In his opinion piece entitled "To do or not to do" (TMID, Friday 23 February), Minister Owen Bonnici defends the plan to hand over control of three of our State hospitals to a commercial company for 30 or more years. He describes the shady Vitals deal loftily as "turning our health sector into the best thing it could ever be". Such barefaced patronizing propaganda is an insult to readers' intelligence and to the dedication of our government health carers.

Over past decades Malta has provided free state healthcare of a high standard even though  funding had not caught up with increased demands,   At the same time the need grew for more hospital facilities, more beds and more staff , but the service remained  dogged  by an unwillingness to allocate  funds. This is not unique to Malta; it has happened in other countries.

Faced with a chronically underfunded healthcare system, the government is now taking the easy way out. Malta is about to handsomely reward a commercial enterprise to do what we could have done competently ourselves at about half the cost. To make matters worse, there is still uncertainty as to the exact identity of the company which will be awarded control over three hospitals for 30 to 99 years. Will it be the incompetent, bogus, semi-bankrupt "Vitals Global Health" with whom Malta Enterprise had entered into a secret agreement on a "public-private partnership" some time back in  June 2015? Or will it be Steward Health Care, "the largest private healthcare operator in the United States, "where it is responsible for a total of 36 hospitals employing some 37,000 professionals"?

The public is still kept in darkness on this deal; only the anointed have had the privilege of seeing the contract in its entirety. Two months ago, on 21 December, we were tweeted with the news that the "largest private healthcare operator in the United States" had "chosen Malta for its first international investment". This company, Stewards Health Care, was proudly touted as "the largest private healthcare operator in USA". Yet everybody knows that the United States is about the most dangerous and expensive country on the planet in which to be sick and admitted to hospital. Does Dr Bonnici honestly expect us to believe that this USA commercial company will "turn the people's ambitious aims into reality"? Dr Bonnici can rest assured that Steward is as hard-nosed as any other business enterprise and that we, the tax-paying public, will pay dearly for decades for this folly.

Dr Bonnici claims that, thanks to his government's bizarre game of Monopoly with state health care, Malta will be "moving forward", "doing the right thing" and that it will give us "a world-class service". These are mere empty buzzwords; they ignore the fact that Malta's standard of medicine has always been very near to "world class" in spite of chronic and insidious underfunding and shortage of beds as a result of skewed governmental priorities.

On what grounds does Dr Bonnici maintain that "government simply cannot walk it alone" , that  "we need to forge a partnership with the private sector"? What is the basis for the lame excuse that Malta cannot 'walk it alone' when our health carers have always delivered a first-class free health service in spite of inadequate funding?  

Does Dr Bonnici honestly believe that 'forging a partnership' with greedy Big Business will not cost us at least twice as much in the long term?

Is Dr Bonnici aware that the experience of privatisation in other countries has been horrendous, both economically and in terms of standard of care?

The UK National Health Service (NHS) is now staggering from failure of its disastrous Public-Private Investment (PPI) scheme and has ended up paying far more than it would have done if there had been no privatisation in the 1980s. An example: the original cost of a number of hospitals and other institutions was estimated at around £11.5 billion. These will now cost the public purse nearly £80 billion with the extra money spent swelling the coffers of PFI groups. Two NHS hospital projects and a string of other healthcare services are threatened after a private outsourcing firm, Carillion, went into liquidation. In the wake of the collapse of Carillion, the UK National Audit Office found little evidence that government investment in more than 700 existing public-private projects has delivered any financial benefits.

The standard of health care provided to patients will also suffer if we commercialize the nation's health. The graphic description by Der Spiegel (17/12/2018) of the experience in privatised state hospitals in Hamburg deserves repetition: "These hospitals are now managed as a sausage factory, where profit margins override the needs of patients. Sick people in need of hospital treatment are regarded as 'revenue sources', nursing staff as 'cost factors' and doctors' performance assessed in terms of profit rather than efficacy as physicians. Hospital staff was reduced to a minimum to reduce costs, putting them under pressure. Staff shortages meant that many patients were being denied what they needed most: A hand to hold as their end approached. Medicine had become inhuman when dignity matters so much."

As to the "concept of medical tourism", this is a minefield. First of all, it begs the question whether Malta Enterprise had conducted any marketing research on this question. So-called 'medical tourism' has been tried in Malta as a private initiative but failed.

In any event, mixing commercial and state medicine is just not on. It will only serve to intensify the skewed priority against needy patients in state hospitals and allow the private sector to cherry-pick for profitable, high-volume work. This has led to a destabilising effect of health services with creeping closure or scaling down of essential services where the "case-mix index" (ie: percentage of private patients) ceased to be profitable and was not quite in line with marketing plans. 

As Dr Bonnici rightly tells us: "Our people deserve the absolute best." But, is what he extols 'the best'? Quite the contrary; this is about the worst thing one might wish on the tax-paying public who cannot afford private health insurance. 

Going by the experience of privatisation in other countries, the best thing that could happen for Malta is to tear up this grotesque agreement with Vitals, cut our losses and do it ourselves. It will cost us less in the end and it will be better all round, especially the less fortunate among us who are ill and in need of hospital treatment.  

The only way to go is to invest in our own infrastructure and health service expertise.

State health is not the simple add-water-and-mix situation that Dr Bonnici makes it out to be. Health is not a saleable commodity. Selling off our health to big business is gross dereliction of government responsibility. It is not the answer. The future of our healthcare needs to be put high on our agenda; it  must be given the priority it deserves and seriously discussed in Parliament until cross-party agreement is reached.

The best investment a nation can make is to improve the health of its citizens.

Exploiting sick patients who need hospital treatment and turning them into cash cows to generate dividends for the shareholders of a foreign company for 30 - 99 years is not the way to go.

 

Dr George Debono

Sliema