Maltese spend on private healthcare is more than double that of other Europeans

The Maltese are twice as likely as other Europeatns to pay for health services out of their own pockets, a recently published OECD ‘State of Health in the EU’ report reveals.

One main reason for this is the ‘cultural preference’ of high-income earners to opt for private doctors and specialists.

Out-of-pocket (OOP) spending as a share of total health spending in Malta in 2020 dropped from 34.3% in 2018 to 30% but remains considerably higher than the EU average of 14%.

Moreover, at 7.1% in 2019, OOP spending on health as a share of final household consumption was the highest in the EU, and more than twice the EU average of 3.3%.

Spending on private primary and outpatient specialist care remains the main driver of OOP expenditure in Malta. In fact, 42% of private care expenditure in Malta is attributable to services provided by generalists and specialists in the outpatient sector.

And while in Malta 52% of the total expenditure on outpatient care is paid from patient’s pockets, in the European Union only 21% of this expenditure is paid for by patients or their families.

The OECD report attributes this phenomenon to longer waiting lists for public specialists and elective care, and to “longstanding cultural preferences, as people with higher educational and income levels commonly seek care from the private sector”.

Another significant chunk of private health expenditure in Malta is spent in buying medicines (28%). This is attributed to the fact that “many prescribed pharmaceuticals for acute conditions are not covered by the Maltese benefits package”. In fact, 86% of spending on medicines in Malta is privately paid in contrast to 63% in the EU.

But the Maltese are less likely to pay for expensive therapeutic appliances from their own pockets. While in the EU, 62% of this expense is paid directly by patients, the percentage drops to 28% in Malta. And while spending on long term care accounts for 25% of private health expenditure in the EU, it only accounts for 9% in Malta.

42% of Maltese spending on dental care is also paid from patient’s pockets but in this case OOP spending is just 1% above that in the EU as a whole.

Despite the greater reliance on the private sector for a number of health services, with nearly universal health coverage, unmet needs for medical care in Malta were well below the EU average in 2022.

Malta spending more on health

The report also shows that health spending in Malta has grown at the highest rate in the EU in real terms over the last decade. While in 2010-11, the average annual growth rate in current health spendintal g in Malta was 5.4 %; by 2018-19 this had risen to 14.7 %. Nevertheless, per capita health expenditure was €3,055 in 2020, below the EU average of €3,719 for that year.

And while most countries raised expenditure on preventive care significantly during the COVID-19 pandemic, Malta’s spending on prevention remained low. In 2020 Malta’s per capita expenditure on prevention amounted to just €44 which was significantly below the EU average of €128.

Class inequalities in breast cancer screening

But the report also shows that Malta’s breast cancer rates exceeded the EU averages for the period 2018-21. But as in many other countries, there is wide variation in the screening rate according to income group: in 2019, 74 % of women in the highest income quintile reported being screened in the previous two years compared to only 51 % in the lowest quintile. Moreover, women are still undertaking cervical cancer screening in the private sector rather than through public programmes, which accounts for the low rates recorded. Although increasing slightly from 22 % in 2018 to 23 % in 2020 and 24 % in 2021, national rates of cervical screening in the past two years among women aged 20-69 remain well below the EU average.