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 |