Can people afford to pay for health care? New evidence on financial protection in Malta

Overview

This review is part of a series of country-based studies generating new evidence on affordable access to health care (‎financial protection)‎ in Europe and central Asia. Financial protection is central to universal health coverage and a core dimension of health system performance. The incidence of catastrophic health spending is higher in Malta than in many other western European countries but lower than in countries with a similarly heavy reliance on out-of-pocket payments. It is largely concentrated in poorer and older households and mainly driven by spending on dental care, outpatient medicines, outpatient care and medical products. In the poorest fifth of households it is mainly driven by outpatient medicines and outpatient care. Unmet need for health care, dental care and prescribed medicines is consistently below the European Union average. Income inequality in unmet need has fallen since 2017 for health care and dental care but remains an issue for prescribed medicines. Coverage policy in Malta has some highly protective features: entitlement to publicly financed health care is based on residence and there are no user charges (‎co-payments)‎ for covered health care. However, key gaps in coverage are likely to undermine financial protection: coverage of outpatient medicines is limited to people with chronic conditions or low incomes; non-emergency dental care coverage is also limited; there is no cap on out-of-pocket payments; and long waiting times push people to access care privately. Increases in public spending have reduced Malta’s reliance on out-of-pocket payments in recent years but out-of-pocket payments remain a challenge and require policy attention, particularly to reduce financial hardship and unmet need for people with low incomes and older households.