Issue link: https://maltatoday.uberflip.com/i/602004
maltatoday, SUNDAY, 15 NOVEMBER 2015 15 concerning private-public part- nerships: is there any logistical or economic reason why 'medi- cal tourism', as a general strat- egy, might not work? "Medical tourism has not been successful so far, and in our opin- ion is unlikely to succeed. Even if we attract large numbers of paying tourists, the fact remains that retired EU citizens, migrant workers, and those having a resi- dency permit through whatever means, all attempt to obtain ac- cess to the national health serv- ice for free. Futhermore, in the summer months large numbers of Maltese residing in Australia turn up requesting free services. By and large, they are accommo- dated…" What is gained with one hand, it seems, is given away with the other. Nonetheless, in this sys- tem at least one of the hands is gaining something. Short of this sort of approach, what other models could successfully be adopted? Balzan has long argued that the affordability issue can be ad- dressed through better manage- ment of existing structures and resources. But how is this pos- sible, when Malta has an ageing population… which in turn im- plies that health demands can only be expected to grow? This argument, he counters, is itself another reason why the present strategy is flawed. It is a point Balzan already made back in 2013, when the project was first announced: "the country cannot afford to invest in new hospitals, so the government must maximise the current in- frastructure and offer health services for longer hours…" In a nutshell: reform the exist- ing service administration, rather than introduce new management concepts. Is he still of this view today? "Yes. There is still scope for more work to be done at Mater Dei Hospital, especially evening sessions, when the bed comple- ment increases. The current hospital infrastructure is utilized in full swing only between 8am and 4pm. Just extending services from 4 to 8 pm would go a long way towards shortening waiting lists for operations, and outpa- tient visits. This has failed to materialize so far, even though both MAM and government are in agreement…" Balzan cites other areas where weaknesses in the present serv- ice result in bottlenecks which cripple the entire system. "Around 60 long term care pa- tients, awaiting transfer to retire- ment homes, continue to block acute beds at Mater Dei because of insufficient provision of serv- ices for the elderly," he points out. This is one of a number of issues that exacerbate the bed shortage situation, and contrib- ute to waiting lists." What is needed to address these problems, then, are admin- istrative reforms rather than new private hospitals. Such reforms, however, have been known to encounter resistance in the past. Balzan proposes extending working hours at Mater Dei; which would naturally imply a change to existing working con- ditions. Certainly, arrangements would have to be made to remu- nerate hospital staff for the extra hours. Couldn't it be argued then, that the proposal is also a bargaining chip, placed on the table by a un- ion demanding better work con- ditions for its members? Balzan rejoins that it is not just doctors who are involved in the proposed reform. "A doctor does not work on his own, and needs supporting staff such as receptionists, nurses, clerks, and support services such as X-rays, blood tests, or ECGs, depending on the speciality." As for improved conditions, he argues that these are already envisaged in the present govern- ment-MAM agreement. The real issue, he insists, is with the administrative set-up. "To date, Mater Dei management has failed to organise the necessary supporting services with the re- sult that most lists keep getting longer and longer…" Meanwhile, controversies re- garding other aspects of the health service seem to also keep surfacing. At present, the gov- ernment is proposing a change to the 'Embryo Protection Act' – which regulates assisted fer- tility in Malta – to allow for the possibility of embryo freezing: a contentious practice, opposed by a vocal anti-abortion lobby. MAM has so far not comment- ed in public on this issue. Does the association have any position on embryo freezing? "MAM has been traditionally against abortion… and prima facie, it appears that embryo freezing may result in accidental loss of embryos. But we prefer to look more in depth into the de- tails of this technique before for- mally declaring our position." Interview Can Malta afford to maintain a costly free health service in the face of population growth and ageing demographics? Yes, argues Malta Medical Association secretary MARTIN BALZAN… but not with current policies time-bomb? PHOTOGRAPHY BY RAY ATTARD