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Letter to Sunday Times in reaction to article by P.Hansen - 8/9/2003

Pamela Hansen’s new challenge to Greek Mythology

With reference to the article “Survey findings on high cost of private medicine confirmed” MAM would like to point out a number of inappropriate conclusions reached by Ms Hansen.

Prof. Vassallo’s study only shows that there is a perception that private medicine is expensive. Only a health economics study of cost-effectiveness could establish if this were true.

However in reality doctors’ fees are very cheap and widely accessible when compared to other services or indeed rates charged overseas. Even a bed in a private hospital costs much less than it costs the state as management is leaner and more efficient.

This wrong perception that private medicine is expensive has been long encouraged by the state itself, which while providing a “carte blanche” free health service, at a yearly cost of tens of millions to the tax payer, spends little on education on what health care really costs. However a reputable opinion leader such as Ms Hansen should be saying that if there are 130,000 tax payers and the state spends 66 million liri a year on health then every tax payer is contributing an average of Lm500 per year. Is that free?? Is that cheap ?? And this without calculating the cost of the new hospital which already cost every taxpayer Lm800. Ms Hansen’s calculator could be put to better use here.

The statement that a practitioner might earn up to Lm180 a day is very unfair. First of all only a handful of doctors out of the around 800 who practise medicine in Malta can earn that amount. Secondly the fairness of the price can only be judged from the value for money of the service provided. Indeed if a doctor manages to attract that many clients, it only means that he is providing the service at very good value for money and not the contrary.

MAM re-assures Ms Hansen that in a small country like ours anybody who charges Lm100 for ten minutes will not have that many clients for long. However should anybody experience Ms Hansen’s unrealistic fantasy, then the matter can be reported to the Medical Council for objective evaluation.

Even more unfair is the criticism that a 15 minute ultrasound is charged at Lm30. That fee also covers the cost of the equipment, meaning it has to cover the initial cost of an ultrasound machine which may cost around Lm20,000. It will take no fewer than 670 visits to recover the initial cost of the machine meaning it would take some time before that machine churns up any profit. Moreover a radiologist's practice often employs the services of a radiographer and a receptionist / secretary. Perhaps if Ms Hansen were to visit her hairdresser, and looks at her bill, than she may interpret facts in the proper perspective. But then did her hairdresser have to undergo a 5 years university course and a further 6-8 years of post-graduate training?

The MAM would also like to point out that the salary of consultants nowadays in the UK is around GB₤100,000 per year, meaning around 7 times the salary of a local consultant. Should the state decide to follow Ms Hansen’s advice, doctors (especially consultants) and their families would be the first to celebrate. Despite being grossly underpaid, and being accused of merely fishing for private practice, client satisfaction was very high according to Prof. Vassallo. Official figures also show that the productivity is very high.

MAM would like to remind “The Times” readers that MAM and health insurers have been guided by an agreement dating back to 1997 determining the maximum re-imbursements by insurers for every single patient contact or procedure. A new agreement between MAM and all Health Insurance providers has now been finalised and will hopefully come into effect for another 4years in an effort to keep private medicine attractive to the consumer, even though it is virtually impossible to compete with a service which is "free". As to the statement that the health insurers are acting primarily in the interest of the medical profession rather than their clients MAM is lost for words to describe the absurdity of this assertion and would leave it up to the Malta Association of Insurers to set the record straight.

In conclusion the comments made by Dr Louis Deguara making everybody aware of the costs of healthcare are most welcome. These comments and any hard measures the government might take are not going to be very popular, but now that the state has started calling a spade a spade, leading journalists like Ms Hansen should comment fairly and responsibly.

Dr Martin Balzan M.D. M.R.C.P.(UK)

General Secretary

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