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When Malta gained independence from the UK in 1964, it retained a health system modelled loosely on Britain’s National Health Service. Public health care is funded through taxation – all residents can get free health care in public health centres, clinics and hospitals. Virtually the only treatments that are not always covered are in vitro fertilisation and some cosmetic surgery. A WHO report in 2000 ranked Malta fifth in the world for its health system, beating the UK, France and the USA.
Health care in Malta is a combination of both private and statutory systems, with care in the public sector highly centralised and regulated with a governmental focus on quality of care. Publicly funded primary health care is delivered through eight health centres – seven in Malta and one in Gozo – supplemented by a further 42 clinics around the country. The health centres are staffed by nurses and GPs, and offer services such as antenatal and postnatal clinics, well-baby clinics, diabetes clinics, ophthalmic clinics, podiatry and psychiatric clinics. Most pharmacies offer a GP service at specified times, but patients usually pay to use this. There are five public hospitals – two are acute hospitals and three are specialised hospitals; there are also a number of private hospitals and clinics. The main hospital in Malta is the Mater Dei Hospital – one of the largest medical buildings in Europe.
Private health services
A rise in the take up of private health care has led to an increase of private health care clinics and hospitals in Malta. Private health services can either be paid for through insurance or on a pay-as-you-go basis. Large employers sometimes contract private doctors to tend the needs of their employees. Most state-employed GPs also work in private practice.
All residents have access to preventive, investigative, curative and rehabilitation services in public health centres and hospitals; those with chronic conditions get free pharmaceuticals. The Ministry of Health, Elderly and Community Care is responsible for all health services, including policy and planning, health promotion and primary care.
Malta has developed a solid regulatory infrastructure for the pharmaceutical sector through the autonomous Medicines Authority and, in pursuit of the country’s aim to become a destination for health tourism, the government has implemented various policies to attract growth in the pharmaceutical industry. The Roche-Bolar Exemption, for example, was established by the government to allow Maltese companies to develop generic drugs in advance of patent expiry to speed up access to the market. These policies have attracted large multinationals to operate in the country.
For specialised treatment that is beyond the scope of Malta’s hospitals, there is an agreement with the UK that allows Maltese nationals to be treated in Britain.
Women aged 50–59 in Malta and Gozo are invited to receive free breast screening every three years. Free immunisation is available for children and employees at risk of contracting TB or hepatitis and TB.
Non-communicable diseases (NCDs) accounted for an estimated 92% of all mortality in Malta in 2012. The most prevalent NCDs in Malta are cardiovascular diseases, which accounted for 39% of total deaths across all age groups in 2012, and cancer, accounting for 31% of all deaths. Non-communicable variants of respiratory diseases and diabetes contributed 4% and 2% to total mortality, respectively (2012). Communicable diseases along with maternal, perinatal and nutritional conditions in Malta accounted for an estimated 4% of all mortality in 2012. A government paper on HIV/AIDS reported that there were an estimated 300 people living in the country with HIV in 2013. The World Health Organization (WHO) considers Malta a non-endemic country for malaria. The estimated incidence of tuberculosis (TB) has increased significantly overall in the period 1990–2013, with significant fluctuation in rates over this period. Estimated mortality from TB (when mortality data excludes cases comorbid with HIV) has remained below one death per 100,000 people since 1991.
In 2013 government expenditure on health was 6% of GDP. In the most recent survey, conducted between 1997 and 2012, there were 350 medical doctors, and 709 nurses and midwives per 100,000 people. There is universal maternal health care in Malta. Additionally, in 2013, 99% of one-year-olds were immunised with a dose of measles. In 2014, everyone was using an improved drinking water source and had adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Malta has 80 pharmaceutical personnel per 100,000 people.
Roughly a third of health care in Malta (34%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 9.1% of GDP in 2012, of which 66% was covered by the government.
Malta has a life expectancy of 80 years, up from 75 years in 1990 and 78 years in 2000. Gains have been primarily due to reduced child and maternal mortality, and improved longevity for other age groups, particularly for older people with chronic diseases.
Communicable and non-communicable diseases
Non-communicable diseases are Malta’s biggest health issue. Bronchial asthma is a particular health concern – its high prevalence is partly explained by the hot and humid climate, genetic disposition and high smoking rates. The Ministry of Health, Elderly and Community Care has introduced policies focused on raising awareness of the health risks associated with smoking, especially among women. Malta ratified the WHO Framework Convention on Tobacco Control in 2003 and the amended Smoking in Public Places Regulation came into force in 2004.
The rate of childhood obesity is one of the highest in the world.
Current policy documents that focus on health promotion and primary prevention include the Non-Communicable Disease Strategy 2010, the National Cancer Plan 2011, the Sexual Health Strategy 2011, the Healthy Weight for Life Strategy 2012, the Tuberculosis Prevention Strategy 2012 and a strategy aimed at addressing the needs of dementia sufferers, together with their families and carers. Most of these strategy documents are target based, with impact assessments being prepared. Malta’s accession to the EU in 2004 was instrumental in driving policy on new legislation on health.
A new Mental Health Act, promoting the rights of mental health patients and encouraging community treatment schemes, came into effect in 2013. A general Health Act was also approved by the Maltese parliament in 2013, creating a modern framework to separate policy from regulation and operations. Its focus on disease prevention and community services has led to the launch of Malta’s first cancer screening programmes.
Malta has signed and ratified the International Covenant on Economic, Social and Cultural Rights, which includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination
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