The central government recently published the 2015 public deficit data of all the Public Sector Institutions and there is a worrying fact: nearly all the autonomous regions have failed to comply with the deficit ceilings committed to at European Union level. It is clear that autonomous regions have to bear most of the expenses necessary to support a modern welfare state, such as health, education and social services.
However, has anyone thought about the significant role that public-private partnerships play in these three sectors? Has anyone recognized and appreciated the effort that the private sector has made, particularly during these tough years, in employment, investment and financing, to maintain the welfare state?
If we had to reflect on pre-crisis, crisis and post-crisis management, I think that during the pre-crisis there was a kind of inflation of new infrastructure in Spain. As a matter of fact, between 2002 and 2009 health expenditure increased by 83%, almost three times more than GDP. If we analyze expenditure during the crisis, it is important to note that expenditure containment has been primarily in pharma, public health, professionals’ salaries and investment. And now that we are entering the post-crisis period, we have a health care system that has not undergone reforms, that is possibly in a worse state than when the crisis began, and that is probably undercapitalized due to a lack of investment during this period. The renewal of the National Health System must be taken seriously. We cannot stand idly by and do nothing about the problems before us.
I cannot imagine a public health care system that could provide the same quality results as the Spanish health system without the collaboration of the network of pharmacies and their globally recognized role model, or without its agreement based model to reduce waiting lists, or without the concession model to cope with new infrastructure or manage existing infrastructure more effectively, and without the Muface model, which reduces the pressure on public hospitals by deriving patients to private healthcare.
In this time of debate and of questioning numerous situations, those of us who believe, defend and want public-private partnerships to ensure sustainable public health, must not be on the defensive. We need to EDUCATE THE PUBLIC on the PUBLIC VALUE that public-private partnerships bring to society, to the public administration and to the health system in general. We must move forward with a new culture of what ‘public’ means, which, of course, must involve everyone understanding that we need to maximize our tax money by seeking management formulas compatible with providing quality and excellence in health care services in a way that is also sustainable.
Just as in the field of education with privately run schools funded by the state, or in the social services, with nursing homes, in the health care system, both pharmacies and the private insurance and health care provider sectors enable the existence, maintenance, future and viability of a modern welfare state. Bringing resources, knowledge, technology, etc. together is not about ideology, but about intelligence and common sense.