Countries covered by the HSPM platform

24 March 2024 | Country Update
Malta launches a new seven-year National Dementia Strategy

6.2. Future developments

Most of the current and recent debates in the health sector have been related to ethical/moral issues, such as debates on revisions to the Embryo Protection Act in order to allow more possibility for embryo freezing, access to the morning-after pill, and euthanasia.

Health policy has been an area in which political consensus has prevailed in recent years with most legislative initiatives receiving support from both the governing party and the opposition. There is consensus on the desire to retain public health services free of charge at the point of use and preserve the current model of health care funding. There is a reluctance to debate health system sustainability notwithstanding that Malta received a Country Specific Recommendation urging the Government to tackle health system sustainability in 2013 and 2014. The public health system continues to be under pressure to deliver more with less. To this, one might add the recent drive by the Office of the Prime Minister to introduce key performance indicators for all ministries in Malta. The Ministry for Health is using a number of selected dimensions from the Health System Performance Assessment framework for this purpose.

Health care expenditure is projected to increase significantly in the long term, reflecting demographic trends. According to the European Commission, the efforts by the authorities to contain the long-term expenditure growth in the pension and health care systems so far do not appear sufficient to address this risk (2016). The steep increase in projected age-related expenditure is related in particular to pension expenditure (3.2 percentage points of GDP) but health care and long-term care expenditure also contribute to this projected increase (2.1 and 1.2 percentage points, respectively) (European Commission, 2016a).

Financing of the public health system has increased in recent years, albeit still remaining lower than the EU average. The Ministry for Health has to ensure tight budgetary control on the one hand with the Fiscal Responsibility legislation that has been introduced for Eurozone countries and on the other hand has to cope with demands made by newly established institutions to protect patients, such as the Health Commissioner (within the Office of the Ombudsman) and the Mental Health Commissioner. Furthermore, the implementation of the patients’ rights charter pledging to give access to the private sector for those patients who wait for a period longer than 18 months has also exerted pressure to increase activity and reduce waiting lists.

The major development is the privatization of three state hospitals. Some concerns have been raised in the public domain about the need to safeguard equity between private overseas fee-paying patients and domestic patients covered by the public health system. Efforts to strengthen the regulatory infrastructure and build capacity for service monitoring are expected to intensify in order for the Ministry to be adequately equipped to ensure quality and value for money in a future scenario where the integrated care model for funding of public hospitals, through direct budgetary control, is being replaced by a contractual relationship with a private for-profit provider.

Initiatives to curtail waste, promote evidence-based health care, foster efficiency in service organization and supply chain management, and monitor health systems performance have started and are expected to be further developed in the future. Areas of the health system which are considered to be underperforming compared with other European countries, e.g. mortality from cerebrovascular disease, are being identified with a view to closing this performance gap.

Investment is planned in a primary health care facility in the Southern Harbour region, a maternity hospital and a new mental health hospital. These are intended to redress the imbalance in resource allocation between the acute hospital sector and the remainder of the health system. The introduction of a single number and a call centre for all patient appointments is being planned. Likewise, EU funds have been sought for important -health projects intended to develop a nationwide electronic health record, facilitate e-prescriptions and ease integration of services. The Church in Malta has announced its intention to support the development of an inpatient palliative care facility in conjunction with the Malta Hospice Movement.

A strong focus on tackling noncommunicable diseases is expected to remain high on the health agenda with the Second National Cancer Plan, and a Health Enhancing Physical Activity Strategy expected to be adopted in the coming months.

In the first half of 2017, Malta assumes its Presidency of the Council of the EU for the first time. The health sector has chosen as its main themes childhood obesity and structured cooperation between health systems as a means of enhancing access to innovative medicines, technologies and highly specialized services. A conference on HIV/AIDS will also be organized.

In February 2024, the new Minister for Health in Malta, Jo Etienne Abela, launched a seven-year National Dementia strategy to improve the quality of and access to dementia services in the country. The aim is to strengthen the quality of life for those with dementia (and their loved ones) by increasing awareness and understanding of the condition; educating health workers on ways to detect and diagnose symptoms early; and helping those with the condition access high-quality care services and safe and supportive dementia-inclusive communities from diagnosis to the end of life. The strategy also contains a preventative element and aims to increase awareness of the modifiable risks and protective factors for dementia so that people take precautionary efforts to reduce their risks of developing the condition. This comes as dementia is increasingly impacting the Maltese population; Malta recorded the highest number of deaths caused by dementia in the EU in 2020 (above 80 deaths per 100 000 population), and estimates suggest that by 2050, 3% of the population will be living with the condition.