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It is not evidence of current operation, ownership, quality or sustainability.", "tags": [], "territory": "Malta, with Gozo General Hospital and named Malta hospital facilities", "title": "A hospital concession is a dated reform record", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" }, { "kind": "source_reference", "source": "Malta: health system review 2017 repository record", "url": "https://www.um.edu.mt/library/oar/handle/123456789/20492" } ] }, { "analytical_mapping": { "mapping_basis": "Consolidated Health Act", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:MLT:decision-autonomy:benefits-and-entitlement", "source_projection_ids": [ "country-improvement-source:MLT:health-act-2024" ], "support_state": "candidate_supported", "target_slot": "benefits-and-entitlement", "target_view": "decisions", "typed_fields": { "boundary": "These statutory provisions do not establish clinical prioritization, budget allocation or actual access.", "formal_decision": "Article 21 assigns the Minister establishment of healthcare benefits. Article 24 provides that insured persons may qualify for free public-system benefits, subject to regulations." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Laws of Malta, Health Act, Chapter 528, Articles 21 and 24.", "country_ids": [ "MLT" ], "coverage_domains": [ "actors", "decision_rights", "governance", "government_responsibilities" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "The Minister shall establish", "institution": null, "locator": { "description": "Health Act, PDF pp. 6-7, Articles 21 and 24." }, "material_id": "material:51c97bf5c86815b771656bd0", "notes": [ "Do not infer a complete purchasing or allocation rule from the benefits provisions." ], "origin": "candidate-analytical-mappings", "period": "Consolidated text published 17 December 2024", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2343b3c858ad633969226982bb60f2f09dbf67530b415df709f53fdc16c07c26", "response_sha256": "2343b3c858ad633969226982bb60f2f09dbf67530b415df709f53fdc16c07c26" }, "statement": "The Health Act assigns establishment of public healthcare benefits and regulatory determination of insured-person status to the Minister. It does not quantify benefit use or determine provider-level discretion.", "tags": [], "territory": "Malta, national public healthcare system", "title": "Formal benefits and entitlement decisions", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://legislation.mt/getpdf/677e3ecacc8e8e3d102ff18a" } ] }, { "analytical_mapping": { "mapping_basis": "Eurostat health accounts", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:MLT:delivery-referrals:provider-spending-boundary", "source_projection_ids": [ "country-improvement-source:MLT:eurostat-provider-expenditure-2023", "country-improvement-source:MLT:eurostat-financing-2023" ], "support_state": "candidate_supported", "target_slot": "provider-spending-boundary", "target_view": "public-private", "typed_fields": { "boundary": "The provider and financing classifications do not show whether activity is publicly or privately owned, operated or purchased.", "observed_financing": "Eurostat records EUR 1,199.21 million for government and compulsory contributory financing schemes in 2023.", "observed_provider": "Eurostat records EUR 754.59 million for hospital providers in 2023." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Eurostat, hlth_sha11_hf and hlth_sha11_hp, Malta series.", "country_ids": [ "MLT" ], "coverage_domains": [ "market_structure", "ownership", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "Health care expenditure by provider", "institution": null, "locator": { "description": "Eurostat hlth_sha11_hf: MT, HF1, MIO_EUR, 2023; hlth_sha11_hp: MT, HP1, MIO_EUR, 2023." }, "material_id": "material:f3ee62c139c6f8b3c2aa7925", "notes": [ "Do not infer provider ownership, operational control, service volume or patient choice from health-account classifications." ], "origin": "candidate-analytical-mappings", "period": "Health accounts reporting year 2023", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "32cd8ff33abe2c291fcc31318c0a653669d4eb88561fa17d317090d2bccff2ef" }, "statement": "Eurostat records 2023 expenditure by financing scheme and provider class, including EUR 1,199.21 million for HF1 and EUR 754.59 million for hospital providers. These classifications do not identify public-private ownership or operation.", "tags": [], "territory": "Malta, national health accounts", "title": "Health accounts distinguish financing schemes from provider classes", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_sha11_hp?geo=MT" }, { "kind": "source_reference", "source": "Health care expenditure by financing scheme, Malta", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_sha11_hf?geo=MT" } ] }, { "analytical_mapping": { "mapping_basis": "Eurostat hospital-bed and inpatient series with WHO review context", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:MLT:delivery-referrals:hospital-capacity-and-activity", "source_projection_ids": [ "country-improvement-source:MLT:eurostat-beds-2016", "country-improvement-source:MLT:eurostat-inpatient-discharges-2020", "country-improvement-source:MLT:who-hit-2017" ], "support_state": "candidate_supported", "target_slot": "hospital-capacity-and-activity", "target_view": "delivery", "typed_fields": { "observed_delivery": "Eurostat reports 10,783 inpatients per 100,000 inhabitants in 2020 for all diseases excluding external causes and Z38.", "observed_input": "Eurostat reports 2,127 available hospital beds in Malta in 2016, equal to 467.11 beds per 100,000 inhabitants.", "reported_context": "The review reports secondary and tertiary care mainly through public hospitals, with Mater Dei as the main acute general hospital." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Eurostat, hlth_rs_bdsrg and hlth_co_disch2, Malta series; Azzopardi-Muscat et al., 2017.", "country_ids": [ "MLT" ], "coverage_domains": [ "facility_data", "hospital_organization", "patient_flows", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "Hospital beds by NUTS 2", "institution": null, "locator": { "description": "Eurostat hlth_rs_bdsrg: MT, HBEDT, NR and P_HTHAB, 2016; hlth_co_disch2: MT, TOTAL, T, A-T_Z_XNB, P_HTHAB, 2020; WHO review PDF p. 78." }, "material_id": "material:1b549bcd71f834c8fd1ff61d", "notes": [ "Do not compare these period-specific input and utilization indicators as a capacity or performance ratio." ], "origin": "candidate-analytical-mappings", "period": "Beds 2016; inpatient rate 2020; hospital-context review published 2017", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "dd97ab5b9670846aebb78640e56935645581a834587ad971b489980589b6ffe2" }, "statement": "Eurostat reports 2,127 available hospital beds, or 467.11 per 100,000 inhabitants, in Malta in 2016. It separately reports 10,783 inpatients per 100,000 inhabitants in 2020 for a stated diagnostic denominator. Neither measure identifies ownership or referral completion.", "tags": [], "territory": "Malta, national NUTS 2 reporting unit", "title": "Hospital capacity and inpatient activity are separately measured", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_rs_bdsrg?geo=MT" }, { "kind": "source_reference", "source": "Hospital discharges by diagnosis and in-patients, Malta", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_co_disch2?geo=MT" }, { "kind": "source_reference", "source": "Malta: health system review 2017", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "Consolidated Health Act and WHO Observatory review", "mapping_group": "actors_and_functions", "mapping_id": "candidate-mapping:MLT:actors-functions:formal-departmental-architecture", "source_projection_ids": [ "country-improvement-source:MLT:health-act-2024", "country-improvement-source:MLT:who-hit-2017" ], "support_state": "candidate_supported", "target_slot": "formal-departmental-architecture", "target_view": "functions", "typed_fields": { "formal_allocation": "The Act establishes policy, service and regulation departments. The review reports the ministry as responsible for provision, regulation and standards.", "territorial_boundary": "The 2017 review reported no health plans at regional or local levels; this is a time-bounded description of a unitary system." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Laws of Malta, Health Act, Chapter 528, Articles 4, 6 and 8; Azzopardi-Muscat et al., 2017.", "country_ids": [ "MLT" ], "coverage_domains": [ "actors", "authoritative_review", "governance", "government_responsibilities" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "formal", "excerpt": "Department for Health Services", "institution": null, "locator": { "description": "Health Act, pp. 3-4, Articles 4, 6 and 8; WHO review PDF p. 11, Organization and governance." }, "material_id": "material:346b402a7e7908da30f57b5f", "notes": [ "Do not infer operational capacity or a current regional delivery structure from departmental establishment." ], "origin": "candidate-analytical-mappings", "period": "Current statute consolidated 2024; review description principally 2012-2016", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "2343b3c858ad633969226982bb60f2f09dbf67530b415df709f53fdc16c07c26", "response_sha256": "2343b3c858ad633969226982bb60f2f09dbf67530b415df709f53fdc16c07c26" }, "statement": "Malta's Health Act formally separates policy, service and regulation departments under the national health framework. The cited review describes a centralized system and does not support a current subnational task map.", "tags": [], "territory": "Malta, national; no current regional allocation inferred", "title": "National departmental architecture", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://legislation.mt/getpdf/677e3ecacc8e8e3d102ff18a" }, { "kind": "source_reference", "source": "Malta: health system review 2017", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "Eurostat inpatient average-length-of-stay series", "mapping_group": "delivery_and_referrals", "mapping_id": "candidate-mapping:MLT:delivery-referrals:inpatient-stay-boundary", "source_projection_ids": [ "country-improvement-source:MLT:eurostat-alos-2020" ], "support_state": "candidate_supported", "target_slot": "inpatient-stay-boundary", "target_view": "delivery", "typed_fields": { "boundary": "The series has no referrer, ownership, hospital, clinical-outcome or unique-patient identifier.", "observed_metric": "The Malta series gives an all-disease total average inpatient stay of 8.6 days in 2020, excluding external causes and Z38." