Once again I raise my head above the parapet, at the risk of attracting the usual snipers who are always ready to shoot new ideas down.
It was heartening to hear the Prime Minister Dr Lawrence Gonzi 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 of the next election!
So how can we finance this? I propose the following measures for Budget 2009, which will provide the NHS with €20 million annually.
1. Road traffic accident costs should be reimbursed by insurance companies.
2. EU citizens receiving treatment in Malta must be 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. By law, these patients are 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. by the ordinary taxpayer) but by the insurance of the individuals who are responsible for the accidents.
Last year, the cost of treating road traffic accidents in Malta exceeded €5 million.

EU citizens must be pay for their treatment in MaltaMalta’s entry in the EU is offering new challenges in the medical field. Any EU citizen from each of the 27 EU countries, plus citizens of Iceland, Liechtenstein, Norway and Switzerland, are now entitled to emergency health treatment. This costs the Maltese NHS €12,000,000 annually.
We need to ensure that we recoup the cost of the treatment that we are giving to all EU citizens. One way of doing this is to contract 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 taxpayer €50,000,000. Eighty per cent of this work could have been performed by the private sector (GPs as well as private hospitals).
The NHS would have benefited a further €12 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, etc.
Private medical insurance should also benefit NHS patients indirectly, because it should relieve some of the workload from 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 €18 to €58 for every day spent in an NHS Hospital.
The insurance company clearly is the one benefiting the most from these schemes, as the insurance liability is limited to a maximum of €58 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, which is 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 service.
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 healthcare
The backbone of any NHS is the primary medical service – that is, the General Practitioner.
Twenty-two years ago we came up with the idea “The Doctor of your Choice” – the first electoral promise of the PN, approved by the population in the election of 1987.
Enough time has gone by for us to decide whether we are going to implement this electoral promise, or whether we will jettison it overboard permanently as 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 the State hospitals.
As an added benefit GPs participating in the NHS would be able to treat EU patients and would be entitled to reimbursement by foreign health authorities according to EU rules.

Dr Frank Portelli, MD FRCS(Ed) FRSM, is director of St Philip’s Hospital

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