MALTA
About the data We were not able to collect a large number of responses in this country. Thus, the information presented below is based mainly on a review of the literature and exchanges with the national diabetes association.
Healthcare Expenditure Profile (2011)2
Key background information: country health system
33%
Public expenditure Private expenditure Out-of-pocket expenditure represents all of private spending on health
Total health expenditure per capita: USD 1,896.95 Proportion of government expenditure on health: 13.3%
67%
Health system overview
- The Maltese government, through the Ministry for Health, the Elderly and Community Care (MHEC), guarantees a package of health services free of charge. People with chronic diseases, such as diabetes, and/or people with limited means are also entitled to additional benefits: certain outpatient medications free of charge, for instance.9,11 The MHEC defines the list of subsidised medications.7,8,12 - Diabetes products included in that list are procured through public tenders by the MHEC and supplied to public healthcare facilities by private wholesalers.4,5,9 Other products are supplied by private actors, according to MHEC’s regulations; in line with EU regulation.4,7,9 A specialised agency ensures the application of all related regulations.10 - A quality issues reporting system is in place.5 The quality of products is also controlled during the tendering process.6
Diabetes prevalence (2011)1
Key diabetes data
IDF Atlas
National Data
9.5% of 20-79 year-olds
No data
Diabetes care procedure
- Prescriptions are provided by hospital-based diabetes specialists (consultants) and GPs.6 - Consultants, diabetes nurse educators and GPs are the main points of diabetes information and advice.6 - Diabetes products are dispensed mostly at hospital pharmacies or community pharmacies.6
Presence of products at national level
Availability
• Products surveyed that are authorised for sale by the EU are authorised for sale in Malta, an EU Member State.11 • However, the presence in the country of some of them, such as insulin pumps and DPP4 inhibitors, could not be confirmed.5
Guidelines and specific prescription criteria
• Malta has guidelines for diabetes care.1,5 • The prescription of diabetes supplies in the public sector is bound by the rules applied to all publicly procured medical products (see also Affordability): o Some insulin, especially insulin analogues, can only be delivered under certain conditions,6 such as: as a second-line treatment for people with type 1 diabetes; or to children or people with complications.8 o Glucagon (medication for hypoglycaemia) can only be prescribed to people on insulin.5 o People with type 2 diabetes are not entitled to self-monitoring devices via public procurement but these are on sale in the private sector.5,6
Use
• Pens are the main insulin injection devices (also see above for criteria on insulin). • Only metformin and sulphonylureas are provided publicly6,8 – metformin being the most prescribed oral medication.5
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