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Eurostat, hlth_co_inpst, Malta total series.", "country_ids": [ "MLT" ], "coverage_domains": [ "facility_data", "patient_flows", "utilization" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "observed", "excerpt": "In-patient average length of stay", "institution": null, "locator": { "description": "Eurostat hlth_co_inpst: MT, TOTAL, T, A-T_Z_XNB, NR, 2020." }, "material_id": "material:c08818b50c1990203649cca3", "notes": [ "Do not interpret average length of stay as a measure of quality, waiting time or integration." ], "origin": "candidate-analytical-mappings", "period": "Reporting year 2020", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "official" ], "source_system": null, "source_version": { "detected_media_type": "application/json", "response_sha256": "8b2b42bced11b8cca06baf721a241f9326cebb7dcd61ecc2b8af0406d51f9176" }, "statement": "Eurostat reports an average inpatient stay of 8.6 days in 2020 for Malta's stated all-disease series. It cannot show referral origins, hospital ownership, care integration or outcomes.", "tags": [], "territory": "Malta, national reporting", "title": "Observed inpatient stay is not a referral-flow measure", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_co_inpst?geo=MT" } ] }, { "analytical_mapping": { "mapping_basis": "WHO Observatory review", "mapping_group": "decision_rights_and_autonomy", "mapping_id": "candidate-mapping:MLT:decision-autonomy:centralized-facility-boundary", "source_projection_ids": [ "country-improvement-source:MLT:who-hit-2017" ], "support_state": "candidate_supported", "target_slot": "centralized-facility-boundary", "target_view": "autonomy", "typed_fields": { "accountability_boundary": "This describes the review period and does not estimate current autonomy by provider or function.", "reported_boundary": "The review reports central Ministry-level resource-allocation and procurement decisions, facility-level day-to-day operations, and limited facility autonomy." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Azzopardi-Muscat et al. Malta: health system review 2017, p. 17.", "country_ids": [ "MLT" ], "coverage_domains": [ "autonomy", "decision_rights", "governance" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "facilities still have limited autonomy", "institution": null, "locator": { "description": "WHO review PDF p. 17, Organization and governance, planning and accountability discussion." }, "material_id": "material:d5b3d4929c258167e80443ed", "notes": [ "Do not assume the same autonomy pattern for primary care, private providers or the current period." ], "origin": "candidate-analytical-mappings", "period": "Reported organizational context through 2016; review published 2017", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68", "response_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68" }, "statement": "The 2017 review reports centralized resource allocation and procurement, while facilities managed day-to-day operations with limited autonomy. This is not a current autonomy score.", "tags": [], "territory": "Malta, public health-service facilities", "title": "Reported centralization and facility autonomy", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" } ] }, { "analytical_mapping": { "mapping_basis": "WHO Observatory review", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:MLT:relationships-networks:primary-care-market", "source_projection_ids": [ "country-improvement-source:MLT:who-hit-2017", "country-improvement-source:MLT:who-review-2014" ], "support_state": "candidate_supported", "target_slot": "primary-care-market", "target_view": "public-private", "typed_fields": { "patient_choice": "The review's patient-choice table reports provider choice in primary care only in the private sector.", "reported_market": "The 2017 review reports state and private GPs operating independently, with private GPs accounting for around two-thirds of consultations and paid fee for service." