81% satisfied with health services - 1/9/2003

From the Sunday times of malta

73.7% have used health centres; 78% have used St Luke's sometime
A high percentage of the population is generally satisfied with the health service in Malta. According to the latest survey, carried out for The Sunday Times by sociologist Professor Mario Vassallo, 81.3% of those interviewed said they were happy with the service. Seventeen per cent said they were generally not satisfied, while 1.7% did not give an opinion.

The survey - the 11th in a series - was carried out in the first two weeks of August by telephone interviews with a randomly selected representative sample of 300 residents in Malta and Gozo, just before Health Minister Louis Deguara spoke on his plans to curtail some aspects of the service as currently provided.

Interestingly, those pertaining to the C2 (skilled manual workers and foremen) and DE (semi-skilled and unskilled) socio-economic categories registered the highest level of satisfaction, while those in the AB (professional, managerial, administrative) group are the least satisfied.

By far the main reason for satisfaction is that hospital services are free, while other reasons given were that the service and medicines are free. Those who expressed dissatisfaction gave the long waiting as the main reason, followed by the fact that results take too long.

An unexpectedly high number of respondents (73.7%) said they had direct experience of health centres. They are made most use of by those in the C2 category (80.9%). This seems to contradict what was stated by Dr Deguara, since the study confirms that persons of all ages, from all levels and from all occupational groups use the health centres, even if at time they also resort to private medicine.

Of those who use health centres, almost 77% said they were satisfied with the service they offered.

Those interviewed in the survey were also asked specifically about St Luke's Hospital, which is used by 78% of all respondents. Almost 84% of these are satisfied with the services provided. While those in the AB category expressed the most satisfaction (90.6%), those in the DE group were the most dissatisfied (24.4%).

The most common reasons for dissatisfaction were the long waiting times and the shortage of staff.

Almost 90% of those taking part in the survey agreed with the decision to build a new hospital, which will cost at least Lm100 million.

Asked whether they preferred private to public health service, only a third of respondents opted for the former. However, 92.7% of those interviewed consider private medical care and treatment to be expensive.

As many as 78% believe that expenditure on private medicine, in fact, should be tax-exempt.

Regarding a promise made by the Nationalist Party to introduce the family doctor of one's choice as part of the free public service, only 24% believe this will ever be honoured; 42.3% are sure it will never be; 19.7% still have some hope, while the remaining 14.3% did not give an answer.

Asked to comment on the results of the survey, Professor Vassallo said: "The impressions that public medicine is generally unsatisfactory and that it is used only by a small segment of the population are both wrong. This study shows that both the health centres and the hospital services are very regularly used by all the segments of the population. This study effectively confirms that many people from all walks of life are increasingly being pushed away from private medicine for all their needs in view of the steep prices they are being charged. The fact that users of private medicine feel that they are paying twice over (in tax and fees) further accentuates this.

"The findings in this study suggests that after many years of providing a free health service, and boasting about it, Government will now find it difficult to curtail, especially if the cost of private medicine remains unregulated. It is perhaps time for radical decisions to be taken in this regard and for clearer demarcations between who offers private medicine and who offers public medicine: during the interviews a good number complained that patients are often enticed to opt for private medicine to jump the queue and made to wait long if they do not comply.

"This study also confirms that the credibility of politicians to implement their promises is very low: only 24% of the Maltese think that the doctor-of-one's-choice scheme in public medicine will ever be introduced. The gap between politicians and citizens appears to be widening very fast, and this does not augur well for Maltese society," Professor Vassallo concluded.

Conclusions on survey on health services in Malta

What emerges clearly from the findings of the Sunday Times survey on health services in Malta is that they are clearly providing a service that is quite positively appraised, since 81.3% of respondents registered their general satisfaction with the Maltese system.

However, this should not be interpreted that satisfaction is universal: of the remaining, 17% unequivocally stated that they are unhappy with what they are getting from the public system of health care, while 1.7% preferred not express their views about the matter. A dissatisfaction level of almost 20% of all Maltese aged over 18 is not minimal, and the providers of the various public services would do well to meet expectations of their paymasters: the Maltese taxpayer.

That this is important is highlighted even more by the fact that large numbers referred to the 'free' aspect of the service as a main reason. As many as 27.5% said so, while another 27.9% stated that free medicines are available through the public sector.

In a later question on the cost of private medicine, as many as 92.3% consider private medicine expensive. Irrespective of the general impression given, even lately through official pronouncements, private medicine is actually preferred by only a third of the population. The cost factor could very well be a main reason for such preferences. Even so, 51.4% stated that they prefer publicly funded medicine because the hospital services are adequate.

Some of the reasons given for the dissatisfaction are in essence management and communication-related issues: long waiting times, delay in the provision of results and the feeling that the patient is not given enough attention as a person. That these issues are on the other hand addressed in the private sector suggests that there is a malady somewhere, and that a careful analysis of this problem could probably provide acceptable solutions if indeed the political will exists to implement change.

