Former health minister – parties’ health proposals ‘a recipe for bankruptcy’

Electoral promises to extend free healthcare services across the board, and especially to farm out services to the private sector (at government' expense), may open the floodgates of abuse and even bankrupt the entire national health system, former health minister Louis Deguara has warned.

Citing electoral promises by both sides, Deguara told MaltaToday that it was irresponsible of political parties to commit themselves to generous healthcare policies without factoring in the additional costs these same policies may entail in future.

"At the moment both parties are competing with each other with healthcare proposals, without stopping to consider how these may impact the sustainability of the entire system," Deguara, who has often voiced concern about the astronomical costs of Malta's generous free healthcare system, said.

As an example he cited a plan, unveiled by the Labour Party on Friday, to address waiting lists by introducing 'timeframes' for operations... failing which, patients would be encouraged to turn to the private sector for the health needs, and send government the bill.

"It's a very dangerous proposal, which creates ample opportunity for abuse. First of all, waiting lists are not just going to disappear - there will always be waiting lists, partly because people are living much longer than ever before. This also means they will be exposed to more ailments as they grow older, and therefore the demand for treatment is constantly on the rise."

Moreover, the proposal does not take into consideration the exponential increase of the cost of providing such healthcare, in the context of a falling birth-rate coupled with greater longevity.

"With an ageing population we can expect to see an increase in degenerative, as opposed to acute conditions," Deguara explained, adding that such conditions are more expensive to treat because they tend to be chronic, and also involve additional expenses in the form of post-surgery treatment.

"I can't understand how a future government can encourage people to bypass the public health service, go straight to the private sector and then bill government for their expenses... without stopping to consider what expenses may be involved."

It is not clear, he added, what measures will be taken to prevent any abuse of the proposed system. With government offering to pay for operations in private clinics, what will stop patients from bypassing public hospitals altogether, even for conditions which are not urgent? 

Even without such abuse, however, Deguara argues that a future government may set itself on a collision course with bankruptcy if it commits itself to services that it can't afford. Nor is his warning limited only to the Labour Party's electoral promises.

"Both parties are competing with each other with proposals that do not seem to have been properly thought through," he said.

In fact, Labour's proposal for roping in the private sector finds a direct correlation in a proposal by the PN, this time with regard to out-of-stock medicines at government pharmacies. In principle, the dynamics are almost identical to Labour's proposal to cut down waiting lists at Mater Dei: when free medicines are out of stock, patients will be urged to buy the products from the private sector and invoice government for a refund.

Again, this proposal is likely to translate into considerable unforeseen expense for government, as the same factors conditioning the cost of medical treatment - the incremental costs incurred by population ageing, among others - also apply to medicines.

Yet despite the glaring similarity between these two proposals, both parties have accused each other of making promises that would eventually introduce the concept of payment for healthcare services - traditionally a taboo among the political class, but one which Deguara hints may soon be challenged.

This is not the first time Louis Deguara has voiced such doubts. In August 2003, he wrote alluded to the unsustainability of the public health system in an article in The Times; and in a press interview the following week, he likewise hinted that health services would be means-tested in future.

It later transpired that his government had already discussed the healthcare financing proposals distinguishing "between those who can and those who cannot pay".

Then as now, the issue elicited a storm of pre-electoral controversy, and Deguara was forced to defend proposals which would eventually be shelved.

Not only have no such measures been contemplated since; but with the opening of Mater Dei in 2007, the national health bill has increased significantly, while the capacity of hospitals and health centres to meet the growing demand has arguably decreased.

But despite a general cognisance of the extent of the problem, political parties cannot bring themselves to acknowledge that free healthcare for all - without distinguishing between those patients who can and cannot pay for certain services - cannot, by definition, be expected to last forever.

"I have been worried about the continued sustainability of the health sector for many years now," he said. "We cannot just carry on ignoring the alarming increase in healthcare related costs, or keep pretending that isn't a problem. These costs can only increase in future, and it is time we started thinking of ways to address this issue on a more permanent basis."

Quoting a 1987 report by former Norwegian Prime Minister and WHO director Gro Harlem Brundtland, the former health minister described the provision of free healthcare for all citizens, covering all conditions, without any restrictions, as a 'recipe for bankruptcy'.

"It seems that both parties are intent on following this recipe to the bitter end," Deguara concluded.