The Catalan healthcare system is in crisis and faces a number of significant general challenges: climate change, globalization, new technologies and artificial intelligence, as well as more specific ones such as insufficient funding, a shortage of doctors and nurses, and demographic changes. Catalonia is one of the regions with the highest life expectancy and, at the same time, has a mortality rate higher than its birth rate; that is, negative population growth. The combination of high life expectancy, low mortality, and a low birth rate leads to a highly aged population. In 30 years, the percentage of the population aged 65 or over will exceed 30%, and of these, those aged 80 and over will approach 40%. It's not new, but it's a persistent trend with significant consequences for the healthcare system: greater frailty, an increase in chronic illnesses and multiple pathologies, higher levels of dependency, and greater demand for care and social support. At the same time, Catalonia's population is growing. We are no longer the 6 million of the 1980s: we have surpassed 8 million. And this is thanks to immigration. It is estimated that by 2039 we will be more than 9 million. Thus, we have two patterns that entail two seemingly contradictory realities: simultaneous aging and population growth, both impacting healthcare demand and spending. Ultimately, our healthcare system is still based on the model of the 1980s, but the entire environment has changed. We start from a position of chronic underfunding, and the political, social, and economic outlook suggests that future priorities will not include strengthening the welfare state. On the other hand, there is a shortage of healthcare professionals, especially doctors and nurses. Increased demand and a lack of staff mean overcrowding. And, by the way, artificial intelligence can be very useful, but it doesn't work miracles. It's a complement, not a substitute.
We need to promote policies that generate health, that is, more "health in all policies." As the former Canadian Minister of Health, Monique Begin, said: "What is the point of curing people and sending them back to the conditions that make them sick?" These are the social determinants..When will we finally understand the age-old adage that "prevention is better than cure"? Someone once said that, rather than health systems, we have disease systems, since they are oriented towards the treatment of diseases and not towards their prevention and the promotion of health.
It's important to remember that human health is strongly influenced by animal and environmental health: we're talking about "One Health." More public health, in a nutshell.
Primary care needs to incorporate a stronger social component and a community-based approach. Change the names of things and add the word comprehensive It's not enough.
Joint work is needed from primary care, public health services, and social services under a single strategy and unified leadership.
The role of regional hospitals needs to be rethought: a hospital is no longer just a place with beds for admitting patients, but a concentration of specialized technological and human resources, with high costs and increasing complexity. The paradigm of a hospital 30 minutes away is unrealistic and, worse, it doesn't guarantee adequate quality of care. Not everything can be done close to home.
We must admit that social and healthcare centers and nursing homes need to change. Several years ago, their residents played dominoes and read; now they receive IV drips and oxygen masks. If sick people need to be cared for, different, more professional staff profiles are required.
New partnerships will have to be forged. And all of this under a new governance structure with decisive participation from local entities, the community, and professionals, in addition to the relevant administrations.
Simply proposing a reform of the healthcare system is useless: while it is necessary to continue demanding more money and more professionals, we cannot rely solely on achieving these demands. The system needs a new model that, in addition to establishing red lines of no regression in matters of universality, accessibility, participation, and quality, improves the levels of satisfaction of both users and professionals. And above all: a system that is highly flexible, which entails management autonomy and more and better communication and empathy. By the way, more management autonomy does not mean "Fair it out yourself."
We must begin working towards a major national pact for a new healthcare system. We are already late.
