1. The performance of the Maltese health system: An idiosyncratic story
K. Grech1,2, N. Azzopardi-Muscat1,2,
N. Calleja2
Department of Health Services Management, University of Malta, Malta
Directorate for Health Information and Research, Ministry for Energy and Health, Malta
European Public Health Conference Milan 2015

2. The Maltese Health System
Malta’s population > 420,000 (plus expatriates)
316 sq.m most densely populated country in Europe
Tax based NHS which is free at the point of use
Integrated model (MOH responsible for public health services delivery, regulation and policy)
Public sector – Dominates hospital services
Private sector – Primary and ambulatory care
Church / NGOs – Elderly and social care provision
European Public Health Conference Milan 2015

3. Objectives of the health system
Health Act (2013) – “To establish and ensure a health system based on equity, accessibility, quality and sustainability”
Four pillars of the National Health System Plan
respond to increasing demand and challenges
increase equitable access, availability and timeliness
improve quality of care
ensure sustainability
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4. Financial protection and equity in financing
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5. Financial protection and equity in financing
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6. User experience and equity of access
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7. User experience and equity of access
European Public Health Conference Milan 2015

8. International Comparison
Health outcomes (1)
Indicator
Trend Over Time
International Comparison
Assessment
Self-perceived general health (SILC) according to income
Stable
Malta fares better
Good
Standardised mortality rates
Improving
Malta fares the same
Standardised premature mortality rates
Very good
Prevalence of adults with diabetes, hypertension, hypercholesterolaemia
More data/research is needed
Annual Incidence of Type 1 Diabetes in children
Deteriorating
Poor
Life Expectancy at birth and at age 65
Perinatal mortality rate
Satisfactory
Infant mortality rate*
Malta fares worse
Very Poor
Child mortality rate (1-14 years).
Standardised Cancer Incidence Rates - Colorectal
*Termination of pregnancy is illegal in Malta
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9. European Public Health Conference Milan 2015
Health outcomes (2)
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10. Quality of Primary Care
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11. Health system efficiency
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12. Transparency and accountability
Number of new national policies over past years
New Health Act with clear lines of responsibility
HSPA to increase performance assessment and accountability
However
no formal hospital governance frameworks yet
no formal clinical auditing or financial reporting requirements
no clear mechanism for medicines pricing
European Public Health Conference Milan 2015

13. European Public Health Conference Milan 2015
Conclusion
Relatively good health outcomes (threat from obesity)
Supply constraints (nursing, beds)
Hospital focused public health services
High out of pocket payments but low unmet need for care
Access to innovation, development of primary care and community services for the elderly are the key challenges
European Public Health Conference Milan 2015