Our healthcare system is in a critical situation and therefore the following issues should be addressed as soon as possible:
Financing. Public health needs sufficient funding to recover from the cut-off stage, which should be around 7% of GDP. In addition, the great variability of the autonomic budgets must end. Health financing should be finalist and linked to the objectives of the Integrated Health Plan, also as an instrument of cohesion and inter-regional coordination.
Exclusion. Royal Decree Law 16/2012 established important exclusions in access to the health system. The royal decree law of universal health partially mitigated this situation, but problems still occur due to a stiff interpretation of some autonomous communities. Therefore, it is important to approve a regulation that guarantees health care to all people in the country.
Copayments. Those established in 2012 remain in force (although some have not been applied, such as health transport) and represent an obstacle to the access of necessary benefits for the poorest and sickest people (1.4 million people do not withdraw, for reasons economic, prescribed medications). It is urgent to end this situation and eliminate co-payments.
Privatizations. There is the opinion that the privatization offensive of health was halted, but it was not, and although privatizations were stopped in specific places, the privatization process continued with less flashy and more silent measures. The result is overwhelming: the cost of services increased, corruption was favored and attention was not improved. Therefore, we must first paralyze the privatizations and then recover the privatized for what, as was proven in the case of Alzira, what is fundamental is the political will.
Greater use of public resources. In parallel to privatization, public health resources that have deteriorated in an intentional manner have been underutilized. It is important to guarantee the intensive use of the great technological resources and infrastructure of this, for which a significant increase in employment in the sector is required to recover the cuts of the last 10 years.
Pharmaceutical expenditure. This item has not stopped increasing in these years (14% of total expenditure between 2014-2017 and 22% in hospital spending), favored by a pact with Farmaindustria that guaranteed a growth in spending in parallel with GDP while spending sanitary decreased in relation to this, putting at risk the sustainability of the system. There is also evidence of an unsound use of medicines and the influence of the industry on key aspects such as the continuing education of professionals. It should be ensured that pharmaceutical expenditure grows less than the increase in health budgets, rationalize the use and stop the abusive policies of the industry (shortages, prices, etc.), as well as strictly regulate the current conflicts of interest.
Decrease over-use Overuse occurs with almost all health technologies (about 30% of its use is not justified). Active intervention is necessary to improve utilization and reduce variability, which above all has to do with changes in professional culture, enhancing instruments such as scientific evidence and patient safety.
Primary care Primary Care (PC) has to be the key and the basis of the entire health system. The PA is the level with the capacity to develop the promotion and prevention activities, facilitate the access of the population in conditions of equity, make the rational and efficient allocation of the resources based on the needs, guarantee the continuity to the health care of the people in all the vital stages, et cetera. Therefore, it is essential to strengthen it by articulating a strategy that ends with its current postponement.
Personnel policy It is key in the health system and has been abandoned in years in which the health personnel is the one who has suffered especially the cuts (less staff, worse working conditions). We need a new policy that guarantees decent working conditions, enhances the adherence of professionals to public service (exclusive dedication) and ensures ongoing training independent of commercial interests.
Public health. Public health (SP) is delayed in our health system because the General Law of Public Health has not been developed and there is a great disconnection between the SP and the healthcare system. We need to strengthen it by making the Law effective, approve the Integrated Health Plan and favor the relationship between PA and SP.
Social and professional participation. Public health is the property of the citizenry and therefore it is necessary that there is the ability of those who maintain the system with our taxes to monitor, be heard and participate in decision-making in the health system, that is, to participate in the management of what belongs to everyone, public health.
Of course there are many more problems that must be addressed to ensure quality public health for the entire population, but to be able to do so with guarantees of success, the first thing is to stop the tripartite neo-liberal and far right that threatens to dismantle it permanently.
Marciano Sánchez Bayle He is a doctor and spokesman for the Federation of Associations for the Defense of Public Health.