US patient trades insurance for Malta care
A writer who moved to Europe for free health care has found that the system has its advantages, but also some drawbacks. The writer, who has multiple sclerosis, breast cancer, and other health issues, was drawn to Malta’s socialized medicine system, which spends a quarter of what the US system costs per person and still has an average life expectancy of five more years.
The writer’s decision to move was motivated by the high cost of health care in the US, where they had been paying $26,888 a year for insurance, with a $6,000 maximum out-of-pocket expense. In Malta, they pay 38 euros a week, about $2,300 a year, which covers them and their medications, including a $80,000 per year medication that they need.
In Malta, the writer has found that the public health care system is guaranteed, but the speed and convenience of care are often found in the private tier. The writer can walk into a pharmacy and see a general practitioner for 15 to 20 euros, or a specialist for 70 euros, always paying in cash. The writer’s neurologist works in a hospital one day a week and in four different pharmacies on other days, allowing patients to choose the location that is most convenient for them.
The writer has also found that the Maltese system has a lot of paperwork, with forms still being used on paper. To get their medication for free, the writer had to scan and send receipts to prove that they had paid into social security, and then wait for a form to be mailed to them. The writer has not received reminder texts or confirmation calls, and has to keep track of their appointments and medications themselves.
Despite the advantages of the Maltese system, the writer worries that if their cancer comes back, they won’t have access to the same level of care that they would have had in the US. The writer is also concerned that some medications, such as Tolebrutinib, which is approved in the EU but not available in Malta, may not be available to them.
Access to Care
The writer’s experience highlights the differences between the US and Maltese health care systems. In the US, the writer had to deal with insurance companies and prior authorizations, which often delayed their care. The writer’s doctors are good, but the writer is concerned that the bench isn’t as deep as it would be in the US.
The writer is discussing a minor surgery with their neurologist to implant a device that delivers medication directly to their spinal cord. “It’s free,” the neurologist said, “so we don’t get as much say.”
The writer’s neurologist and other specialists in Malta often work in pharmacies, which provide a convenient location for patients to see their doctors. The pharmacies also dispense medical care alongside prescriptions and other products, such as sunscreen and perfume.
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On the one hand, they have found that the system is more affordable and convenient than the US system. On the other hand, they are concerned about the availability of certain medications and the depth of care. As the writer continues to learn more about the system, they are becoming more aware of its advantages and disadvantages.
One doctor who works in Malta has an office in the basement of their house, with a waiting area that has six chairs. The doctor uses an ancient laptop and wears a digital Casio watch. Patients note who arrived first and go in, in turn.
The doctor does bloodwork by appointment only, on Tuesdays at 7 a.m. Patients tell the doctor in advance what they need, and the doctor has the tubes ready, hand-labeled with their resident number. The tubes track the two diseases the writer brought with them to Malta.
Medical Care in Malta
Sometimes patients get a receipt. An ultrasound can be done for 120 euros, performed by a doctor specializing in breast cancer imaging. The report is given at the appointment.
Most specialists in Malta see patients both publicly and privately, and many private appointments happen inside pharmacies. There are tiny offices tucked in the back or upstairs.
The writer’s oncologist scanned their records visually, not electronically, and ordered a hormone panel to see whether they should switch from tamoxifen to an aromatase inhibitor. The doctor ordered an ultrasound, handwriting a referral on letterhead and sealing it in an envelope.
They scanned and sent receipts, and after three weeks, they called to check on the status. The form had been mailed, but it must have been lost, so they mailed it again. The writer could expect it in 10 business days.
