Conclusions of health services survey
This study confirms that the majority are generally satisfied with the medical service in Malta. In fact, 56.7% agree that they are generally satisfied with the various aspects of the health service, while 43.3% stated that they are not generally satisfied. This feeling was expressed about the health system as a whole, i.e. including both state-run and private medicine taken together.
Satisfaction is highest amongst those aged 65 and over (71.7%); dissatisfaction is highest among those aged 36-50 (55.3%). The highest level of satisfaction was registered among AB (67.4%), while the highest level of dissatisfaction was registered among C2 and DE (53.3% and 50% respectively).
The most common reason spontaneously put forward by those who expressed satisfaction was simply that "hospital services are adequate" (70.6%). Another 30% explained their viewpoint because "the service is free", while 17.1% pointed out that 'Maltese doctors are good'. Another 15.9% stated that the "health centres were good", while 11.2% explained that they were satisfied because of "free medicines".
A mere 2.9% said that "the services meet one's needs" and that "private medicine is excellent". Yet another 2.4% praised the staff for being helpful. All these reasons were given spontaneously, and many offered to give more than one reason.
It is interesting to note from the detailed breakdowns of this group of replies that the health centre services received least praise from DE respondents (17.6%), while they received the highest praise from AB respondents (6.9%).
Conversely, the most common reason given was "waiting is too long", a reason given by 70.8%. This is followed by "many things are lacking" (36.2%), "results take too long" (18.5%), "poor hygiene" (18.5%), "the patient is given little attention" (15.4%), "private medicine is expensive" (11.5%). "The doctor is never the same" and "Some patients receive preferential treatment" were respectively mentioned by 7.7% and 6.9%. "Medicines are expensive" received 5.4% spontaneous mention, "diagnosis is never given" and "equipment is lacking or does not function" were mentioned by 3.8% and 2.3% respectively.
The detailed breakdowns of this set of replies show that "Waiting time is too long" is a particular source of dissatisfaction for those aged 65+ (84.6%), and to those aged 36-50 (76.6%), but registered high percentages for all age groups. Of the socio-economic groups, it was most frequently mentioned by those in the C1 socio-economic group 75.8%). This is, in turn, linked with the lack of certain facilities. Males are more critical in this regard (at 41.3%) than their female counterparts (31.3%). Females are however more critical than males on the fact the results take too long (20.9% vs. males 15.9%). Most critical in this respect are those aged 51-65 (25.8%) and the members of the AB (28.6%).
Areas for improvement
This study also sought to elicit views on what aspects of the health system called for improvements. The appointment system is the area that a large number of Maltese (63.7%) spontaneously referred to when they were asked a question on this subject. This was followed by concerns on the cost of private medicine (20%), levels of hygiene (another 20%), quicker results (19.7%) and the cost of medicine (16.3%). Other aspects, like "true equality of access", "more staff" were also mentioned, but by much fewer persons. It is to be noted that participants could give more than one area where they want to see improvements, and as such the totals add up to more than 100%.
A detailed analysis of the breakdowns shows that the need for improvement in the appointment system concerns all sections of the Maltese population, and most those aged 26-35 (80.8%), members of the C1 socio-economic group (64.9%).
In turn the cost of private medicine was spontaneously mentioned most often by those aged 51-65 (28.6%) and by persons n the C2 socio-economic group. But even this aspect is of considerable concern to all socio-economic groups: AB: 14%; C1: 17.5% and DE: 11.8%. It has to be recalled that all these were spontaneously mentioned, and as such constitute a main preoccupation.
Reference to the high cost of medicines is also equally spread, with the highest figures recorded by persons aged 51-65 (30%) and by persons in the C2 socio-economic group (19.6%). As such, it is very clear that these concerns for improvement do not belong to one particular component of Maltese society but are spread all across the board.
Preference for private medicine
For a number of years now public debate in Malta has been engaged on the different options available for the further development in social policy in respect of the medical service in Malta. All those taking part in this survey were specifically asked whether they prefer private medicine to the state-run system. Sixty-five per cent of the population prefer a private service while 35% preferred a government-run service.
The preference for private medicine is more articulated among females (66.4% vs. 63.5% females), most commonly among those aged 26-35 (75%) and among the C2 socio-economic group (71.7%).
These figures clearly point to a general dissatisfaction with the quality of care provided in the public sector. Although most prefer private medicine, they are at the same time very critical about its cost. In fact, as many as 94.3% consider private medicine to be expensive; only 5.7% think it is fairly priced.
These findings are quite significant especially in view of the lack of satisfaction expressed for the government- run system. Private medicine in Malta is known to have become much more expensive in recent times and people are feeling the pinch despite the fact that they recognise that they get a better service if they visit their preferred doctor or consultant privately.
In effect, the detailed findings unmistakably show that 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+ (97.8%). But even the very young registered a high 89.4% stating that they consider private medicine expensive. It is very significant that among the socio-economic groups so many of the professional class (AB) consider private medicine expensive (83.7%). The highest incidence in this regard was registered by those in the C2 group, at a very high 98.9%.
