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

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

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 European Public Health Conference Milan 2015

Financial protection and equity in financing European Public Health Conference Milan 2015

Financial protection and equity in financing European Public Health Conference Milan 2015

User experience and equity of access European Public Health Conference Milan 2015

User experience and equity of access European Public Health Conference Milan 2015

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 European Public Health Conference Milan 2015

European Public Health Conference Milan 2015 Health outcomes (2) European Public Health Conference Milan 2015

Quality of Primary Care European Public Health Conference Milan 2015

Health system efficiency European Public Health Conference Milan 2015

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

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