Health service reform

I agree with Dr Mario Tabone Vassallo on the general points that he commented on (The Sunday Times, October 19).

To sustain a functioning health service, the authorities concerned have to give primary importance to financial resources and financial limits. It is also a truth that patient psychology and political necessities play an essential role in provision of health services.

As Dr Tabone Vassallo opines, everyone recognises that a health service delivers. In Malta, as in some other European countries, there is general concern about the way the particular health service delivers. Not all are, or can be, entirely happy with a given health service and no one would want to deteriorate a functioning health service.

Dr Tabone Vassallo correctly says that it is patently untrue that health services are free. All who pay tax, pay for health services. With a free service at the point of delivery, one will have already paid for the service before using it, in fact even if one does not use it. Because of this, one may not be aware that one is squandering one's own money by abusing the system.

The essential step in any given society will be to decide on the kind of formula one wishes for the health service system of one's choice.

In a health service system based on solidarity between a nation's citizens there can be no real alternative to Dr Tabone Vassallo's comment that the more one earns, the more should one pay (up to a fixed salary ceiling), even if the particular payer happens to use the service less than others during a given period of time.

Considering the course of human nature within a demographic framework, there will come the day for the majority of the paying citizens when they will ultimately equate their needs with the contributions they would have already paid over the years.

One can only agree with Dr Tabone Vassallo when he comments that any kind of abuse should be curtailed.

Transparency in any given system helps to curtail abuses.

Some factors pertaining to transparency in provision of health services can only be achieved through respective legislation. This step requires consensus between all parties represented in Parliament as many of the factors necessary for transparency will essentially mean unpopular measures.

It is envisaged that hospitals in Malta will one day perhaps enjoy full autonomy.

In this scenario the CEO of a given hospital will be primarily responsible and accountable for the hospital's budget. The hospital will have to be a profit centre, if its message would be to sustain excellence in the practice of a state of the art medicine. Profits will be necessary for reinvestment, for refurbishing and for introduction of high technology methods in routine medical investigations and/or research.

As yet, it has not been possible for the normal citizen in Malta to elicit the source from where the CEO of a given hospital will be getting his budget revenue.

A state-of-the-art medicine, as envisaged for the new Mater Dei Hospital, is a very expensive adventure, especially if the authorities wish to avoid having different classes of patients. The simple calculations, which an official from the Ministry of Health recently published in The Sunday Times (September 28), can only be regarded as very amateurish.

If a patient does have an additional private insurance, what would be wrong, if this patient (or rather his insurance) would have to pay a fee for special consultations, for special operations and for each day the patient spends in hospital? Dr Tabone Vassallo's comment on this matter was absolutely valid.

Again as Dr Tabone Vassallo opined, if an aged patient is kept in hospital beyond clinical needs (geriatric dumping), what should be wrong, unethical or immoral if the patient's pension should pass in part or in whole to the state?

Considering Malta's national debt and structural deficit in relation to the so called Maastricht criteria, I also agree with Dr Tabone Vassallo that the electorate and the law-makers in Malta have to decide on priorities concerning parastatal enterprises increasingly running at a loss and the necessities of a general modern health service.

A reform or renovation of a health service system essentially requires closest co-operation with the official organisations of the providers in the system that be.

It should therefore seem imperative that all doctors be members of their professional association, in which they can hold their own parliament according to democratic guidelines. The same should apply for nurses and paramedical personnel.

It will also be necessary to decide whether the providers in a health service system are employees in a civil service responsible to Government, or whether they will be employees in a truly autonomous system, which aligns itself to competitive market requirements.

There are of course many more aspects to be considered when discussing a health service system, which includes the running of health centres/polyclinics and hospitals.

Dr Said, who is living in Germany, is a retired pathologist holding a postgraduate diploma in Health Services Management