A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes

Katharina Abraham, Margreet Franken*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

1 Citation (Scopus)
40 Downloads (Pure)


Background: The processes that operationalize the evaluation framework for new medicines are implemented to reach the system objectives of public health, financial sustainability, and equitability. However, when the activities and procedures of these processes are misaligned, the objectives of the system may be at risk.

Objectives: To evaluate the supporting processes for introducing new medicines in public healthcare services in Malta.

Methods: We first reviewed literature on the Maltese reimbursement system and subsequently conducted semi-structured interviews based on the Hutton Framework. Interviewees included policy makers, committee members, procurement staff, medical specialists, pharmacists, and pharmaceutical industry representatives. After validation, we analysed the data with a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis.

Results: Most medicines are assessed for introduction on the Government Formulary List. Exceptional requests fall outside this policy and pass through the Exceptional Medicinal Treatment route. Efficiency, quality, and transparency are major weaknesses across the supporting processes. Taking up responsibility, however, is considered the most important factor in reaching system objectives. Stakeholders tend to shift responsibilities to other processes, start/stop activities that impact the activities of subsequent processes whilst dismissing any contribution to the weaknesses of the system. Consequently, system objectives cannot be reached in an optimum manner.

Conclusions: The Maltese case showed that recommendations for introducing new medicines in the public healthcare setting are influenced beyond the choice of HTA tools and criteria. Earmarked budgets, political steering, delays, and uninformed applicants as well as HTA capacity are impeding on system goals of public health, equity, and sustainability.

Original languageEnglish
Article number100095
Pages (from-to)1-8
Number of pages8
JournalHealth Policy OPEN
Early online date10 Apr 2023
Publication statusPublished - Dec 2023

Bibliographical note

Funding Information:
This study was financed by a grant of the European Structural and Investment Fund (Project: SF04.084). The sponsor had no role in the conduct of the study nor in the writing of this manuscript.

Publisher Copyright:
© 2023 The Author(s)


Dive into the research topics of 'A SWOT analysis of the complex interdependencies of the Maltese reimbursement processes'. Together they form a unique fingerprint.

Cite this