Healthcare in free fall

Public healthcare in Spain is falling into a state of deterioration, and is yet to touch bottom. The Medical Association has broken its usual silence to point to the critical nature of this situation, which, in its own words, is harming “the poor, the weak, the old and the helpless.” In spite of greater activity in terms of healthcare, per capita expenditure has fallen by 10 percent in just two years. The consequences of these cutbacks are worrying: scarcity of basic materials, such as blankets, bandages and gauze; longer waiting lists; the closure of operating theaters; the diversion of patients with higher purchasing power to private clinics; staff cutbacks; and a generalized malaise among healthcare professionals.

Healthcare quality is at risk of being eroded to levels so far unseen in a system still highly appreciated for its universality and efficiency — thanks to which, among other reasons, Spain ranks among the leading countries in the world in the index of human development.

The pharmaceutical industry’s threat to demand cash payment from Spanish hospitals is a good example of the danger hanging over the system. Farmaindustria, the industry’s association in Spain, calculates that non-payment for medication now amounts to 8.3 billion euros. Public hospitals have an average delay of 525 days in paying for pharmaceutical supplies. For many months the pharmacists in several regions have been protesting at the delays of the Social Security system (control of which has been transferred to regional governments) when it comes to paying for the medication they dispense to the public.

In view of the serious situation of public finances, it appears inevitable that we are going to see spending cutbacks in public healthcare, which is a cornerstone of the welfare state. Yet those who administer the system have an obligation to carefully explore ways of belt-tightening that will not see the quality of service suffer. Some of these means are already at hand, although their application has so far been exasperatingly slow — such as greater use of generic drugs, or the establishment of a central purchasing center.

Other data point to the choice of a strategy that actually contributes to the deterioration of healthcare. The most disturbing example is the Popular Party’s defense of private management, considering it to be more efficient in offering a service that, they say, is still public and free. This approach was evident in the unacceptable case — investigated by the Catalan regional government only after it came to light in the press — of the hospital in Seu d’Urgell, whose facilities are used by the hospital doctors for afternoon appointments with their private patients, or to those diverted from overcrowded public hospitals.

Another issue is the advance of risk-capital funds as managers of public hospitals. These funds, which form an oligopoly in Spain, have a single client — the public health service — and profits that do not appear to be of any benefit either to the public, or the public coffers.