PPP: The healthcare con

Our taxes fund a health system that is free at the point of use. It is accessible to all those who need it regardless of their social class, lifestyle, beliefs, political affiliations or ability to pay. As taxpayers, we are in solidarity with those in our society whom we may not know personally, but are in need. This is something we should be proud of.

Though as with most things that have been so good for so long, we take it for granted. Our publicly funded health system is under threat. A private company, Vitals Global Healthcare (VGH) has been granted a lease of 30 years to run three state-funded hospitals: St Luke’s Hospital, Karen Grech Hospital and the Gozo General Hospital. 

This, however, is just the start. Similar deals have been struck in the psychiatry and primary care sectors and the Medical Association of Malta (MAM) have recently revealed that new gynaecology, obstetrics and paediatrics blocks are being built at Mater Dei Hospital to be privately run. My hazy description is not deliberate. The details of the contracts have been shrouded in secrecy from the start, and are still not available for public scrutiny.

Thankfully we have precedent to gauge the likelihood of success of these private-public partnerships (PPPs, as those involved euphemistically call them). The UK’s NHS has been down this road before. ‘Private Finance Initiatives’ were designed, beginning in 1992, to bring business into state-funded hospitals to make them profitable. 

Currently there are more than 100 hospitals run by ‘Private Finance Initiatives’ operating within the NHS. Their track record is poor. According to a recent article in the UK Independent, they initially cost about £11.5 billion. It is now estimated that they will cost the British taxpayer over £80 billion. The total debt they have accumulated (about £300 billion) is enough to run the entirety of the NHS for two years.  In short: they have been an unmitigated disaster

The question is why has introducing the profit incentive into state-funded hospitals not worked? The answer is that even with government oversight, the profit motive cannot always align with the real goal of our health system - that of the health of its people. What happens, in practice, is that those who cunningly bypass regulations in place to protect patients, come out on top, and those who altruistically put patients before their own pockets lose out. Patients become clients to be exploited. They are prioritised based on their potential for profit, not their need for treatment. 

Further exacerbating the situation in Malta, the checks and balances associated with a private market will not apply. A real market would require various competing commercial entities, much like the private healthcare market that already exists in Malta. Karen Grech Hospital, Gozo General Hospital and St Luke’s Hospital will operate in a monopoly. One ring to rule them all, one ring to bind them, one ring to wring us all, and in the darkness line them.

Only VGH (and those who greased the wheels) stand to benefit. Make no mistake: this is private profit at public expense. It is unaffordable, unaccountable and unjust.

Yes, our health system is in need of innovation and refinement, but the answer does not lie in lazy delegation to the private sector. Rather we need transparent, robust public funding and shrewd allocation of resources to needs identified through research. We must encourage local innovation and improvement through consistent self-audit. We must invest in our own passionate health professionals and not revert back to colonial subservience. We must not empower corporations, but local experts, whose motives to lead are their dedication to the common good and their love for their community.

Thomas Calleja is a medical student and a member of Patients not Profit which advocate for a patient-centred health system, evidence-based public health policy and greater transparency for healthcare deals. Patients not Profit are organising a public demonstration in La Vallette Square, Valletta on 1 April between noon and 5pm, to bring attention to the above. Free health checks will be offered to the public.