The current practice engaged by Maltese patients to have recourse to a consultant privately before seeking treatment in hospital was also asked about in this study. As many as 58% do not consider this practice to be fair on the ordinary person, while the remaining 42% do not consider it necessarily unfair. This tallies with the widespread belief that private medicine provides one with better care, since it naturally leads to one being treated by the consultant of one's choice.
Most against the practice are persons 65+ (at 69.6%), and persons in the DE socio-economic group (64.7%). But again even professionals (AB = 46.5%) consider it unfair that one needs to go privately to a specific consultant to be able to get treatment from the same person in the public service.
As many as 82% of the Maltese believe that expenditure on private medicine and visit private medical insurance should be tax-exempt since this constitutes a saving for government expenditure.
This study also addressed a number of issues regarding the government-run health centres. All the participants were first asked whether they ever used the services provided by the health centres. The findings show that as many as 91% have had some direct experience of these services; only 9% had not.
It is also incorrect to believe that these centres are patronised by one social group much more than it is by others since the usage figures for all the other categories are not low at all: AB: 88.4%; C1: 89.7%; C2: 93.5% and DE: 91.2%. This study very forcefully confirms that, possibly because of the increased cost of private medicine, and despite the belief that private medicine provides a better service, persons of all ages, and from all occupational groups of Maltese society, are perhaps being forced to use the health centres.
Questions on the extent of satisfaction by the services provided at the health centres were limited to those who had direct experience of them, which is 91% of all the Maltese population aged 16 and over.
Of those who have direct experience of the health centres 4.4% are very satisfied with their services, 43.2% are satisfied, 30% are neither satisfied nor dissatisfied, while 21.2% are dissatisfied and the remaining 1.1% are very dissatisfied.
When a 100-point Satisfaction Index is computed on the basis of these figures, the result obtained is a mere 27.96 points, which is quite low. Those "generally satisfied" are most numerous among those aged 51-65 (45.3%), and among members of the C1 socio-economic group (44.8%). Those "generally dissatisfied" are most numerous among persons aged 36-50 (25%) and among those in the DE socio-economic group (24.2%).
Conversely, the reasons for dissatisfaction with health centres point to two main complaints - long waiting times experienced (35.9%) and absentee doctors (14.1%). Staff shortages were also mentioned by 12.4%. Other reasons were given: lack of a professional services, incorrect prescriptions, the fact that patients are sent to St Luke's all too quickly rather than treated there, limited hours, bad mannered staff, too much bureaucracy shortage of medicines and lack of privacy.
Mater Dei Hospital
This study also collected views on two aspects related to the new Mater Dei Hospital. All those taking part in this study were asked whether they agreed that it was necessary to spend a lot of money to build a new hospital. Effectively, 84.7% are in favour of this decision; while the remaining 15.3% are not. Of all the age groups, most in favour are those aged 16-25 (91.5%) and persons in the C1 socio-economic group, at 87.6%.
What does this extent of approval translate itself into from a practical point of view? The Maltese agree with the project because they expect improvements in the health services. When asked to indicate where, a number of unprompted areas were mentioned. The area where improvement is most expected is in the quality of service to be provided, an item that was spontaneously mentioned by 52.3% of respondents.
This was followed by an expectation that waiting times should be completely eliminated (49.3%). An increase in the number of services and measures to prevent specialists from leaving hospital early were each mentioned by 20%. Other areas where improvement is expected are: better hygiene/more cleanliness: 15.3%; increase in discipline: 11.0%; all doctors should be employed full time: 7.7%; better environment for patients: 7.0%; services should continue to remain completely free: 3.3%; more qualified staff: 3.0%; improve catering services: 2.3%; more modern equipment: 2.0%; better management: 1.3%; more medicines: 1.0% and better emergency services: 0.7%.
This study confirms that there is a duality of views about the health services in Malta. On the one hand many recognise that the system generally delivers good medical care, but there are reasons which, despite one's will, are at the same time pushing patients to and away from their real preferences. Private medicine is recognised to be better, but too costly for many all across the social spectrum of Maltese society. This has given birth to a strange practice: one needs to visit a consultant privately to ensure that one is well looked after in the state-run system.
The effect on patients and doctors of this practice are very obvious. From the patient's point of view, this means that one has to pay twice to ensure a good service, through direct payment for private medicine and through taxation.
Among the members of the medical profession private practice is considered necessary because of what they consider to be low remuneration rates in the public sector. This effectively means that a private practice without access to the state-run system is financially not very rewarding because patients prefer to privately visit consultants with direct access to the state system. The issues involved in this tussle are obviously not easy to address, but it is clear that this study clearly confirms that the Maltese have a latent demand for a more open, more value-for-money health service in Malta, and one that truly, and not merely on paper, reflects their choice.
AB - professional, managerial, administrative
C1 - higher clerical, clerical, supervisor, skilled craftsmen and technicians, owner/manager of small business
C2 - skilled manual workers and foremen
DE - semi-skilled, unskilled, labourers, casual workers and persons whose income is provided by the state.