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Table 4 Inertia and resistance to health system reform (Malta 2004–2014)

From: Europeanisation of health systems: a qualitative study of domestic actors in a small state

Health system continuity
Description Europeanisation Mechanism Analysis
Primary care Inertia Directive (on training of general practitioners) The necessary changes were implemented to the specialist training for general practitioners but otherwise no significant changes were reported and the planned 2009 reform was not implemented
Patient safety Inertia Non-binding EU Council Recommendation on Patient Safety Reports on the implementation of patient safety indicate that the Maltese health system has not made any significant advances on this aspect
Cross border care Inertia Directive Transposition of minimal requirements of the directive
Pricing and reimbursement Inertia Directive Minimum requirements of the transparency directive on medicines were transposed but no major changes to the system of pricing or reimbursement were implemented
Working time Retrenchment Directive Extensive use of the ‘opt-out’ clause for doctors agreeing to work more than 48 h weekly so as to avoid major changes to the system
Funding of public health care Retrenchment Country specific recommendations emerging from EU fiscal and economic governance mechanisms Despite health system sustainability being repeatedly mentioned in several annual reports the model of health financing has been strongly protected by successive Governments