Despite free public healthcare, Maltese patients are still incurring significant costs for treatment, prompting the European Commission to flag the matter in its 2025 Country Report. Published last month, this document provides a comprehensive assessment of the challenges and opportunities facing each Member State, by pin-pointing country-specific vulnerabilities and needed reforms.

It transpires that Malta has very high ‘out-of-pocket payments’ which is the term used for a direct payment for healthcare goods and services from the household primary income or savings, where the payment is made by the user at the time of the purchase of goods or the use of the services. The report notes that in Malta, patients have to fork out almost a third of the expenses of health-related services (30%) which is more than double the EU average.

The largest share of out-of-pocket payments went towards outpatient care, followed by retail medical goods, inpatient and dental care. On the other hand, Malta continues to report one of the lowest levels of self-reported unmet needs for medical care in the EU, at 0.3% of the population in 2024 compared to 2.5% EU average.

The Commission also pointed out that one of the reason why out-of-pocket expenditure in Malta is hight is that after all, government expenditure on health was lower than EU Average. In 2022, health spending per inhabitant (adjusted for differences in purchasing power) was lower than the EU average (81.3%), and only 67% of it was publicly funded. The largest share of health expenditure, above the EU average, was for outpatient care. This, together with a relatively low number of hospital beds (335 per 100 000 population in 2022 vs an EU average of 444), points to Malta’s organisational focus on primary care. Public spending as a proportion of total health expenditure in Malta was among the lowest in the EU in 2022.

At the same time, due to ageing, the projected increase in public healthcare spending raises fiscal sustainability concerns for Malta with respect to public healthcare.

As regards public health, Malta places a modest focus on disease prevention. In 2022, spending on prevention in Malta accounted for 1.2% of total spending on health, much lower than the EU average of 5.5%. This share has been decreasing in recent years, contrary to the EU-wide trend, driven by exceptional expenditure related to COVID-19. More than one third of all deaths in Malta are driven by behavioural risk factors. Dietary risks and smoking are major contributors to mortality. The proportion of the population reporting daily consumption of vegetables in 2022 was among the lowest in the EU, as was the frequency of physical activity outside working time. These factors contribute to the country’s high prevalence of overweight and obesity, which in turn drive its comparatively high mortality rates from diabetes and heart disease. Lung cancer is the second main cause of preventable mortality in Malta, which may be linked to high smoking rates.