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22 March 2024 | Country Update
Malta has a new Ministry for Health and Active Ageing -
31 January 2024 | Country Update
Malta’s hospitals’ concession agreement with a private consortium has been rescinded
2.3. Organization
Health services are provided mainly by the state and the private sector, though there is some involvement by the Catholic Church and voluntary organizations to provide long-term and chronic care services. The public health care system provides a comprehensive basket of services to all persons residing in Malta who are covered by Maltese social security legislation and also provides for all necessary care to groups such as irregular immigrants and foreign workers who have valid work permits. There are no user charges or co-payments for health services. The private sector acts as a complementary mechanism for health care coverage and service delivery.
The state health service and private general practitioners (GPs) provide primary health care services, although independently from one another as the latter are estimated to account for around two-thirds of consultations. Secondary and tertiary care is mainly provided by specialized public hospitals of varying sizes. The main acute general services are provided by one teaching hospital incorporating all specialized, ambulatory and inpatient care and intensive-care services. When it comes to the provision of highly specialized care for the treatment of rare diseases or specialized interventions, patients are sent overseas because it would be neither cost-effective nor feasible to conduct such treatment locally.
The main actor in the health system is the Ministry for Health, responsible for the provision of health services, health services regulation and standards, and the provision of occupational health and safety (see Fig2.1; see also Box2.1 for the reshuffle that took place between 2014 and 2016). The Ministry for the Family and Social Solidarity also provides some health services within its portfolio, which includes social policy and policy relating to children, family and people with disabilities, older people and community care, social housing, social security, pensions and solidarity services. Ultimately, the Ministry for Finance is generally responsible for Malta’s economic policy and consequently allocates budgets for all ministries. The private system is market-driven and comprised of autonomous, independent providers. In 1995, following an amendment to the laws regulating provision of private health care, private hospitals were opened and private clinics were able to register as hospitals provided they satisfied the regulations.
| Fig2.1 | Box2.1 |
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The 2013 Health Act replaced the Department of Health (Constitution) Ordinance, which was enacted in 1937 and assigned powers to specific government positions. The Act creates a basic framework for the public component of the health system. In essence, it seeks to regulate the entitlement and quality of health care services and providers, and to consolidate and reform the government structures and entities responsible for health. To this end, the Act establishes three directorates: the Directorate for Policy in Health, the Directorate for Health-Care Services and the Directorate for Health Regulation. In addition, the Act also aims to empower patient rights and safety, and provides for the enactment of a Charter for Patient Rights and Responsibilities. Many details concerning the roles and responsibilities of the bodies established by the Health Act will be determined by subsidiary legislation.
Within the Ministry for Health, the Permanent Secretary is the administrative head. S/he is a public officer accountable to the Prime Minister. S/he has the responsibility to support the general policies and priorities of the Government and to operate within the context of management practices and procedures established for the Government as a whole.
The Act clearly defines the roles of the three directorates. The Chief Medical Officer, as the person responsible for the Directorate for Policy in Health, will act as chief adviser to the Minister for Health on all matters related to government health policy. The Director-General for Health-Care Services will ensure the effective and efficient operation and delivery of health care services. The Superintendence of Public Health, who leads the Directorate for Health Regulation, will safeguard public health, licensing, monitoring and inspecting provision of health care services with respect to quality and safety; the Superintendence will also advise the Minister for Health on matters related to public health.
In addition to the three directorates described in the Health Act, there are three bodies that play an important regulatory and advisory role. These include the Health Policy and Strategy Board, the Council of Health and the Advisory Committee on Healthcare Benefits. The Health Policy and Strategy Board brings together all the directorates, the Minister for Health, the Permanent Secretary and the financial controller of the Ministry for Health to ensure a concerted approach towards policy development and implementation. The Council of Health brings together the Government and other stakeholders to advise the Ministry for Health on matters related to public health. The Advisory Committee on Healthcare Benefits recommends the benefits package to be provided by the public health care system and maintains a publicly accessible list of such benefits.
In addition to the above, in the interests of patient rights the Government established three commissioner functions: the Commissioner for Health, the Commissioner for Mental Health and the Commissioner for the Elderly. These officials act as Ombudsmen in dealing with grievances and concerns from the public in their respective areas. In particular, the newly established Mental Health Act assigns rights and responsibilities to the Commissioner for Mental Health, primarily to safeguard the well-being of patients and the public.
There are also various other bodies, which arise out of other legislative instruments. These include regulatory professional councils, government boards and committees with specific functions. Their main role is to act as advisers to the health authorities and the Minister on very specific issues. Some of the Boards also have a decision-making function related to their area of concern. Boards and committees include, but are not limited to: the Advisory Committee for Immunization Policy, Committee on Smoking and Health, Food Safety Commission and Government Formulary List Advisory Committee and Appeals Board.
A number of voluntary organizations (nongovernmental organizations, NGOs) exist to promote health-related activities. They range from those having a broad scope of activity to patient self-help groups for specific illnesses. They act as policy advocates, self-help groups and service providers. There is no umbrella organization to bring these groups together, although the Malta Health Network is increasingly assuming this role, and they are not formally represented on decision-making bodies.
The Catholic Church still plays an important role in the provision of nursing homes for older people, homes for people with disabilities, homes for people with mental disorder and homes for children. However, it is increasingly facing great difficulties in continuing to provide these services as the care providers are dwindling in number. This is because most nuns are now in older age and are not being replaced by sufficient younger ones, as well as the limited resources available.
A number of associations exist for the health professional groups. These include the Malta Union of Midwives and Nurses, the Medical Association of Malta, the Dental Association, the Chamber of Pharmacists, the Nursing Association of Malta, the Malta Association of Physiotherapists and the Midwifery Association. The Malta College of Family Doctors and a number of specialist associations are also active, mostly in the field of providing continuing education.
Some of the above-mentioned associations are also registered trade unions and represent their members to various bodies both at local and international level, including Government. Other health service employees are represented by sections of the two largest national unions: the General Workers Union and the Union Haddiema Maghqudin – Voice of the Workers.
Following a cabinet reshuffle in January 2024, Chris Fearne has been appointed as Minister for European Funds, Equality, Refroms and Social Dialogue, whilst Jo Etienne Abela has been nominated in his stead as Minister for Health and Active Ageing. Beyond the change in leadership, the Ministry for Health has a new expanded portfolio, merging its mandate and operations with the Ministry for Active Ageing, as Dr. Abela retains his previous position as Minister for Active Ageing. The two Ministries had already functioned under one roof in past legislatures.
As the Ministry takes up operations under its new remit, a range of new policies and initiatives are expected to be launched over the coming year. This includes a national strategy to fight dementia, highlighting the cross-cutting mandate and priorities of the newly formed Ministry for Health and Active Ageing.
References
Malta: Country Health Profile 2023, https://eurohealthobservatory.who.int/publications/m/malta-country-health-profile-2023