More questions than answers over primary health reform
Matthew Vella Parliamentary Secretary for health Joe Cassar left his audience none the wiser with uncertain statements on whether the government’s upcoming primary health reform would see patients, without referral tickets from private GPs, turned away from the hospital emergency department.
Interviewed by di-ve.com editor Vanessa Macdonald, Cassar first said “people could be turned away” from health centres – in cases where minor ailments could have been seen to by a private GP – and then flip-flopped when pressed on the matter by MaltaToday.
“Nobody is going to be turned away… nobody will risk turning a patient away from hospital,” Cassar said about his reform’s vision of shaving off patients from the public health system, who could be better assisted by their family doctors.
Cassar insisted the reform is geared towards nurturing patient-doctor relationships that will ultimately lead to better prevention and reduced morbidity rates.
The primary care reform is a patient-registration system, where patients register with their family doctor, who will be the keeper of their medical files, and assist to the needs of the patients on a 24/7 basis. As gatekeepers, doctors can keep track of patients’ histories, exchange them via IT with other doctors and health centres, and ensure better care.
But the government’s policy document is unclear on how this will work – it says patients can still walk into a polyclinic, but that they will be “encouraged” to be referred there by their GP – who must provide 24-hour coverage for their registered patients.
When pressed over why the reform did favour improving public health centres, rather than making patients use private GPs, Cassar claimed the reform would “optimise and improve health centres, because GPs are already the main choice of the public.”
“The backbone of a nation’s health is primary care… our system at this point does not provide continuity of care, which will be facilitated through the use of IT and strong incentives for GPs to register their patients.”
Cassar claimed it was a “Christian-democratic” principle to subsidise patients who, while today still avail themselves of free healthcare at health clinics and Mater Dei, will register with private doctors.
Cassar said a culture change will be necessary to get patients to make what he called an “informed choice” to choose a private GP over presenting themselves without a doctor’s referral to a public health clinic.
When pressed over why it shouldn’t be public health clinics that are invested in, Cassar gave generic replies to Macdonald. “That’s your opinion… back in the day, government believed it had to invest in institutional care. Today it is primary care,” he said.
When asked whether patients that are registered with doctors will still be allowed to just walk in to public health centres, Cassar responded by saying: “That is not continuity of care. If we go down that road, having a free-for-all, it will be a problem.”
He stressed that a patient-doctor relationship was at the core of the reform, saying it was not enough for public health clinics to have online medical information of patients.
But when pushed on whether minor injuries or ailments would mean patients are turned away from hospitals and instead told to consult their GPs, Cassar said: “People could be turned away from health centres… we want to educate people to make an informed choice, it will take years and it will be a culture change.”
Cassar would not answer whether any quantification of financial savings had been made on offloading some of the public healthcare’s chores onto the private doctor’s scheme. “They will be exorbitant because prevention will reign supreme with less obesity, less diseases… but it’s not about short-term savings from people using GPs.”
But Labour MP surgeon Anthony Zammit and Labour spokesperson for health Michael Deguara, both told Cassar that this was the beginning of a system of payment on health provision that is otherwise free.
Cassar also indicated that government is still considering whether to preclude doctors employed with the State from having a private practice, part of the system that evolved in Maltese healthcare. Under the proposed reform, doctors must choose whether to be part of the patient-registration system, or else refrain from their private practice if they are employed with the State. Cassar said he was in discussions with doctors’ representatives to “find a system which keeps a balance”.
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