Malta and Cyprus: What can they learn from each other and what lessons emerge for health system reformers?

Cylus, JD; Muscat, Natasha Azzopardi

doi:10.1093/eurpub/cku163.098

Cited by 1 publication

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“…As with the rest of the countries under consideration, Malta has two healthcare systems (public and private), and practitioners are allowed to participate in the private system, as well as the public system. The public or government healthcare platform is free to all Maltese and European citizens ( 24 ). However, the private sector utilizes insurance policies to provide medical care to the patients who opt for it ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

“…Foreigners in Malta are encouraged to use the private healthcare system and are advised to take medical insurance for the same purpose ( 26 ). Financing in the healthcare sector is therefore predominately sourced from the public sector ( 24 , 25 ). The quality of Malta's healthcare services is uniquely high and, as mentioned earlier, the country was ranked fifth by WHO in 2000 ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Cyprus is the only EU member state without (near) universal public health coverage, with around 83% of the population in 2014 covered by free healthcare ( 12 ). The nature of the current healthcare system in Cyprus encourages residents to take up private insurance since the public system is largely inefficient, with problems related to coordination, waste of resources and corruption in public hospitals ( 24 , 34 ). In 2013 the Cypriot government, upon the recommendation of the European Central Bank, the International Monetary Fund and the European Commission, announced its intention to reform the health service and establish a National Health Insurance Scheme (NHIS), with the aim of ensuring universal coverage ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

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High Out-of-Pocket Health Spending in Countries With a Mediterranean Connection

Grima

Spiteri

Jakovljević

et al. 2018

Front. Public Health

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In this study, we analyzed healthcare provision and health expenditure across six Mediterranean countries that adopt the National Health System (Beveridge model) and that form part of the European Union (EU) with the main aim being that of analyzing and comparing out-of-pocket health spending in countries with a European Mediterranean connection. To this end, we considered various economic indicators and statistics to derive commonalities and differences across these countries and also compared trends in these indicators to those observed across the rest of the EU. We then analyzed these findings in light of other data related to the quality of healthcare delivery and the infrastructure of the health system and discussed recent developments in healthcare within each country and the main challenges faced by the respective health systems. The results show that on average, Mediterranean countries spend less on total healthcare expenditure (THE) than the EU average, both as a proportion of GDP, as well as in per capita terms. This is primarily driven by lower-than-EU-average public funding of healthcare. The 2008/2009 macro-economic and financial crisis had a significant impact on the countries under review, and explains the persistent reductions in public health spending as part of the austerity measures put in force across sectors. On the flipside, Mediterranean countries have a higher presence of private health providers in total funding, thereby explaining the higher Out-of-Pocket (OOPs) health expenditures in these countries relative to the EU-average. With regard to the overall health infrastructure in these countries, we observed that although the supply of physicians is largely in line with the rest of the EU, there is under-supply when it comes to hospital beds. This may be symptomatic of lower government funding. Nonetheless, all countries score highly in the evaluation of the quality of health services, as recorded by international rankings like the WHO's 2000 metric, whereas health system performance indicators, namely mortality rates and life expectancy reveal favorable health outcomes in the Mediterranean EU countries. The findings in this paper may be seen in light of the Mediterranean region's lifestyle in terms of diet, health behavior, health beliefs and shared culture. In particular, the higher out-of-pocket expenditure may reflect the tendency for one-to-one relationships with private clinicians and the pursuit of person-centered care (1). Additionally, the Mediterranean people may not be as disciplined as their European counterparts in accessing and using the public health sector. The lower THE also reflects the fact that the Mediterranean countries are less wealthy than the more economically-advanced European countries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%