The health authorities’ handling of the COVID crisis has generally passed the tests of effectiveness and efficiency. The full financial cost of fighting the pandemic must still be quantified but the final figure on the bottom line of the country’s medical bill will be justified if such vast expenditure has protected the health and lives of Malta’s citizens.
Dealing with the pandemic, however, is just one of the formidable challenges being faced by our free health services, which, together with free education, form the bedrock of the nation’s social infrastructure.
The challenges include Malta’s ageing population, which is growing at a fast rate. This factor will continue to pile pressure on the free health service in terms of both its physical and human infrastructure. The life expectancy of men and women keeps going up and the latter years of many older people are characterised by increasing morbidity that requires long-term care for afflictions that range from osteoporosis to chronic kidney disease.
Lifestyle-related conditions add a further burden on an already stretched healthcare system. Type 2 diabetes, obesity and smoking-related bronchitis are just a few of the conditions that keep stretching its resources.
Another growing pressure is the effects of under-investment in mental health over the last several decades. The pitiful condition of Mount Carmel Hospital is symbolic of how the duty of care for vulnerable patients with mental health problems has been shamefully ignored for so long. The government has a lot of catching up to do in this area and has announced plans to do so.
Modern medicine has also become increasingly capital intensive, with medical technology now eating up a more significant proportion of the public health budget. Patients’ expectations have also risen as they expect access to the same medical technology made available by private healthcare providers.
Planned investment in technology cannot rely on short-term budgetary considerations. It should form part of a long-term strategy to provide the public with the kind of technology that private healthcare already provides without unduly long waiting lists.
The Muscat administration sold the privatisation of health services as a solution to the problem of ever-rising demand for investment in the public health system. But, as in most other substantial public procurement projects during Joseph Muscat’s premiership, the privatisation of three public hospitals has been an unmitigated disaster, reeking of corruption and abuse of public funds.
Prime Minister Robert Abela and Health Minister Chris Fearne are undoubtedly struggling to undo the complex Gordian Knot of that is the agreement with Steward Health Care. This agreement was approved by the “kitchen cabinet” that reputedly decided on most things that mattered in the Muscat administration.
It will not surprise anyone if rescinding the Steward contract will come with a high cost for taxpayers and an equally high political cost for the government. But the country needs to ensure that the long-term viability of our public health system is underpinned by sound management and solid financial planning.
The privatisation of health services management is not the way forward. The way ahead is to let the hospitals be run by trusts that give them autonomy from undue political interference. Such trusts must be financed by the government, have representatives from all stakeholders and aim to provide the best and most cost-effective health service possible to the public that finances them.
The short-term success achieved in dealing with the COVID pandemic needs to be projected into the future. The government must ensure that the country has a reliable health system guaranteed to consistently give an excellent service to all who choose to use it.