Malta retains modest ranking in healthcare index

Malta has moved little up its mid-range ranking in the Euro Health Consumer Index, from 663 points in 2015 to 666 points in what is a performance index of national healthcare systems in 35 countries.

The EHCI, started in 2005, which is published by a private firm, bills itself as “the leading comparison” on 48 indicators such as patient rights, access to care, treatment outcomes, prevention and use of pharmaceuticals, ranking the countries out of a maximum 1,000.

For the first time two countries – the Netherlands (927) and Switzerland (904) – broke the 900-point barrier in the EHCI, which means they are close to meeting all criteria for good, consumer-friendly healthcare. A notch behind are Norway (865), Belgium (860), Iceland (854), Luxembourg (851), Germany (849) and Finland (842).

In spite of a general improvement among all national health systems the gap between top performers in the northwest of Europe and Switzerland, and least developed in eastern and south-eastern countries, persists.

A short note on Malta summed up the NHS as having “decent accessibility, but not too strong on treatment results. Also, there seem to be gaps in the public subsidy system of Maltese healthcare. This is particularly prominent for drug subsidies; many Maltese do not bother with receiving a subsidy. The result is that Malta has little data on drug use!”

Malta offers free healthcare to all citizens as well as EU citizens, and in certain cases to non-EU citizens against payment. Free medicines are also provided by the State when patients qualify for such medications offered on the national formulary.

In a sub-index dubbed ‘Bang-For-The-Buck’, Malta performed in the bottom quarter of the 35 nations surveyed. This EHCI ranking of cost-efficient healthcare shows the relation between money spent on public healthcare and the performance of healthcare systems.

At the lower end of the rank are countries that pay far too much for healthcare, given the poor performance. Professor Arne Bjornberg, of the EHCI, said that for example Romania and Bulgaria had a tradition of long hospital stays which they could not afford. Poland and Hungary were said to “try to deny the need for radical health systems reform”. And Ireland was described as sticking “to inefficient, unequal semi-private funding”.

Malta’s main negative remarks concerned the absence of electronic patient information sharing and e-prescriptions, a lack of malpractice insurance, major elective surgery that took over 90 days to take place, a high rate of Caesarean sections and MRSA infections.

Success stories

The EHCI’s success stories included countries like Norway and the Netherlands: the latter were said to have made GP gatekeeping a cornerstone of their healthcare system, reducing waiting lists in hospitals and ensuring continuity of care.

“The Netherlands’ example seems to be driving home the big, final nail in the coffin of Beveridge healthcare systems, and the lesson is clear: remove politicians and other amateurs from operative decision-making in what might well be the most complex industry on the face of the earth: healthcare. Beveridge [William Beveridge, the daring social reformer who designed Britain’s NHS] systems seem to be operational with good results only in small population countries such as Iceland, Denmark and Norway,” the EHCI said.

Beveridge systems employ financing from one responsible authority, such as the NHS in the UK, the largest Beveridge-type system in Europe. Bismarck healthcare systems are based on social insurance, where there is a multitude of insurance organisations, which are organisationally independent of healthcare providers.

The EHCI results for the past 10 years find top performers to be dedicated Bismarck countries. “Large Beveridge systems seem to have difficulties at attaining really excellent levels of customer value. The largest Beveridge countries, the UK, Spain and Italy, keep clinging together in the middle of the Index.”

The EHCI suggests this is down to the difficulty of managing a corporation with over 100,000 employees. “Managing an organisation such as the English NHS, with close to 1.5 million staff, who also make management life difficult by having a professional agenda, which does not necessarily coincide with that of management/administration, would require absolutely world class management. It is doubtful whether public organisations offer the compensation and other incentives required to recruit those managers.”

The think-tank also says Beveridge organisations are prone to influential politicians who use the healthcare system as a source of job-creation or national patronage.

Bismark systems are named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, it uses ‘sickness funds’ as an insurance system financed jointly by employers and employees through payroll deduction.