On the other hand, the reasons given to explain satisfaction with the public sector are noteworthy: besides those referred to above (in respect of the adequacy of the hospital services and the fact that the service and medicine are free), another 12.7% stated that the health centres are good. The fact that these comments came from a wide spectrum of citizens clearly shows that the many Maltese are appreciative of the system provided, even though they do not hesitate to be critical of its shortfalls.

Satisfaction and dissatisfaction runs across the various services provided, with the health centres around the island and with the general hospital. A careful reading of the tables shows that although particular sub-groups are more satisfied than others, the criticism levelled at the system is present in all of them. The increasing level of education of the Maltese in general makes criticism and the expression of demand more articulated. This mood has been very clearly captured by this study in respect of the health services.

What emerges quite clearly from this study is that the public service is used by all kinds of people, from all walks of life. This study confirms that 73.7% of the total population has used the health centres and that 78% has used St Luke's. This is a far cry from recently published figures suggesting that public services are patronised by small segments of the population.

Females used the health centres slightly more than males (77.1% vs 70.1%). Use is also more common among those aged 26-35 (82.4%), among the 65+ (80.4%) and among the C2 socio-economic group (80.9%) but it is incorrect to believe that these centres are patronised by one social group much more than by others since the usage figures for all the other categories are not low at all: AB: 63.6%; C1: 71%; C2: 80.9% and DE: 74.2%.

The situation in respect of St Luke's is not very different: Malta's main hospital caters for the needs of all socio-economic groups and persons from all ages. The respective usage for the socio-economic groups is: AB: 72.7%; C1: 84%; C2: 77.7%; and DE: 72.6%.

Health centres
An impressive 76.9% of those who have direct experience of the health centres are happy with their services, while 22.6% are not. Those most satisfied are those aged 51-65 (83.3%), and members of the C2 socio-economic group (80.3%). Most dissatisfied are those aged 26-35 and 36-50 (28.6% and 28.8% respectively).

Most complained about are the long waiting times experienced (44%) and absentee doctors (42%). The fact that working hours is limited was mentioned also by 32%. Other reasons given were incorrect prescriptions, the fact that patients are sent to St Luke's all too quickly rather than treated there, lack of professional service, poor quality medicines available and lack of hygiene.

On the other hand, as many as 83.8% of those who have direct experience of St Luke's Hospital are satisfied with the services; 16.2% are not. This study shows that males are generally more satisfied than females (86.8% vs 80.8%); those most satisfied are those aged 26-35 (86.5%) and members of the AB socio-economic group (90.6%).

Conversely, more females than males were dissatisfied (19.2% females vs 13.2% males). Those aged 18-25 registered the highest level of dissatisfaction at 17.6%. The socio-economic breakdowns show that those in the DE registered the highest level of dissatisfaction, at 24.4%.

This most common causes for dissatisfaction with services provided at St Luke's relate to long waiting times (mentioned by 42.1%) and the shortage of staff (36.8%). The most disturbing are aspects which go counter to the essence of hospital care, namely poor hygiene (28.9%), absentee doctors, poor quality medicines (15.8% each), lack of professionalism in the service tendered and a general atmosphere of carelessness (13.2% each) and incorrect prescriptions (7.9%).

When asked whether they agreed with the decision to spend Lm100 million pounds to build a new hospital, 89.3% of those interviewed said yes, 10.3% disagreed, while a mere 0.3% are unsure. Males are more in favour than females (91.2% vs 87.6%). All those aged 65 and over agreed with this decision. Of all the other age groups, most in favour are those aged 26-35 (88.2%). All DE members agree with this decision as well, and these are followed by members of the C1 socio-economic group, at 87%.

Private health care
The co-existence of public and private medicine has already been commented on above. The preference for a private medicine is more articulated among females (35.9% vs 30.6%), among those aged 36-50 (42.4%) and among the C2 group (37.2%). As already stated, as many as 92.3% consider private medicine to be expensive; 7% think it is correctly priced while a mere 0.7% consider it 'cheap'.

The belief that private medicine is expensive is common to all socio-economic groups and all ages. Males are relatively more aware of the expense than females, most aware of the expense are the more fragile 65+, but even the very young registered a high 87.5% stating that they consider private medicine expensive.

It is very significant that, of the socio-economic groups the highest incidence that private medicine is expensive was expressed by the professionals in the AB socio-economic group, at a high 93.2%. In this context it is not surprising that as many as 78% believe that expenditure on private medicine should be tax-exempt since this actually translates into a direct saving for government expenditure.

The last question in this study focused on the oft-vented idea that public medicine should be organised around the concept of a user-chosen family doctor. This study sought to collect views on whether the Maltese thought that this political commitment would ever be honoured. The findings show that very few continue to believe what politicians say to attract votes: only 24% actually believe that this promise will ever be honoured! Forty-two point three per cent are convinced that it will never be; 19.7% have some hope and said 'perhaps' while the remaining 14.3% did not commit themselves.

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