Monday, February 6, 2023

The national health system needs a re-foundation

According to the CIS Barometer for November 2022, health is the second issue that affects Spaniards personally. If in November 2010 only 3.5% of the population called health their main problem, today 32.6%. Really worrying. Spanish healthcare has been hit, hurting it for more than 10 years, when the financial crisis caused a drop in economic activity and tax revenues, and the European Union responded with so-called austerity, which led to significant cuts in public services, including healthcare. Hui.

The effect has been a deterioration in the quality of care and access, which is evident, for example, in the growth of waiting lists. These excessive, unacceptable delays are due to staff shortages and care overload. It is necessary to train enough doctors or nurses, to address deficiencies in some specialties, but, above all, what is needed is stable recruitment and remuneration that compensates for the responsibility of the work, thus providing the necessary professionalism for quality of care. allows development. Hundreds of professionals move to other countries because they cannot find lucrative jobs in Spain; Hundreds of professionals retire early, or do not request extensions, or devote part or all of their time to private activity, because they feel mistreated in public health and do not see an exciting professional horizon. This decline in public health means that more and more of the population (who can afford it) turn to private health care. Between 2011 and 2021, the number of people with private insurance is set to grow from 8.5 to 11.5 million.

As seen in the COVID-19 pandemic crisis, good public hygiene is very important for everyone. Furthermore, the need for care and resources will increase in the coming years as the proportion of older people increases. We know that public health is a factor of social cohesion that contributes to the economic development of a country, that it is a human right and an equitable necessity. Well, today the National Health System (SNS) persists and is still of very acceptable quality, but it is affected, and the current trend, if it continues, will give us public healthcare for the poor and private healthcare for the rich. can lead to. , I am not exaggerating: there are political alternatives that want this development.

Can health financing be reformed? Undoubted. The Spanish economy can continue to recover its ability to generate wealth, and a progressive tax policy must be promoted, along with concrete actions to prevent and fight tax fraud. Thus, while GDP recovers, Spanish healthcare should increase its participation in it until it reaches the average of advanced EU countries. New resources would be directed to specific health strategies and policies: adequate staffing, primary care, mental health, public health, co-pay reduction, inclusion of non-covered benefits, and so on. Additional economic transfers to autonomous communities should have specific investment commitments in defined policies, monitoring of their implementation with standards and indicators, and corrective mechanisms in case of non-compliance. These additional resources, along with efficiency improvements primarily in pharmaceutical expenditure, will allow the SNS to recover its strength and quality.

However, in addition to being essential economic resources, there are other factors, some of a structural nature, that affect our public health. I will mention only three of them. According to the 1986 constitution and the General Health Law, which created the SNS, health management was transferred to the autonomous communities, completing the said process in 2002. In this way, the government of the system was split between the central government and the people. of autonomy, with a coordinating body whose decisions were not binding: that is, we created a quasi-federal system, but without federal decision-making bodies. Since then, each autonomous community developed its own management and information systems, its personnel policies, its investment strategies, etc. to promote a generally positive, but uneven development. Meanwhile, the Ministry of Health was getting weaker. Today it is necessary to supplement the government, coordination and cooperation capacity of the SNS (an obvious need in the management of the pandemic), strengthen the Ministry of Health and create a federal-type structure for the system as a whole that allows binding decisions to be made. to be created, as well as evaluation and control mechanisms that guarantee quality healthcare for all throughout Spain.

On the other hand, the weight of private interests in healthcare is increasingly unbalancing an SNS that must always put the general interest first. I refer to pharmaceutical policy and privatization. In Spain we will spend twice as much on medicines as this year. The additional spending is due to the outrageous prices of new drugs (well above the cost of manufacturing and research) and prescriptions driven by industry pressure. This abuse of power is linked to the granting of monopolies by states, an issue that affects the EU and all countries, and on which the government may propose a change strategy in the medium term. In the meantime, it is about establishing greater contributions to the SNS on the additional profits now received by pharmaceutical companies to reduce prices and allow independent training of health professionals, officials and decision makers.

The third aspect is the penetration of private management of public health in the form of concessions and outsourcing of services. These privatizations have been promoted above all in the autonomous communities with the Partido Popular governments, especially the Community of Madrid. It is a process of financialisation, through which healthcare becomes a speculative business, leading to fragmentation, weakening of the system and loss of global efficiency. It would be appropriate to restrict and reverse such concessions of critical management parcels, information systems, etc., and thus recover the robustness of the SNS.

The 13 November demonstration in Cibeles to protect public health was a direct challenge to Díaz Ayuso for his health management in Madrid, but also, as Soledad Gallego-Díaz pointed out in this newspaper, it opened a larger debate. should, “more generally, on measures to correct the deterioration of the Spanish health system and the increasingly dramatic problems in public health”. After 36 years of the General Health Law, the financial crisis and its cuts, and an epidemic that has Having cost the lives of more than 115,000 people (many of them health workers), the time has come for the governments of the Autonomous Communities, together with the Government of Spain, to soberly analyze this situation and come up with a plan to rebuild the national health system. Promote state agreement. It’s not easy, but it’s not impossible either. And, of course, at this point the patches no longer work. The creature dies.

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Nation World News Desk
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