I refer to your report of the parliamentary debate on the Estimates of Social Policy Ministry (TMID, 15 November). Appreciating the long list of speakers and shortage of space I noted that my contribution regarding the health sector was omitted. As the only MP to emphasise equity, I thought my proposals may interest your readers on public health service waiting lists.

Having missed this point in the budget speech I thought it fit to work for change in this sector. I focused on two issues – sustainability and equity. About the former I remarked that the PN would not consider cost-sharing – shifting costs to patients – even though these had increased, most commonly in the case of pharmaceuticals, to varying degrees in OECD countries since the 1980s. I welcomed the introduction of Cost Controllers referring to the National Strategy Report for Social Inclusion 2008-2010 that states the “government will explore the setting up of an appropriate mechanism to verify entitlement to free health care services”.

The report also recommended the development of health tourism in Malta. I did recall that the life expectancy in the Maghreb is still low.

Regarding equity, which can be defined as equal treatment for equal need irrespective of income, this report was very categorical in stating that “health inequalities have not yet received sufficient attention” and promising that “an exercise to identify gaps in the provision of free medicines for chronic illness leading to inequalities between different types of chronic illness shall also be carried out”.

In my opinion however this report fell short of insisting on tax incentives to encourage timely take-up of private patients a priori rather than spilling over the private sector belatedly long after having reached over-saturation points in the public sector. Such practice has already been carried out in residential care for elderly people and hence I am sure retrospective auditing can be made.

Public and private health, side-by-side, as practised here, does result in lack of equity generated by out-of-pocket spending and private health insurance unless the latter is well regulated. If so, tax incentives to private health insurance users should come into force as soon as possible to alleviate the pressure on public services. This has already been introduced in the education field, so why not in health? Are waiting lists not long enough already?!

I referred extensively to another report, which I did pass on to the minister and parliamentary secretary: Equity in the Utilisation of Health Care in Ireland by Richard Layte and Brian Nolan: “Although public hospital care is subject to only relatively small or no charges at the point of delivery in Ireland, waiting lists for most forms of treatment mean that one’s ability to pay for treatment directly, or having access to medical insurance which can pay will allow individuals to access treatment more quickly and may influence the individual’s decision to seek treatment initially. Around 50 per cent of the Irish population are currently medically insured either with VHI or BUPA. Wren (2003) has also argued that hospital care for public patients is also less effective than among private patients, the latter being given more time in hospital, more attention and a greater range of tests... The rate of prescribed generic drugs among GMS patients was roughly twice that among private patients.”

Jean-Pierre Farrugia is a Nationalist MP