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Opinion & Analysis

‘No reduction in spending will affect the provision of health services or high standard of care’

In My Opinion

by Neil F Costa MP, Minister for Health, Care and Justice

I would like to take the opportunity to reply to your article, published on the 19th July edition of your newspaper, under the headline “Government clamps down on ‘staggering’ GHA overspend”.
It is certainly the case, that it is one of my overriding objectives to control the Gibraltar Health Authority’s historic overspending in areas where there is clearly a need for effective financial control and unnecessary spend.
As you also rightly point out in your article, I am firmly of the view, in light of the advice I have received from clinicians, the GHA’s Finance Department, very ably led by the new Director, Mrs. Jessica Montado and the supporting evidence, that any reduction in spending will in no way adversely affect the provision of health services or indeed the high standard of care our community has come to expect and deserves.
Quite the opposite is true; any savings that can be achieved on unnecessary spending by the implementation of strict financial controls, will undoubtedly result in an increase in locally delivered health services and further improvements to patient care.
I would like, if I may, to comment on the statistical information contained in the article in terms of the comparison made between Gibraltar and other EU countries in relation to the amount spent on healthcare as a percentage of GDP.
Whilst I agree that comparisons are difficult, I feel it is important to note that countries such as Germany, which you quote in your article as spending 11% of its GDP on healthcare, include the cost of private healthcare, which can be as much as 2.5%, so that the public element of that expenditure is 8.5%.
Also, countries such as Germany, include the cost of long-term nursing care. The figures published in respect of the GHA do not include such elements as elderly residential nursing care or domiciliary care.
If we were to include the cost to the public purse of Elderly Residential Services and Domiciliary Care, this would increase our percentage of GDP spent on healthcare from 6.3% to approximately 7.5%.
The point can also be made that GDP does not translate into Government revenue in Gibraltar to the same degree as in Germany and the United Kingdom due to higher taxes and other charges, and it is revenue, not GDP, that is relevant in meeting expenditure.
The public spending on healthcare in Gibraltar for the year 2016-17 was £119,863,986, which would present a per-capita value of elegible health care users of £2,685. If, in addition, we were to add to this figure the amount spent on long-term residential nursing care, as in the Germany calculation, the per-capita figure for Gibraltar would be £3,136.
Further still, during the past five years, public spending on healthcare in Gibraltar, strictly in relation exclusively to the GHA, has been consistently above 6% of GDP.
When one considers that under this Government, GDP has risen 45% from £1.32B in 2012/13 to £1.91B in 2016/17, it is clear that public spending on healthcare has been increasing consistently year on year maintaining the ratio of over 6%.
On the other hand, in the United Kingdom, health spending per person in real terms, between 2009 and 2013 has shown zero growth.
I wish to thank you for the opportunity for noting these matters through the medium of your newspaper.

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