coronavirus crisis | The collapse of the primary due to covid increases the membership of private mutuals

But it is also true that the health crisis of the coronaviruswhich has absorbed the activity of the primary care the last 48 months, has contributed to the insurance company profits. In 2020, the year in which the pandemic broke out, the private mutuals of Catalonia gained nearly 49,882 more clients, according to data from the Spanish Union of Insurance and Reinsurance Entities (Unespa). some like Health Assistance had, between March and December 2020, a 36% more registrations compared to the same period of the previous year. During the first half of 2021, Assistència Sanitària won 24% more affiliates.

According to Unespa, a 31.82% of Catalans (a total of 2,436,133 people) had in 2020 (last year of the offers figures) a private insurance. On 2019, It was him 31.35% (2,386,251 people). It is a percentage that has been growing progressively over the years: in 2011, the 26.86% of Catalans (2,025,544 people) had private insurance. This is a moderate but constant growth year on year.

Catalonia, beside Madrid, it is the autonomy of Spain with a greater number of insured in private mutual insurance companies. The 2010 cuts in public health, that they left her naked, and then pandemic, which made access to the system even more difficult, have sought economic benefits for the private health coffers. According to Unespa sources (who insist that "Public and private healthcare are not rivals, they complement each other"), these gains are also due to the fact that, in recent years, "many companies have incorporated the health insurance for their workers as complementary remuneration concept".

The primary, absorbed by the covid

Although in recent months it has resumed its pulse, the primary care It has been nearly two years absorbed by covid-19. Although the pandemic also impacted hospitals, especially during the first wave, on the health centers, as a gateway to the health system, the bulk of the costs have fallen diagnostics of covid-19 and the vaccination. There has been no time or resources to attend other pathologies. And, at this juncture, many patients, who can afford it, have opted for private insurance.

"The pandemic has impacted a public health system that was already underfunded and poorly managed. And, of course, he has not been able to respond to some things," he says. Meritxell Sánchez-Amat, president of Catalan Forum of Primary Care (Focap) and family doctor at CAP Besòs. Sánchez-Amat values ​​how "very negative for society as a whole" that patients go to private healthcare. "If the middle and upper classes leave the public sector, it will lose prestige", ensures.

One of the arguments put forward by private mutuals is the saving and the job download involving the public health system. This family doctor rejects it. "The private sector -says Sánchez-Amat- tends to medicalize much more, to do more tests and that affects more expenses and in creating the culture of 'the more tests, the better.'"

In addition, according to the president of Focap, the growth of mutuals has, specifically, a negative impact on the primary care. One of the "supposed improvements" of mutuals is that they allow "direct access to specialists", something that, "far from being an advance for health, does not give good results," according to her. "What is needed first is a general care. If referral needs are later detected, referral is made. Primary school solves 80% of health problems," Sánchez-Amat points out. Specialist doctors are usually "more aggressive" in diagnostic tests and treatments, something that can sometimes be "harmful" for the population.

underfunded

But private mutuals really started to grow in 2010, with the start of healthcare cuts. The pre-cut investment level never recovered. The Union Metges of Catalonia (MC) has pointed out several times that the budget of the Generalitat destined for the Conselleria de Salut is "the same as in 2010, but 12 years later". In 2010, Catalonia allocated 9,875 million euros to health. This 2022, 11,244 million. "But from this figure you have to subtract about 1,500 that belong to the bill for the covid," says the general secretary of MC, Xavier Leonart, who claims that "public health is increasingly bureaucratic, more complex and less decisive" Due to the lack of doctors and nurses.

In this sense, the 'conseller' of Health, Joseph Maria Argimon, that recognizes the "chronic underfinancing for many years" of the public health system, claims to maintain covid state funds for this year. Health sources also highlight the hiring of 600 professionals for primary school (the unions criticize that many have health profiles other than doctors or nurses, such as nutritionists) and the "de-bureaucratization" of the CAP thanks to the "strengthening" of the use of La Meva Salut, among other measures.

"We have one of the highest figures in all of Europe in Medicine graduates but, either they have left the country, or it is not profitable for them to work in public medicine because of the bad conditions", Leonart points out. And all this has repercussions, he adds, in "Increasingly, people are looking for each other." The general secretary of MC warns that, if more is not invested in health, Catalonia (and also Spain) will end up having "a American-style public health: charity [para los pobres] and private insurance for those who can afford it.

The underfunding of public health is recognized even from the private sector. "The public health system in Spain is very powerful, but it is underfunded. The user cannot take tests when he wants and there are important waiting lists," he says Ignatius Orce, president of the mutual Healthcare Assistance, who defends that"if there were no free insurance entities, the public I would be even more collapsed."

"Price War"

He too Official College of Metges of Barcelona (COMB) expresses his "concern" about the increase in policies of the private sector, among other things because this can be detrimental to the quality of care. "In recent years there has been a policy war between companies to see who offers the cheapest" values ​​the president of the COMB, Jaume Padros. This leads to offering policies "for 12 or 15 euros per month", which "consolidate precarious models that put the quality" of the sector at risk.

According to Padrós, the Generalitat must not "forget" the private sector and must therefore "regulate contractual frameworks", since the offers of some private companies do not respond to criteria of "clinical safety" nor of "quality of services".