Does Ayuso's healthcare system make the Catalan system look good?
The Spanish healthcare system needs reforms importantThis uncertainty about the future has led the most daring politicians, guided only by their ideology, to implement changes. The winds of privatization began in Galicia, later spreading throughout the country.It's because of the Valencian Community, and a storm was brewing in Madrid. President Ayuso, in fact, inherited many of the reforms now being debated. But if you only have ideology and no evidence of the implemented proposals, you can only defend them by making the little macho, instead of learning by doing and correcting course if necessary.
Faced with this mismanagement of healthcare and the scandals plaguing the Madrid health system, the monster of the central administration has risen, with a head but no claws due to healthcare decentralization. It announces red lines and legal threats, wrapping itself in the banner of healthcare equity and social justice. I am referring, of course, to the draft bill on public management and integrity of the National Health System. Thus the two monsters roar, locked in conflict.
However, I will focus on washing our own dirty laundry, because the justified attempt not to get caught up in the diplodocus battle cannot become a way of making a spectacle of it. We cannot take refuge in thestatus quo Thinking that saving the actors in the system will save the system as a whole is a mistake. The Catalan healthcare system has many well-known problems, and for the moment, very few solutions. Some are related to funding; others to spending management.
For example, we have many medical professionals, but at the same time we say there's a shortage. They might seem like a lot if we consider the significant amount of activity they carry out outside of clinical practice, such as research (not always sufficiently structured) or teaching positions offered by industry. And they might seem like a shortage if we consider the waiting times for healthcare. All this while maintaining a loose compatibility with private practice, with increasing absenteeism concentrated on certain days, and with some resistance to being replaced by nurses in some clinical tasks, all within the framework of their professional statutes. ad extensum...to proclaim that healthcare (they) "is untouchable." Not everyone is like that, and the description I've given corresponds more to the leading voices within the system, including some unions where the "What about my share?In this system, private providers parasitize the portion of the public system that suits them by throwing money at the problem, taking advantage of the latter's relative collapse. And we, the citizens, pay for it, because we are children of our time and are willing to dig deep into our pockets for private insurance.
Ours is a system where those in charge (or perhaps I should say "those who believe they have the power"), those who purchase and pay for services, and those who provide them all sit at the same table—a debatable point, since one group's income is another's expense. And they deceive each other with the tactic of "whoever pushes the other day, year after year": I'm referring to the contributions to subsidized private schools that aren't paid when due and drag on endlessly through budget extensions; or I'm also referring to the joint approval, by all these actors, of future-projected budgets that they know will be insufficient because they're lower than the actual budgets for the current year. There are board meetings where they openly discuss expenses already incurred but not yet accounted for, while the auditor, when money has been spent for which there was no budget allocation, I suppose, has to turn a blind eye. It made sense that, at the time, some of us spent so much time trying to understand that British saying: If not for profit, then for what? (If it's non-profit, what is its purpose?). It's true: today Ms. Ayuso no longer hides her intention to profit from healthcare. But Madrid's healthcare policies don't make everything we do here seem good.
The old debate about public administration remains, however. As a young researcher, I often debated with Minister Ernest Lluch. I reminded him that budget constraints had to be credible to ensure efficient spending, and that funding had to be sufficient to eliminate the "every man for himself" mentality of under-budgeting and expandable appropriations. a posteriori (Pharmacy and supplies, above all). He refused, because of the high capacity he observed in the system's "agents" to "devour" all the resources put on the table and more. And perhaps he was right. Similarly, today many question the argument that if doctors, complaining and burned out, were paid more, their greater dedication would increase activity. And they can base this on the fact that increasing staff has, so far, brought nothing more than a near-zero reduction in waiting lists.
Certainly, the debate surrounding existing alternatives in the field of healthcare reform currently favors the Catalan system. However, we must not forget all the areas where improvements are still needed.
