Europeans have at least one distinct advantage over their US friends: the availability of public health systems that are affordable and of good quality. Countries with free public health systems at the point of delivery have a strong element of solidarity hardwired in their societies – a legacy from the forward-looking European statesmen that introduced the welfare state concept.

Still, European health systems, including Malta’s, face unprecedented challenges. These challenges come from the spiralling demand for complex and costly long-term health and social care for age-related chronic diseases.

The challenging economic prospects that most European countries face risk making the investment in public health a lower priority just when governments need to power up public health systems.

Governments must no longer regard health spending as a cost or burden, or a target for short-term cost containment. We need to learn from the mistakes of other countries. The current debate in the UK on the inadequate services provided by the NHS highlights how cost-cutting strategies and the privatisation of health services, starting when Margaret Thatcher became prime minister, have short-changed the most vulnerable in British society.

The COVID pandemic pushed public health systems to their limits, exposing and exacerbating underlying severe flaws. Decades of under-investment, short-term savings and misplaced spending on inefficient healthcare models that reward the quantity of care delivered, rather than its quality and the outcome achieved, must be addressed.

Malta has achieved some remarkable successes in healthcare in the last few decades. We have one of the best longevity records in Europe. Our expenditure on health services as a share of GDP is among the highest in the EU. Part of this positive indicator must also be attributed to private healthcare providers. Still, the rock base of our healthcare services will always remain the public health system.

Powering up our healthcare service will have to focus on five main areas: people, resilience, efficiency, workforce and outcomes. It needs hardly be stressed that before this regeneration exercise can start, we need to jettison the heavy baggage of mistaken past strategies relating to the privatisation of some public hospital services.

Like in any successful business, a public health service strategy that aims to promote solidarity in society must put people at the centre of its actions. Currently, Malta faces unprecedented healthcare challenges due to a fast-growing population due to immigration and the importation of foreign labour, an ageing population, capacity limitations in the public healthcare facilities, and spiralling medical equipment costs.

If we earnestly believe in a fair society, we must be prepared to pay for a public health service that can be both an engine for the economy and a security net for communities

Future health expenditure across the EU, dominated by chronic diseases care costs, will continue to grow rapidly unless there is a shift to disease prevention and more sustainable models of care.

Societal ageing multiplies the threats to the sustainability of financing models for public health services. We must be prepared to pay more taxes if we want our public health system to be resilient and sustainable in the long term.

Efficiency drives can deliver better value for money for the taxes we pay to support our public health system. A few years ago, there was some discussion of reorganising the management of our public hospitals by introducing the concept of health trusts to give hospitals more operational autonomy. In this way they could focus more sharply on patients’ needs. Sadly, this opportunity was missed, and a flawed privatisation strategy was adopted.

I have a very high opinion of and respect for the professionalism and competence of our healthcare workers. Whenever I used the services of our public healthcare system, I found doctors, nurses and other paramedics committed to serving patients even in the most demanding of circumstances. 

There is a risk that we take for granted the commitment of these healthcare workers by not rewarding them adequately for their input in the public health system. We must invest more in the working conditions of these workers. Ultimately, they are a bridge over troubled waters for many struggling with health issues.

Regrettably, economic and political debate in most countries often portrays public health services as a drain on public resources. Far from health spending being seen as a drag to growth, it should be part of a balanced strategy for economic prosperity.

If we earnestly believe in a fair society, we must be prepared to pay for a public health service that can be both an engine for the economy and a security net for communities.

Investment in health must be at the heart of our vision for a prosperous future for all of society.