In recent weeks we have been learning the true way of thinking of the Minister of Health, Mónica García, and her controversial proposals on how to organise the doctors’ collective in the future of the national health system, as well as her vision of public-private collaboration, based on the situation of Muface. I am not surprised by her position or her statements, but I do believe that we in the sector should adopt the same position.
On the one hand, we already knew, from her political career, the minister’s position against public-private partnerships in general and the Muface model in particular. What has surprised me, and I think it is worrying for a political leader, is that she blames the insurance companies for the crisis in the Muface model, when the only person responsible is her government, which is not interested in dialogue and reaching a consensus on a model with solid foundations for the future. I have already commented on this blog on other occasions: a responsible government has to permanently audit the good management of public funds in public-private partnership models, and do so in a transparent way, to maintain what works and undertake consensual reforms when necessary. Always responsibly and with the citizens and the guarantees of the quality healthcare they deserve in mind
What the minister, or any other policymaker, cannot do is force companies to work at a loss. Quality and excellence come at a cost, and the lack of agreement can only be solved by more negotiation between the parties, understanding all points of view and putting the citizen at the centre, not by interventionism or inflammatory statements.
However, what has really caught my attention, and what I would like to reflect on in greater depth in this blog entry, has to do with the minister’s two most recent announcements regarding the professional career of doctors. On the one hand, the initiative, which is not new, that heads of department in public hospitals should only be allowed to work for the public health system, thus preventing any collaboration with private health care. And on the other hand, the proposal included in the draft of the new Framework Statute to oblige the MIRs to work for 5 years in the public system. Nonsense and nonsense. And now I will explain my point of view
It is surprising that in a government that calls itself progressive, it uses the verb prohibit for everything, instead of facilitating greater freedom and choice for citizens in general and health professionals in particular. This government uses prohibitions to try to make citizens do what they consider appropriate based on their ideology and not on the general interest or the opinion of citizens. They improvise proposals and launch trial balloons, from what I see and hear, to generate conflict and divert attention away from other controversial issues instead of focusing on solving the real problems that have been dragging on for some time.
I have to say that my position is the opposite of what the minister says. In my opinion, the formula for strengthening the public sector is not to prohibit or prevent doctors from developing professionally, but quite the opposite. More flexibility should be introduced in the management of resources, including the management of people, which is key in health care, and also to give them the necessary leadership and protagonism in decision-making in the system, since they are the ones who really know the day-to-day running of patient care. If the administrations provided them with the means to create value in the public system and introduced people management tools that are up to date with the demands of 21st century professionals, it would be easier to attract and retain talent.
The system should evolve towards a more flexible, open model that adapts to change and to the demands of patients and professionals. As opposed to prohibition, the system should be professionalised, responsibilities should be delegated to professionals and there should be consensus on the model.
What this minister is doing is resorting to formulas that have already proved ineffective in the past. If an excellent and capable professional wants to take on responsibilities in the public system, but also to develop in private healthcare, prohibiting him or her from doing so could lead him or her to discard his or her work in the public system, and could lead to the decapitalisation of the best professionals in the public system.
And as far as the MIRs are concerned, nobody can imagine that professionals who have studied for at least six years, plus another year of preparation for the MIR exam, plus the four years of work and training as resident interns can be forced to work for five more years in the public system, in a sort of compulsory and captive contract. After at least 11 years of training and apprenticeship, and in such a vocational profession, where passion and effort are so important, their personal judgement should be enough to make the decisions they deem appropriate. Making «prisoners» of those you want to attract as professionals seems to me to be a terrible proposition.
Nor do I understand why the minister wants to generate this kind of debate when we have so many other problems on the table that have been unresolved for years. Let us prioritise and be serious, please. While we argue about absurd proposals, waiting lists continue to grow, primary care is collapsed, technology is not being introduced at the pace it needs to be and the system is beginning to show clear signs that it is running out of capacity to respond effectively to the needs of citizens.