Charity begins at home

The Medical Association of Malta would like to clarify any possible wrong impression arising out of the article "Rates charged by doctors are a 'free for all'" (September 26).

One of the roles of the MAM is to encourage the highest level of professionalism and to insist on the personal integrity of each and every member of the medical profession.

This was exactly one of the reasons why the MAM, five years ago, had entered into an agreement with the then leading health insurer, clearly defining maximum reimbursement of medical fees.

This enabled one and all to have a clear guideline of what is a "fair charge" and what is not. Furthermore, one has to note that medical fees are also regulated by market forces which are particularly strong when one considers that there is a free public service competing with the private one.

The MAM categorically denies there is "a free for all" as some seem to be implying. Indeed, medical fees are still quite cheap when compared to those overseas or even to what other professionals such as architects, accountants, IT experts etc., charge for their services locally.

Contrary to the "free for all" misconception, the vast majority of the medical profession exercises self-discipline in its fee charging as confirmed both by local insurers' recent comments in The Times and by the extremely low number complaints of overcharging brought before the medical council in the last few years.

There is indeed an effective reporting process, and the citizen can be assured that all doctors are fully accountable to the Medical Council. The lack of reports simply means that the vast majority of medical professionals are charging fair and equitable fees. This is very remarkable in this day and age when there is no lack of sensationalistic media, which are ready to exploit such episodes with ruthless mud-slinging.

The MAM is also aware that a great many doctors do valuable social work, and charge no fees to patients in charitable institutions or to those who would not otherwise afford private medicine. However, these doctors do this discretely in line with the highest ethical standards. Many thousands of Maltese can bear witness to this.

Most insurance companies also behave ethically and honour their contractual and moral obligations towards their clients. However, a few try to find every excuse not to do so whether a motor, a home protection or a health insurance policy is involved. Everyone is aware of this.

The Times gave much prominence to the insurance company's (IMR) claim that there was no medical indication for admitting Ms. Page to St Philip's Hospital.

I challenge IMR to declare what the medical indications of admission to a private hospital in Malta are. Of course, there are none because the public hospitals offer a full range of services. What the insurance company is saying is that it will cover treatment in a private hospital only if there is a medical indication for doing so, implying that there are certain medical conditions or circumstances where one has to be admitted to a private hospital.

This is insulting to our public health service and it is surprising that the Health Division has not reacted to this point. The truth of the matter is, of course, that the reason for admission to a private hospital rather than a public one is never a medical one but is the patient's personal choice.

It is this choice which constitutes the main reason of taking an insurance policy in the first place; one does not buy an insurance health policy to be admitted to a state hospital which is free anyway. When an insurance company insists on sending its clients to the public hospital, all it is doing is taking their money but if they then fall ill it demands that the Maltese taxpayer foot the bill, while also aggravating the overcrowding problem at St Luke's in the process.

The MAM would also like to clarify some facts regarding the reciprocal health agreement with the UK. Doctors in the public health service every year see around 1,500 foreign in-patients and another 10,000 at the emergency department or at the health centres.

Besides the added workload, doctors have to shoulder enormous responsibility when dealing with these visiting patients. Because of this practice, a far smaller number of Maltese patients can be sent abroad for free treatment of such diseases as certain cancers or for super-specialised surgery.

These Maltese patients should be grateful to the state but also to local doctors and other health care personnel who take care of the foreign patients without any extra payment. Now that Maltese doctors are offering many more services locally, one should review the wisdom and economics of this reciprocal agreement.

In conclusion, the episode brought to light by The Times has highlighted an important issue. If the excellent health service provided to the Maltese has a problem of being already overloaded with Maltese patients, should free treatment of foreigners in the public health service continue?

Or should the state opt out of the reciprocal health agreements and start either a) charging all visiting foreign patients for the use of our national health service or b) encouraging them to use private health care?

Furthermore, should the state continue to foot the bill of foreign insured patients? We certainly do not pay taxes so that a foreign insurance company can make profit!

Charity begins at home!