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

Former health minister Louis Deguara gives candid view of party promises to pay for private sector provision of public health services that cannot be delivered on time to patients.

“It seems that both parties are intent on following this recipe to the bitter end” - Louis Deguara
“It seems that both parties are intent on following this recipe to the bitter end” - Louis Deguara

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.

More in Elections 2013
avatar
Thanks to Deguara an architect earen a good some of money because there was a change in plan for the new Cancer treatment hospital. Or we call this another drop in the Ocean.
avatar
taf x'naf inghid hux? il flus li gonzipn nefaq u ghadu jonfoq fuq l isptar konna nibnu sptar iehor .il hela li hawn u kif jintefqu il flus tal poplu alla biss jaf.
avatar
"Free" health care should be sustained by further small increases to VAT as happened a few years ago when the VAT rate was increased specifically to meet the increases in health expenditure. Introducing means testing would be very unfair on the employed as these cannot hide their income unlike the self employed and those offering various services. Dr Deguara should know that a patient is rarely given a VAT receipt when going private.
avatar
"Free" health care should be sustained by further small increases to VAT as happened a few years ago when the VAT rate was increased specifically to meet the increases in health expenditure. Introducing means testing would be very unfair on the employed as these cannot hide their income unlike the self employed and those offering various services. Dr Deguara should know that a patient is rarely given a VAT receipt when going private.
avatar
In the end its us, the taxpayer that has to contribute for promises be they from one side or the other and then...well, we have plenty of living examples what happens when a country overspends, countries not far from us at all !! I think Dr Deguara's assessment is spot on.
avatar
Mater dei is not effective because of delayed discharges. The hospital must be made more efficient. More sheltered homes in the community, A Elderly Home in Every Village and Town, is a must, and receiving two social services for the same condition should be stopped completely.
avatar
PL is only promising what EU regulations ask for, that is, one can seek private cure if the time on the waiting list is excessive and unaccepatble according to the patients' rights charter. Anyway Dr Deguara is the last to speak as gonzi found it fit not to involve him in the health sector due to his past as a minister of same.
avatar
I agree 100%. Political parties are only interested in power. Power at all costs.
avatar
Both parties are also promising many other expensive "freebies", neither of them explaining how exactly how they are going to finance the same. More political hot air, anybody?
avatar
I'm wondering whether Dr Deguara was another 'Brutus' in the PN Parliamentary Group!! Dr.Deguara was the Minister of Health who closed the Cospicua, Rabat, Gzira and Qormi Health Centres in the afternoon and during the nights. Dr Deguara was the Minister of Health who succumbed to his collegues MAM so that their members in the Health Centres can have time to attend to their private clinics in the evenings; to divide their duties so that half of them work in the morning and half of them work in the evenings, especially of Sundays and Public Holidays. Dr. Deguara was the Minister of Health of the lack planning at Mater Dei Hospital and in fact if it wasn't for Dr Gonzi himself, God knows if Mater Dei is still not ready!
avatar
"but with the opening of Mater Dei in 2007, the national health bill has increased significantly", so this proves beyond any doubt that not only the "hotel services" part was over the top, but this hospital was far too small for Malta's needs. Exactly like the first Delimara power plant. Two enormous errors of judgement by the Nationalist Party.
avatar
Joseph MELI
So when he assumed an MP's and Minister's role he never made unfulfillable or unactioned pre-election promises once in power?.Funny how when no longer in office these "exes" always discover probity and a newly found zen-like quality allied with remarkable powers of responsible accountancy.What a hero and a loss to the country!