Parts of your editorial under the encouraging title ‘VGH-Steward deal – The questions will not stop here’ (The Malta Independent daily edition 21 February) are misleading and unacceptable.
This applies in particular to the following comment: “We are not against the privatisation of state hospitals as long as there is a guarantee that the level of healthcare remains of high quality and free for Maltese citizens”.
This statement is both jejune and contradictory. On what evidence or criteria is this statement based?
Who will (or can) ‘guarantee’ (for 30-99 years) that the level of healthcare ‘remains of high quality’ if our health care (or a significant part of it) becomes a marketable commodity?
As correctly implied in the editorial, Malta’s level of healthcare has remained of high quality and is delivered free to all who need hospital treatment. And so it should continue. As in some other countries which provide a similar free health service to everyone, state health services have performed well despite continuing deterioration in state funding.
Under exactly the same situation of inadequate funding, Malta’s health-service has continued to deliver spectacularly – this is witnessed by frequent letters of gratitude from patients published in our newspapers.
The experience in two countries that have privatised state medicine – Germany and the UK – have shown privatisation to be disastrous, specifically: expensive and a threat to the standard of health care.
Throughout the UK, Private Finance Initiatives (PFI), originally introduced by John Major’s government, are now destroying public services. Private finance policies were misguidedly designed to use private financing to build and run public sector infrastructure projects (hospitals) with repayment on the work completed made over decades. The original cost of (new hospitals) should have been around £11.5bn, but, in the end, they cost the public purse nearly £80bn – that is seven times as much.
Equally, the standard of patient care is threatened if a profit motive is introduced. This was the experience in Germany: medical staff in privatised hospitals started being assessed by their ‘deliverables’ in terms of money. Staff clinical meetings became primarily discussions on income and profit rather than clinical issues and patient welfare.
In fact, we have already had a spine-chilling sign of the priority of profit over patient care with a Vitals shareholder reportedly suing Vitals because he was not offered a place on the ‘Medical Board’ as promised in the contract. Turning our health into a business will simply mean that money will be prioritised over patient welfare. This is exactly what happened in privatised hospitals when medical staff performance began being judged in terms of profit rather than clinical competence and patient welfare at staff Medical Board meetings.
Hospital departments at privatised hospitals are closed if their financial returns do not show improvement over the years or if there are insufficient (‘lucrative’) cases to make them profitable. Departments are also closed if the percentage of private patients becomes too low, resulting in an unprofitable ‘case-mix index’ or if admitted patients were not as ill as foreseen by the marketing plan – and therefore unlikely to assure sufficient financial return.
This is the grim scenario that awaits our excellent healthcare service, painstakingly built over many years. It will simply degenerate into incompetent dirty ‘big business’ and our sick will suffer.
Finally, for an editor to imply that the three hospitals are now in good hands because they been transferred to Stewards, “a company that runs over 30 hospitals in 10 US states” is both meaningless and naïve: the United States epitomises a country in which patient welfare is absent and which has an abysmal record in health-care.
What is particularly worrying is the complacency about this serious threat to our public health – of both your columnists and the public at large.
Dr George Debono
Sliema