EU commission book on patient mobility - chapter on Malta - UK agreement - 7/6/2006

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New services halve number of patients treated abroad
Cynthia Busuttil

The introduction of cardiac surgery and magnetic resonance imaging (MRI) at St Luke's Hospital has more than halved the number of patients needing to be sent abroad for treatment.

The number of patients sent to the United Kingdom had reached an average of around 550 between 1992 and 1994 but went down to around 320 in 1995 when the Cardiac Unit was opened at St Luke's Hospital.

There was a further drop after the introduction of MRI screening in 1998 and the total number of patients referred to British hospitals annually has now stabilised at around 240.

The figures emerge from a paper in a new book called Patient Mobility In The European Union: Learning From Experience. It is compiled under the Europe For Patients project and published under the auspices of the European Observatory on Health Systems and Policies.

The paper on Malta, called Sharing Capacities - Malta and The United Kingdom, was written by Institutional Health director John Cachia, hospitals CEO Kenneth Grech, Health Ministry EU and International Affairs director Natasha Azzopardi Muscat and Health Services Management Division research assistant Deborah Xuereb.

A bilateral care agreement between Malta and the UK has been in place for the past 30 years and Malta has links with around 25 centres of excellence in the UK. The system, the authors explain, has its roots in the fact that most of the local doctors receive their specialised training in the UK and create close professional ties with key consultants.

The agreement provides for the referral of a quota of Maltese patients for treatment within the United Kingdom National Health Service. But the number of patients requiring treatment overseas has always exceeded the agreed quota, the authors say, adding that additional patients incur an additional charge to the Maltese government.

Patients who need to be sent abroad normally need bone marrow transplants, liver transplants, complex major spinal surgery, paediatric cardiac surgery, surgery of the jaw and face and specialist paediatric intervention. To date there have been no strong clinical and economic arguments to develop these services in Malta.

"The investment cost is too high, the patients are too few and full-time professional staff employed to perform this type of service will quickly become deskilled."

Moreover, the authors say, several specialists from British centres of excellence come to Malta once or twice a year to carry out consultations.

There are no statistics on Maltese seeking treatment abroad through the private sector but it is believed that these are only few in number.

On the other side of the coin are tourists who seek treatment while on holiday in Malta. The paper says there were 4,122 visits by foreigners to the St Luke's accident and emergency department in 2003 while 1,229 foreigners were treated as inpatients.

In 2004 the number of inpatients was 1,172 while 4,966 foreigners visited the accident and emergency department. The authors say the cost of treatment of foreign nationals accounts for around 2.4 per cent of the total recurrent hospital costs.

They argue that although local health care standards compare well with those in other EU countries, foreign patients' expectations still need to be managed carefully.

"Compared to Maltese patients, foreign patients have a greater propensity to make their feelings known and this gives rise to more praise or more criticism than local health care providers would normally expect. Anecdotal experience shows that they are more likely to institute formal complaints than Maltese patients."

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