SPEECH BY THE HON. LOUIS DEGUARA, MINISTER OF HEALTH ON THE OCCASION OF THE 30TH ANNIVERSARY OF BUPA OPERATIONS IN MALTA

The Maltese Health Care system operates by means of an integrated health service that is organised at the national level. The statutory system is publicly financed and is free at the point of use. However, private health care also plays a significant role in the delivery of health care in Malta. For many years the private sector has been involved in both the financing and the provision of health care with both primary care practitioners and specialists rendering their services in the private sector.

Although the Government Health Services provide universal coverage, there is significant private sector activity, which accounts for approximately 40% of the total health care expenditure in Malta. This activity is more marked in the primary care sector where it is estimated to account for almost two thirds of workload. People tend to use the private sector for a number of reasons. The private sector is perceived to provide a more personal care, guarantees the physician of one's choice, and is more flexible thus providing appointments at times more convenient to the client. It must also be said that the private sector is also seen by some as a means of by passing waiting time for access to the public sector.

Since its very beginning the method of payment for private medical care used to be by direct out of pocket payment. This remains the predominant method of payment for private general practitioners and features extensively in specialist consultations. The introduction of private health care insurance thirty years ago saw the beginning of erosion of this trend.

The closure of private hospitals in 1980 led to the setting up of a number of private day-clinics. My Government's policy has always been in favour of private medical care and soon after returning to Government in 1987 started to work for the re-establishment of private hospitals in Malta. Indeed for many months discussions were held with BUPA in this regard. In 1995, following an amendment to the laws regulating the provision of private health care, private hospitals were once again opened.

Apart from the numerous clinics, we now have three private hospitals, which together account for 12% of acute hospital beds in Malta.

The opening up of private hospitals and the increasing provision of specialist and secondary/tertiary care in the private sector has led to an increase in the demand for voluntary private health insurance. An increasing number of employers now provide a package of private health insurance for their employees and their families. There are today several companies providing private health insurance coverage, offering different packages, with varying levels of coverage that may include primary care, hospital care as well as nursing at home. The private health insurance market has now become highly competitive to the benefit of the many customers. Although the number of people covered by private health insurance is not known, there is no doubt that the trend is increasing and is expected to continue to gain popularity.

What we have today is the result of my Government's continued commitment to the development of the private health care sector. We are once more bearing the fruit of our clear and determined policy over the past years. This commitment is no less clear today. It is my Government's declared policy to encourage the further expansion and development of the private health care sector. The removal of the tax levy and the proposed introduction of a tax rebate on health insurance premiums are two fiscal measures aimed at promoting such expansion.

Further collaboration with the private sector in the provision of health care is also required. Such collaboration must be based on sound principles and should not arise as a crisis interventional measure to reduce the pressure on the state hospitals. Collaboration must be mutual and while one may envisage the public sector contracting out services from the private sector, the reverse cannot be excluded. I have no doubt that the reforms currently being implemented in the public hospital services leading to autonomous hospital management will provide the right setting for such collaboration to develop. The Ministry of Health and the Health Division will assume a policy formulation, service-purchaser and regulatory role. The reformed sector will provide for a level-field, which not only allows for constructive collaboration but will also provide the right scenario for healthy competitiveness from which the only beneficiary will be the Maltese public.

The role of private health insurance companies may also be called in to play in the wider context of health care provision. The rapidly expanding medical and interventional technologies, together with the demographic changes taking place, are putting increasingly heavy burdens on public health care systems. The sustainability of health care in the future is a problem which all countries across the globe are facing and is an issue that is being discussed at the highest international fora. Malta is no exception. There is no doubt that the issue needs to be urgently addressed as an issue of national importance. It is my Government's intention to face this challenge.

I feel that on this occasion I must thank and congratulate BUPA for the vision they had 30 years ago when they ventured to extend their service to the Maltese market. I have no doubt that their presence in Malta has contributed in no small way to the development of the private health care sector in our islands.

I hope that in looking at the past we can see an even brighter future.