3.4 Out of pocket payments
Out-of-pocket payments mainly consist of direct payments, which can be for private general practice care, specialist care, medicines and elective surgery, but the majority of out-of-pocket spending is for general practice and ambulatory specialist care. Two entitlement schemes that exempt individuals from out-of-pocket payments for medicines are in place – one is means-tested and the other is disease specific. The Maltese health system registers a relatively high percentage of out-of-pocket payments when compared to other EU health systems.
Residents of homes for older people contribute 60% of their total income (this includes their pension from the Social Services Department, bonuses, foreign pensions, bank interest, rents, etc.). Residents at St Vincent De Paul contribute 80% of their income, provided that they are not left with less than €1400 per year at their disposal (Parliamentary Secretary for Rights of Persons with Disability and Active Ageing, 2016).
3.4.1 Cost-sharing (user charges)
There is no cost-sharing for public health services in Malta.
3.4.2 Direct payments
In Malta there are no user payments at the point of use for goods or services for health care. However, for the few services which are means-tested, such as elective dental care, optical services and some formulary medicines, these are largely paid for out of pocket, although some patients may be covered through private insurance for certain services and medicines.
3.4.3 Informal payments
Whilst there is no evidence of the existence of informal payments for utilization of public health care services, anecdotally it is suggested that patients may seek to consult doctors privately in the hope that this will give them more individual attention or preferential care within the public health service. No studies on this particularly sensitive topic are known to have been carried out.