year if the Health Division was geared toward collecting its dues for treatment to foreigners in state hospitals, according to a private hospital operator.

St Philip's Hospital chief executive, Dr Frank Portelli, said the Health Division could pull itself out of the financial doldrums if it beefed up its administration systems by creating a partnership between the private and public health sectors.

Dr Portelli was speaking to The Sunday Times after Health Minister Louis Deguara recently said he would be proposing radical changes to the national health system, which he said had become unsustainable.

Dr Portelli said he believed the Health Division was losing millions of liri simply because it was failing to collect its dues from foreigners who received medical treatment at St Luke's Hospital and health centres.

Most of these foreigners were actually insured for emergency medical treatment.

The Health Division was failing to collect basic information such as patients' home address and insurance details, he claimed.

During the last 12 months some 2,000 foreigners were admitted to St Luke's Hospital for emergency medical treatment, up from an average 1,400 in the past years.

The average length of stay of these patients was 10 days, equivalent to occupying 55 beds a day, stretching St Luke's Hospital's resources beyond the limit in the process.

There are an average of 70 patients being treated in the hospital corridors every day, he said.

According to Dr Portelli, most of the foreigners admitted to St Luke's needed serious medical or surgical attention and cost Government some Lm250 a day, bringing up the tally to Lm5 million a year.

Additionally, 20,000 foreigners were treated in health centres and in the casualty department, costing taxpayers another Lm1 million.

He said that following Dr Deguara's statement the Health Division seemed to have finally "woken up" and was writing to hotels requesting addresses of foreigners who had stayed in the hotels and had received treatment at St Luke's Hospital.

Dr Portelli claimed that tour operators were telling tourists, as soon as they arrived in Malta, that they were entitled to free health treatment on Malta's NHS.

A number of countries, such as the UK, do have a reciprocal health agreement which entitles British citizens to free emergency medical treatment, under certain conditions.

At present however, Dr Portelli said, the Health Division automatically assumed that every Briton was entitled to free emergency medical treatment in Malta.

Anyone presenting a British passport at St Luke's is provided with free medical treatment, even if that person is not entitled to receive medical treatment in the British NHS.

All those who were registered with the British NHS had an individual NHS number. But Dr Portelli said he was astonished to learn that the Health Division did not have access to this number and could not check whether a British passport holder was entitled to NHS treatment.

Dr Portelli said he felt that the government should actually bill a patient when he was insured, irrespective of whether a reciprocal health agreement existed or not.

With EU membership, all Europeans travelling to Malta would be eligible to free emergency medical treatment in St Luke's Hospital on producing what is known as an E111 card.

An E111 entitles Europeans to free hospital treatment in any European country - the Health Division can then claim the costs from their respective governments.

But Dr Portelli wondered whether the Health Division was geared to administer this system.

He said it was high time for Government to stop local insurance companies sending "cash presents", ranging from Lm8 to Lm25 a day, to those clients who opted to receive treatment at St Luke's Hospital.

The government should make medical insurance premiums tax-exempt as this would slash the real cost of insurance premiums by up to 50 per cent for most people.

He admitted that the Maltese were still rather cynical about health insurances and estimated that less than ten per cent of the Maltese were fully insured, contrary to their European counterparts where the rate is between 20 and 30 per cent.

"People seem to be willing to pay Lm300 for their car insurance, but insuring their health for the same price seems to be a big deal. They service their cars for Lm60 minimum, but are averse to doing a full medical check-up for Lm50. I cannot understand this," he said.

Dr Portelli said it is about time the government and private hospitals collaborated more.

Private hospitals could do a lot to whittle down the long waiting list for certain operations in state hospitals, more so in view of EU membership.

Dr Portelli referred to a case decided by the European Court of Justice which ruled that the health authorities of EU member countries were obliged to meet the costs of a patient's private medical treatment when that patient did not receive treatment on the NHS because of "undue delay".

In effect, this meant that any patient who has been on the waiting list of state hospitals has the right to seek treatment privately, or in any other EU member state, at the expense of the Health Division.

This could become a major headache, considering the waiting list for certain cases of orthopedic surgery could run up to five years.

Dr Portelli said that in most cases it would cost the government less to refer patients for operations at private hospitals.

Through his calculations, a bed at St Luke's Hospital cost on average Lm165 a day and not Lm85, as claimed by the health authorities.

On the other hand, a private hospital could provide a bed at a basic Lm90, rising up to Lm250 for a high dependency case.

"The Health Division seems to look at the private sector with an 'us and them' attitude - as though we're competitors."

Dr Portelli said it was disconcerting to note that the Health Division had not asked for the private sector's input to make its recommendations to Cabinet.

"They seem to think they can go it alone," he said.