Once again I raise my head above the parapet, always at risk of attracting the usual snipers – forever ready to shoot down new ideas.
It was heartening to hear the Prime Minister state that the NHS will start providing the much-needed drug Herceptin (Trastuzumab) for breast cancer patients.
A step in the right direction – and if we could combine this with a Breast Screening programme we would potentially save the lives of more than 200 women by the time the next election comes round!
So how can we finance this?
I am proposing the following measures for Budget 2009 that will provide the NHS with e20 million annually
1. Road traffic accidents costs should be reimbursed by insurance companies.
2. EU citizens receiving treatment in Malta must pay for their treatment.
3. Costs of private medical treatment – should be tax allowable – against receipts of medical bills.
4. Medical insurance premiums should be made tax allowable.
5. Insured patients receiving treatment in an NHS hospital should be invoiced for all medical expenses incurred by the NHS.
Road traffic accidents costs should be borne by insurance companies
Hundreds of individuals are injured every year in traffic accidents on our roads in Malta.
Most of these injured patients are treated in government hospitals.
Their treatment is highly complex and costly.
These patients are, by law, all covered by motor vehicle insurance either as drivers or as third parties.
The cost of this expensive treatment should not be borne by the NHS (i.e. not by the ordinary taxpayer) –the cost should be borne by the insurance of the individuals who are responsible for the accident.
The cost of treating road traffic accident cases in Malta last year exceeded e5 million.
EU citizens receiving treatment in Malta must pay for their treatment
Malta’s entry in the EU is offering new challenges in the medical field
Any EU citizen from each of the 27 EU countries, as well as citizens of Iceland, Liechtenstein, Norway and Switzerland, is now entitled to emergency health treatment.
This is costing the Maltese NHS e12,000,000 annually.
We need to ensure that we recoup the cost of the treatment we are giving to all EU citizens.
One way of doing this is to contract the private hospitals to perform most of this work. This is what is happening in various countries in the EU.
In addition, the NHS will benefit from the income tax collected on the income generated from these EU patients.
Treatment given to EU citizens on the NHS since we joined the EU has so far cost the tax payer e50,000,000.
Eighty per cent of this work could have been performed by the private sector (GPs as well as private hospitals).
The NHS would have gained a further e12 million from the tax collected – without having to do the work!
Costs of private medical treatment should be tax allowable against receipts of medical bills
Patients who are not insured should be given tax credits for medical bills paid privately.
This would ensure greater tax compliance from the medical sector and a resultant increase in tax revenue for the government.
Medical insurance premiums should be made tax allowable.
Private medical insurance has an important role to play in the health sector.
The primary scope of private medical insurance is for the patient to benefit from the advantages normally associated with private medical treatment, i.e. to avoid NHS waiting lists, to have planned surgical treatment at the patient’s convenience and so on.
Private medical insurance should also benefit NHS patients indirectly because it should relieve some of the workload in NHS hospitals when patients choose to go privately.
Medical insurance therefore has the potential to reduce waiting lists and it needs to be encouraged by the government.
Therefore all medical insurance premiums should be made tax allowable to encourage everyone to take up private health insurance.
Insurance cash benefit schemes
However, some medical insurance companies have introduced schemes that defeat the primary aim of private medical insurance.
I refer to cash benefit schemes.
Cash benefit schemes are schemes that reward the insured patient, if he/she elects to receive treatment in an NHS hospital.
These schemes reward the patient with a cash benefit for every day that the patient lingers in an NHS hospital
The patient is given a cash benefit which varies from e18 to e58 for every day spent in an NHS Hospital.
The insurance company clearly is the one benefiting most from these schemes, as the insurance liability is limited to a maximum of e58 per day.
The insurance does not have to pay for hospital fees, nor for doctors’ fees nor for any pharmaceuticals or expensive consumables.
At present, the taxpayer is footing the bill and places a heavy burden on the NHS.
Instead of relieving the pressure from NHS hospitals, these cash benefit insurance schemes are actually riding piggyback on the NHS increasing the problems for the NHS.
All insured patients receiving treatment in any NHS hospital should be invoiced for all medical expenses incurred by the NHS.
It is not right for insurance companies to reap profits from premiums and then expect the NHS to foot the bill when medical treatment is required.
Primary health care
The backbone of any NHS is the primary medical service – that is the general practitioner service
Twenty-two years ago we came up with the idea “The Doctor of your Choice”, the first electoral promise of the PN and approved by the population in the 1987 election.
Enough time has gone by for us to decide whether we are going to implement this electoral promise – or whether we will jettison it permanently as being unachievable.
There are some 300 General Practitioners in Malta and they could provide a good primary care service in the NHS.
We must start active discussions immediately with interested GPs, with a definite time frame to conclude an agreement.
A primary health service with “empowered” GPs will strengthen the NHS and remove a great deal of pressure from State hospitals.
As an added benefit, GPs participating in the NHS would be able to treat EU patients and be entitled to reimbursement by foreign health authorities according to EU rules.
Dr Portelli is Director of St Philips Hospital
