You get what you pay for

This is a fact that consumers are very much aware of, and each and every one of us makes daily decisions that balance quality with cost.

There are many amongst us who are more than willing to pay a few extra euros to buy prosciutto originating from Parma, as opposed to regular ham. Similarly, the number of luxury cars on the road shows that many don't shy away from spending their hard-earned cash to get what they perceive to be a superior set of wheels.

The mental association between price and quality is so strong that I remember our lecturer in marketing at university telling us that pricing a product too low can damage its brand. We've all been there - comparing two tins of baked beans in the supermarket aisle and going for the one which costs a few cents more because "it must be better quality."

Unfortunately, when it comes to government services, the "you get what you pay for" adage is quickly forgotten. This is especially so for our national health service. The good quality of our general hospital is obvious when comparing our excellent mortality figures (including infant and maternal) to other countries. Similar excellent results are seen in the levels of satisfaction registered in surveys and in our ranking by the WHO.

The Maltese are very much aware of the fact that we have an excellent national health service. In fact, save minor and cosmetic procedures, outpatient visits or constraints due to long waiting lists, Mater Dei is the immediate choice when anything serious is suspected.

Despite this and the overall satisfaction of the general public, the complaints regarding long A&E waiting times, the waiting lists for elective procedures and the erratic supply of free medications are issues that mar our health system's reputation and are a constant thorn in the side of the administration.

It is not unreasonable to expect good quality and swift service at Mater Dei. However, just as one does not expect a five-star hotel room at two-star rates, one cannot expect a highly efficient service without spending that extra buck. A quick glance at WHO data from 2009 shows that Malta spends around 50% less on health than Germany and 30% less than the UK, on a 'purchasing power parity per capita' basis. We spend 8.5% of our GDP on health, while they spend 11.7% and 9.8%, respectively. Now I am not saying that we should be embarrassed about the fact that we are more cost effective - having good quality healthcare and running it efficiently, with lower costs, is something to be proud of. However there is something to be said for spending a little bit more in order to improve efficiency.

Successive health ministers have focused their capital expenditure on bricks and mortar and anything suitable for a ribbon-cutting ceremony. The new minister has lamented that Mater Dei lacks an electronic stock-control system for consumables, as does the government pharmaceutical service. Operation waiting lists lack a centralised system, while medical notes and prescriptions are still made with pen and paper, as in the days of the Sacra Infermeria (now known as the Mediterranean Conference Centre).

In the interest of full disclosure, I have to say that I own a software company, so I am fully aware of the fact that a good hospital management IT system costs millions. However, inefficiencies cost money. Medicines and consumables get thrown away every day, having passed their expiry dates, while purchasing drugs at short notice because you've run out of stock comes at a high premium. Similarly, prescribing with pen and paper may be very cheap, but the risk of error while deciphering a doctor's scribble not only costs money but can be fatal. With the thousands of different drugs available nowadays, it is impossible for a doctor or pharmacist to know all possible drug interactions - while a good old computer can spot potential problems in a split second.

Having medical notes in electronic format also has the obvious advantage that doctors can access your medical records without any delay. No more fear of missing notes. However, the power of such a system lies mainly in the knowledge it gives to a hospital's administration. At the touch of a button one can know how many patients in hospital had fever last night and what antibiotics were used. One can also know which doctors are prescribing which drugs or ordering which tests. One can easily audit the efficiency and quality of care given by medics and nurses.

The minister of health and most people working at the ministry are aware of what I have written above, as was the previous minister. However, by sounding like a broken record and excluding co-payments for healthcare, the politicians have made it difficult for themselves to do what is right. The solution to all this is finding another saying, this time in Maltese: jekk ma tidholx mill-bieb tidhol mit-tieqa. Instead of getting people to pay some money when they are sick, make them pay when they are healthy!

With the government claiming to spend around €1 million a day on healthcare, this works out to around a whopping €1,000 a year from every Maltese (kids included). Short of finding a large oil reserve, taxing us a little bit more is the only way the government can spend more money. I suggest that the health department should be the one to come up with who and what to tax. Cigarettes and fatty and sugary foods immediately spring to mind.