A dangerous setback for our healthcare system

The Minister of Health, Mónica García, has announced the start of the processing of the Law on public management and integrity of the National Health System, with the first step, the public consultation opened on Monday. The main aim of this law is to limit the private management of public hospitals with a criterion based on populist slogans. In short, and as the ABC newspaper recently defined it well, it is about turning into law one of the easiest slogans of Sumar-Podemos, «public health is not for sale, it is defended». We should all defend quality and efficient public health care.

The reality is that they neither defend the health system, nor the patients, nor the professionals by trying to give the status of law to their sophistry. They defend themselves in their position as politicians. That is all. In fact, it is very sad that the only concern of the Minister of Health right now, which should be focused on solving very urgent problems such as the endless waiting lists or the lack of professionals, and on finding solutions to the very complicated challenges of the system, is only thinking about introducing populist debates, to see if it will reanimate the rank and file of a party that is on its way to extinction. What a coincidence that this type of announcement comes after elections, such as the Catalan ones this weekend, in which Sumar practically disappears!

Being a member of a government should make Ms Garcia reflect on the implications of legislating for all. In fact, limiting the role of private management in the public health system goes against the Constitution itself. The Constitutional Court said as much years ago with some other attempts along the same lines. The right to health is guaranteed in the Constitution, but health management models are determined by the autonomous communities, depending on what they consider appropriate or convenient to provide the best health care to their citizens. 

Let us remember that, in Spain, the public service management model is used in many areas, from infrastructure, energy, education and social welfare to health. We have Muface, Mugeju or Isfas, where civil servants can choose whether they wish to be treated by public or private healthcare; mutual insurance companies for accidents at work, which are another model of private management of public funds, and with historically very good results; and outpatient pharmacies, with private pharmacists who also offer a public service and where we are an international example of good practice. And let us not forget other formulas for coexistence or collaboration with the private sector, such as concerts of all kinds, from the traditional agreement to reduce waiting lists, capitation agreements with mixed or totally private companies, or public hospitals that are allowed to carry out private activities. 

The symbiosis between the public and private sectors is commonplace and is well appreciated by citizens, as long as it is done with transparency, accounting for the results and putting the data on the table, with ethics and fairness. Above all, because universal access to healthcare is guaranteed, with the highest quality care for patients, shorter waiting lists and better guarantees for the sustainability of the system. Furthermore, these formulas bring us closer to and on a par with the most prosperous and advanced European countries, such as Germany, France and Portugal.

Collaboration with the private sector in healthcare – as in other sectors – has amply demonstrated its effectiveness and efficiency. Moreover, as I have developed in other posts on this blog, it will become increasingly essential if the administrations want to maintain high quality standards for patients. Political instability and budgetary constraints, together with the major challenges facing healthcare that I have already mentioned – waiting lists, lack of professionals, chronic illnesses – make this collaboration in healthcare essential. 

What minister Mónica García is aiming for is the Cubanisation of the system. Or a return to a Francoist model: the state builds the infrastructure and civil servants manage it. Either of these two references are clearly outdated, archaic and look to the past, not the future.

I sincerely believe that the minister is on the wrong track and is moving us further and further away from our more developed European partners. 

My only doubt is whether he wants to create an artificial debate, recovering the supposed confrontation between public and private because of his disastrous electoral results and the decline of his populist policies, or because he wants to deliberately deceive Spaniards, proclaiming a defence of public healthcare, which is not such, when what he is really doing is «condemning» many citizens to mediocre public healthcare, knowing that many other citizens will take out private insurance in order to have access to better private healthcare, thus creating a first-class healthcare system and a second-class healthcare system. A real nonsense in either case. 

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