The law detailing who should be paying for healthcare in Malta and the fees that apply for patients who are not entitled to free healthcare is not clear and is being interpreted differently by those applying it, according to NAO audit reports.

On Wednesday, a governance action report on the annual reports by the NAO on public accounts 2017 and other NAO reports 2018 was presented.

One of the recommendations put forward by the Auditor General about foreign patients and fees, that “differing interpretations are being given to the subsidiary legislation stipulating feels charged to foreign patients,” was accepted by the public administration.

Although a Legislative Review Working Group was set up in order to discuss the necessary changes to improve the legislation, another point of action in the report notes that a new proposed amended legislation that will include a more comprehensive list of patients entitled to free healthcare and revised tariffs is to be concluded by this month.

The current subsidiary legislation states that healthcare fees do not apply to a person who is or even was a citizen of Malta. The same applies to any child under the age of 18 years of a person who is or was a citizen of Malta.

Free healthcare is also entitled to those who are citizens or nationals of a country outside the European Union, as long as they hold a license of work and pay social security, in accordance with the law.

There is also another clause which states that some people that are citizens or a national of a country outside the European Union may also be entitled to free healthcare if they enjoy the freedom of movement in terms of the Constitution.

Another proviso is for those who are in Malta in an advisory or consultative capacity to the government. It applies even those rendering a service to a government department or to a parastatal body and who is certified as such by the Minister of the department, and their dependents.

Those who are citizens or nationals outside the European Union but who are studying at the University of Malta, MCAST or ITS also benefit from Malta’s free healthcare.

There are also some cases when a patient is entitled to free healthcare if there is a reciprocal healthcare agreement in force with Malta and the care and treatment would be in accordance with that agreement.

The regulation also gives a list of fees that need to be charged to those who do not fall under the mentioned categories.

Amongst other issues brought up in the NAO report is that the bills charging foreign patients who are ineligible for free healthcare are generated on the basis of handwritten details listed on pre-printed forms. The issue is that the completeness of the information could not be guaranteed.

The action that will be taken on this matter is that the form used at present will be incorporated in the billing module, an IT system which is currently available. This should be done by March 2020, according to the report presented to the media by Principal Permanent Secretary Mario Cutajar on Wednesday.

Another issue is that there is no control to ensure all foreign patents who are not entitled to free treatment are billed accordingly upon discharge from MDH. This recommendation was accepted by the public administration.

The point of action for this issue, which is intended to be done by March 2020, is that “the present procedure pertaining to the treatment of foreign patients is to be updated and enhanced, as necessary. The procedure is then to be disseminated to all officers involved in the said procedure.”