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MALTATODAY 2 January 2022

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4 maltatoday | SUNDAY • 2 JANUARY 2022 NEWS JAMES DEBONO OUT-OF-POCKET spending as a share of total health spend- ing in Malta in 2018 was 34.3% – the fourth highest proportion in the EU and more than twice the EU average, a recently pub- lished OECD 'State of Health in the EU' report reveals. Government or compulsory schemes in the EU as a whole account for nearly 80% of all health spending, but in Malta, government spending accounts for 64% of the total expenditure on health. This shows that a good deal of Maltese make extensive use of private health providers as well as retail pharmaceutical spend- ing. Voluntary health insurances account for only 2.2% of health spending in Malta, compared to 5% in the EU. Spending on outpatient care accounted for the largest share of out-of pocket (OOP) spend- ing, with the OECD report at- tributing this high share to "so- ciocultural reasons". "Maltese people with a certain level of income and education have traditionally sought care from private practitioners," the report says, finding that many people seek outpatient care di- rectly from private specialists without a referral "often to cir- cumvent long waiting lists for certain specialties in the public sector." But the report warns that this is "essentially creating a de facto two-tier health system". Despite the greater reliance on the private sector for a number of health services, the universal coverage by the State contrib- uted to Malta having the low- est reported un-met needs for medical care in the EU, due to cost, distance or waiting times, with little difference between high-income and low-income groups. But the report does indicate a degree of health inequality. 89% of the Maltese population in the highest-income quintile (20%) reported being in good health, compared with 58% of those in the lowest-income quintile. "These income-based disparities were much larger in Malta than the EU average." Malta's NHS covers a broad benefits package, with public healthcare services and emer- gency dental care available free of charge to entitled individuals. Children under the age of 16, police and armed forces person- nel and those on low incomes are also entitled to free elec- tive dental services, prostheses, glasses and hearing aids. The rest of the population must pay out of pocket for elective den- tal care, which explains Malta's low share of public spending on dental care. But despite the widespread availability of free services, pri- vate general practitioners (GPs) account for approximately 70% of primary care visits, with many patients opting to attend private practices – where they can choose their physician and set appointments – rather than public clinics which, in the main, operate on a walk-in ba- sis. M a l - ta has also regis- tered the larg- est growth rate in total health spending in the EU in the past dec- ade; and the third high- est growth per capita in health spending, behind only Bulgaria and Romania. Health spending per capita (€2,646) and measured as a share of GDP (8.8 %) in 2018 nevertheless remained below the EU averages. Malta's strong economic per- formance prior to the COV- ID-19 pandemic has seen ris- ing health spending absorbed by high economic growth, so that total health spending as a proportion of gross domes- tic product has declined slightly over the past five years. Second highest life expectancy Life expectancy in Malta was 82.6 years in 2020 – the second highest in the EU and two years higher than the EU average. Since 2000, life expectancy in Malta has risen by 4.1 years, which is higher than the aver- age increase of 3.3 years in the EU. Most gains in life expectan- cy occurred between 2000 and 2010, with an overall increase of 3.0 years. Life expectancy gains slowed in the following decade, with an increase of 1.1 years, although this was above the EU average of 0.8 years. Following the outbreak of the COVID-19 pandemic, life ex- pectancy temporarily declined by 0.3 years between 2019 and 2020. This was nevertheless be- low the average decline of 0.7 years seen across the EU as a whole. Men in Malta were more af- fected than women: life expec- tancy fell by 0.4 years between 2019 and 2020 for men but re- m a i n e d u n - changed for women. Overall, the gap in life ex- pectancy between men and women is lower than the EU average, with women living on aver- age 3.8 years longer than men, com- pared to the EU average of 5.6 years. T h e country p r o - f i l e s i n - c l u d - ed in the re- port are the joint work of the OECD and the European Ob- servatory on Health Systems and Policies, in cooperation with the European Commission. Higher earners are relying on private health services when it comes to outpatient care, as OECD report warns of 'two-tier system' 34% of Malta's health bill paid from people's pockets Distribution of health out-of- pocket spend Malta EU Inpatient 1.4% 1% Outpatient medical care 12.1% 3.4% Medicinals 8.3% 3.7% Dental Care 2.2% 1.4% Long-term care 6.9% 3.7% Others 3.5% 2.2% Total 34.3% 15.4% Overall share of health spending Govt* Vol** OOP Malta 63.5% 2.2% 34.3% EU 79.7% 4.9% 15.4% * Government, compulsory ** Voluntary scheme OOP - Out Of Pocket

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