Lino Spiteri - Talking point - Consultant salaries - 1/9/2007

link Article 02 in The Times

Talking point
Public health and private medicine
Lino Spiteri

An article in the business section of The Times (August 23) titled Private Consultants Up To 20 Times More Expensive set the cat among the pigeons in the medical profession. Various consultants I know well considered the perception created by the article as very unfair, and also queried its basis. That was a dissertation by a graduate student in which she compared the cost of 10 surgical interventions at St Luke's and in a specified private hospital. My contacts felt the study itself was awry and did not compare like with like.

The issue of public health and its satisfaction is the subject of ongoing discussion, ranging from the flight of graduating medical students to foreign pastures to the flight from practical reality that is the definite functioning of the Mater Dei Hospital. In between all sorts of oddities crop up. These include the belated realisation that there are not enough nurses to service the projected needs of the new hospital and other medical centres. As a consequence it is planned to import expatriate nurses, even as mature members of the health care sectors at times wonder why they returned to Malta after specialising abroad, and toy whether to fly in the opposite direction.

The bubbling issue should not for one moment blur the basic facts. These are that we have one of the finest public health services in the world, manned by professionals who can take up employment anywhere in the global society. That the private part of the health service, including specialists, family doctors and paramedics gives very good service, albeit at not inconsiderable price.

Another basic fact is that members of the medical staff in the public hospitals are, objectively and comparatively speaking, much underpaid. A consultant, with qualifications that allow the person a passport to the best hospitals in the world, gets a princely Lm11,000 annually. If it were not for the fact that consultants also work in the private sector one can see a massive outward migratory wave building up. The dissertation on which The Times' report was based aimed to develop a methodology that could be used to set up a remuneration mechanism to finance hospitals.

Such a system, known as a Diagnosis-Related Group System, was introduced in the USA and various other countries use it. To discover to what extent the system can be fruitfully used in Malta, considerable further research would be required, along with a range of adjusted assumptions.

From a straightforward economic standpoint, the cost of public health care cannot be compared to that available in the private segment of health care. Users of the latter sector are not driven there by dire necessity - that is covered in the public health care which offers the whole gamut of care. Those who resort to private medicine do so to be ahead of any queue that may exist in state hospitals and for the "hotel aspect" whereby they get more personal attention and comfort in the follow-up to the medical care given by the specialist of one's choice.

Another naked fact is that users of private medical care are generally covered by health insurance. The economic rate borne by insurers cannot be compared with the social cost of similar care in a state hospital, where the taxpayer pays for the "free" factor, and the professional staff "subsidise" the cost by accepting, albeit reluctantly, to be very markedly underpaid.

The mix of public care and private medicine can be improved, especially were the administration of the day willing and able to pay economic rates. The ongoing debate, however, should never be allowed to mask the fact that we enjoy top-drawer healthcare, in the first instance thanks to the medical professionals.

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