In my previous article there were ideas left in the drawer because there wasn't enough space to address them. My intention was to propose practical solutions because having plans is essential for moving forward. Let's continue.The annual increase in the cost of public healthcare is 5-6%, while the Generalitat's overall spending grows by 3%. The population is aging and requires more attention. Healthcare professionals have increased their professional level. New technologies derived from bio sciences –more specific– are more effective, but also more expensive. The efficiency of the Catalan health system is due, in part, to the low salaries of medical staff, who, however, treat patients with a professionalism and care not found in any other member state of the European Union.Universal public healthcare is an asset that generates well-being and social cohesion, and that preserves the essence of the service that its creators wanted and achieved. The first universal health system was created in Prussia in 1880 by Bismarck, a visionary conservative who feared the decomposition of the Reich by socialism and the proletarian masses, at that time strong and organized due to the industrial revolution. To avoid this, Bismarck adopted, for health, socialist principles. The system was based on funding from contributions paid by employers and workers as part of their wages.In 1941, Churchill asked William Beveridge to plan a universal health system for after the war, to be financed through taxes. When Labour won the elections in 1945, Prime Minister Clement Attlee implemented the system that Churchill had imagined. It was a success, a pioneer in Europe. The Spanish system is based on this structure.Catalan healthcare was an invention of Convergència. The party intended to strengthen and consolidate a society that had emerged from the dictatorship with “scars”, but also with the will to create a society for the new political environment where it was “Catalan whoever lives and works in Catalonia”. Health became an autonomous competence. Trias planned it, Ribó's left supported it and the government's work was completed... Today we have the result.Time passes, and the precious asset we have today —few will argue that the Catalan health system is not excellent— requires increasing funds to maintain the current quality level. It also needs a reform of the system to make it more efficient and reduce spending without affecting services. The problem with our health system is its cost, and reforms must be aimed at containing it. The system has an attribute that makes it unique: the combination of the staff's professionalism with a public-private mix – private entities, such as La Caixa, and public ones, such as universities, hospitals, and research centers, which maintain quality and innovation as their hallmarks –. Everyone wants to be treated by the public health system in case of serious illness.
The system requires an update –an update– after decades without changes. We should ask ourselves some questions. Is the paradigm of a network of large hospitals within 30 km of any citizen in Catalonia sustainable? Is it not more efficient to expand existing ones than to build new ones? How can the robotization of surgery be maintained efficiently while reaching everyone? Can health services not be optimized with new technologies, segmenting treatments? As I said, cost is the main problem of our health system. Let's list reforms that can be carried out to contain it:—Reduce the cost of primary care to be able to maintain secondary care. It is a matter for debate: everything that primary care does not cover will pass to secondary care. Therefore, the way forward is to reduce the cost of primary care by discerning what is necessary from what is not. Reducing the cost of the service without affecting quality requires being more precise and determined.—Reduce pharmaceutical spending by dispensing only the medications strictly necessary for treatment, thus reducing waste.—Establish a co-payment for primary care to reduce its abuse. And the same for non-essential treatments that do not increase the patient's health risk.—Sell services at a high price to third parties who come for treatment, to generate extra income.—Focus services on what is essential for health, and not on what is convenient for the patient.There are many more. Why not create a committee of experts to define measures that would make the service cheaper and, at the same time, increase the salaries of professionals? First, possible measures must be defined and their impact quantified; then, they must be classified according to this, and implemented progressively.For example, pharmaceutical spending must be reduced. An essential path is for patents to have a shorter duration than the current one and to be universally usable after 5 years of their publication, instead of 20 years, as they are now. It can be argued that, then, pharmaceutical companies will reduce research expenses. But they will not: research is precisely the reason for their profitability. The decision to reduce the duration of patents does not fall to Catalonia or Spain, but to Europe. It will be difficult, but it must be taken to the European Parliament and publicly challenge anyone who wants to vote against it.Healthcare is of radical importance for our social well-being and does not reach 8% of GDP. Everything that is done to maintain the level of service and reduce costs is important. Reform is needed, but to move from ideas to plans, work must be done. And listen to the experts.