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Azzopardi-Muscat et al. Malta: health system review 2017, pp. 12, 26 and 123; European Observatory, Malta: health system review 2014.", "country_ids": [ "MLT" ], "coverage_domains": [ "hospital_organization", "market_structure", "ownership", "primary_care" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "around two-thirds of consultations", "institution": null, "locator": { "description": "WHO review PDF pp. 12, 26 and 123; 2014 review publication overview." }, "material_id": "material:1557f0f81b16dce1d2e66aaa", "notes": [ "Do not convert the reported consultation estimate into a current public-private activity, spending or ownership share." ], "origin": "candidate-analytical-mappings", "period": "Reported organization and estimate principally 2012-2016; review published 2017", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68", "response_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68" }, "statement": "The 2017 review reports independent state and private GP provision, with a large time-bounded private consultation workload and private-sector primary-care choice. It does not establish current ownership or utilization shares.", "tags": [], "territory": "Malta, national primary-care market", "title": "Reported parallel primary-care provision", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" }, { "kind": "source_reference", "source": "Malta: health system review 2014", "url": "https://eurohealthobservatory.who.int/publications/i/malta-health-system-review-2014" } ] }, { "analytical_mapping": { "mapping_basis": "WHO Observatory review patient-pathway figures", "mapping_group": "relationships_and_networks", "mapping_id": "candidate-mapping:MLT:relationships-networks:public-private-pathways", "source_projection_ids": [ "country-improvement-source:MLT:who-hit-2017", "country-improvement-source:MLT:eurostat-inpatient-discharges-2020" ], "support_state": "candidate_supported", "target_slot": "public-private-pathways", "target_view": "referrals", "typed_fields": { "observed_boundary": "Eurostat reports inpatient counts, not referrals, completions, bypassing or pathway adherence.", "reported_design": "Public GPs were described as gatekeepers referring to specialists, hospital outpatient facilities, emergency departments and rehabilitation. Private patients were described as having direct access to GPs, specialists and dentists." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "Azzopardi-Muscat et al. Malta: health system review 2017, pp. 71-73; Eurostat, hlth_co_disch2.", "country_ids": [ "MLT" ], "coverage_domains": [ "networks", "observed_referral", "patient_flows", "primary_care", "referral_design" ], "display_status": "shown_in_full", "document_type": null, "evidence_mode": "reported", "excerpt": "General practitioners in the public sector", "institution": null, "locator": { "description": "WHO review PDF pp. 71-73, Patient pathways; Eurostat hlth_co_disch2, Malta total series, 2020." }, "material_id": "material:cf36bf101f0acbb21c0fce42", "notes": [ "Do not present the pathway figure as a current observed referral-rate series." ], "origin": "candidate-analytical-mappings", "period": "Reported pathway design through 2016; inpatient-count observation 2020", "publication_date": null, "publication_year": null, "record_kind": "candidate_analytical_mapping", "record_kind_label": "Candidate Analytical Mapping", "screening": { "previous_boundary_detected": false, "previous_visibility": "previously_not_projected" }, "source_layers": [ "review_literature" ], "source_system": null, "source_version": { "detected_media_type": "application/pdf", "file_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68", "response_sha256": "9553037a1698096e269759ccc6a996efaf8a1fed33fb7acbcdd13bf6417ffa68" }, "statement": "The 2017 review describes public GP gatekeeping and a distinct private pathway with direct specialist access. The cited inpatient series cannot measure whether these referral pathways were followed.", "tags": [], "territory": "Malta, public and private pathways; Gozo-to-Malta rehabilitation transfer where stated", "title": "Reported pathways differ across public and private care", "urls": [ { "kind": "url", "source": "not supplied", "url": "https://platform.who.int/docs/default-source/mca-documents/policy-documents/report/MLT-CC-37-01-REPORT-2017-eng-Malta-Hit-report.pdf" }, { "kind": "source_reference", "source": "Hospital discharges by diagnosis and in-patients, Malta", "url": "https://ec.europa.eu/eurostat/api/dissemination/statistics/1.0/data/hlth_co_disch2?geo=MT" } ] }, { "analytical_mapping": { "mapping_basis": "WHO Observatory 2024 health-system summary", "mapping_group": "time_and_reform", "mapping_id": "candidate-mapping:MLT:time-reform:strategy-and-digital-investment", "source_projection_ids": [ "country-improvement-source:MLT:who-summary-2024" ], "support_state": "candidate_supported", "target_slot": "strategy-and-digital-investment", "target_view": "reforms", "typed_fields": { "implementation_boundary": "The publication overview does not establish implementation, coverage, funding execution or impact.", "reported_reform": "The summary describes expansion of remote healthcare after COVID-19, digital-health developments, and a strategy focused on modernization and infrastructure through 2033." } }, "annotation_status": "open", "authors": [], "availability": {}, "citation": "European Observatory on Health Systems and Policies. 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