Mariska Breland moved from the United States to Malta after calculating that health insurance would become unaffordable for her and her husband. She has multiple sclerosis and a history of breast cancer, and says she had repeatedly reached the maximum out-of-pocket limit on her U.S. insurance. In Malta, she pays 38 euros a week in social security contributions, which covers her and her medications, including one she says costs $80,000 a year in the United States.
Breland says Malta’s public system provides care without charges for hospital stays or emergency helicopter rescues, and she has not faced the prior authorization hurdles she experienced in the U.S. But access to quicker appointments and greater convenience often means paying privately. She says a private general-practitioner visit typically costs 15 to 20 euros, while a specialist appointment costs 70 euros. A fast ultrasound cost her 120 euros.
Many private specialists see patients in community pharmacies, where appointments can be arranged without the infrastructure of a conventional clinic. Breland describes seeing her neurologist in pharmacies on different days of the week. For an oncology checkup, she secured a private appointment two weeks after contacting a clinic.
The public system has been harder for her to navigate. A referral appointment was expected to arrive by post, and she waited longer than anticipated before calling to ask about it. She also describes paper-based procedures for securing free medication through Malta’s Pharmacy of Your Choice program, including having to send proof of social security payments and later collect a form that had apparently been lost in the mail.
Breland says she has no reminder texts or confirmation calls for appointments and keeps photographs of doctors’ handwritten notes on her phone. She recently learned that a portal exists for the public system, but says she still misses the patient portal she had in the U.S.
She also worries that Malta may offer fewer treatment options for some conditions. Breland says there are more multiple sclerosis drugs available in the United States, and that a medication approved by European regulators in June is not expected to reach Malta soon because the country has too few patients to warrant it.
Despite the differences, Breland writes that she has never received a medical bill in Malta. She says her neurologist has told her that a planned procedure will be free, but that she will have less choice over the size of the implanted device. For Breland, the move has brought lower costs and fewer insurance disputes, alongside slower processes, paper records and less control over some aspects of care.
Sources: STAT News.