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.

There are laws that regulate. And some that redefine entire models. The Draft Bill on Public Management and Integrity of the National Health System, approved in its first reading by the Council of Ministers on February 10, falls into this second category. And when models are redefined, it is essential to be extraordinarily precise: not everything is the same. Not all forms of public-private partnerships are equal. Not all respond to the same incentives. And not all generate the same impacts on the public health system.

The healthcare system is one of the most complex and successful achievements of democratic societies. Complex because knowledge, and consequently the capacity to treat illnesses, is constantly evolving for the benefit of us all, and also because those of us who are part of the healthcare system sometimes speak indecipherable jargon. Furthermore, healthcare activity indicators are not easy to interpret in their entirety. We must acknowledge that today we have more information than we are capable of processing to draw the necessary conclusions and adjustments.

The Catalan healthcare system is in crisis and faces a number of significant general challenges: climate change, globalization, new technologies, and artificial intelligence, in addition to more specific ones such as budget shortfalls, shortages 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 exceeding its birth rate; that is, negative population growth. The combination of high life expectancy, low mortality, and 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 or 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 conditions, 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.

The standoff between the Spanish government and the Community of Madrid over the privatization of healthcare services escalated on Tuesday with the announcement of a draft national law to make public management of healthcare centers "preferred." This move comes in the wake of the scandal surrounding... Torrejón Hospitalin which economic profit was allegedly deliberately prioritized over patient care. The future law aims to make privatization "exceptional" and limited to those issues that the public healthcare system cannot address, a change that has sparked some concern in Catalonia: that it could be used to dismantle Catalonia's historic comprehensive public healthcare system (Siscat). However, the Minister of Health, Mónica García, has assured that this will not happen and, in fact, has cited the unique Catalan healthcare system as an example of "healthy public-private collaboration." The minister explained in statements to RNE that the law to prioritize public management of healthcare services seeks to curb "obscene" and "mercantile" practices in public-private models, and she specifically referred to the policies of the PP government in Madrid, which "forgets" to charge patients. She made these remarks in relation to the information published by Eldiario.esGarcía, who points out that Isabel Díaz Ayuso's government allegedly "forgave" 71 million euros to Quirón and Ribera Salud after they took on and treated its patients, clarified, "What we don't want is for patients and money from our public healthcare system to continue being diverted to private healthcare." García explained that this law doesn't limit the privatization of healthcare, but rather models "driven by speculative and commercial interests." "What the law says is that it will put an end to this public-private partnership that is predatory to our healthcare system; non-profit models, models that work, that are a healthy public-private partnership, can perfectly well be maintained," he argued, citing the Catalan model as an example.

Neglecting to treat sick people in order to earn more money goes against the ethical principles and professional conduct of doctors, and yet this is what was allegedly happening in at least one hospital in the Community of Madrid for months. These past few weeks have set off alarm bells throughout the public healthcare system as a result of... the Torrejón de Ardoz Hospital scandalA publicly owned but privately managed center, where the directive was allegedly to reject unprofitable patients or procedures in order to lengthen waiting lists and increase profits. This information has ignited yet another political battle between the governments of Isabel Díaz Ayuso and Pedro Sánchez, but it has also reopened the debate about the provision of services in the public healthcare system.

It looks like it will fine healthcare users who commit violence against healthcare staff. And among these acts of violence are "raising one's voice, intimidating, insulting, or threatening, whether in person or through social media, as well as assaulting or causing material damage inside or outside the centers."

Between residential and home care, the overwhelming majority of Catalans (93%) would prefer to receive care at home, according to the latest Òmnibus survey. More chronic, neurodegenerative, oncological, and mobility-related illnesses associated with aging, greater loneliness, and greater economic hardship—coupled with demographic predictions that indicate that in less than a decade, one in four inhabitants of the country will be over 65—reveal the need for healthcare and social resources.

Pediatrician Ana Roca (Torrelles de Llobregat, 1963) is the new president of Doctors of Catalonia (MC), the country's main medical union. The current vice president is the first woman to hold the presidency of the organization in its 125-year history. In a conversation with ARA, she reviews the main challenges facing the healthcare system and evaluates the actions of the Department of Health and the Ministry of Health.

There is only one month left until 27 Primary Care Centers (CAP) in the country become Comprehensive Reference Health Centers (CSIR) for a year. This isa pilot test that will begin on June 30 with the goal of transforming current centers, a long-standing demand of the healthcare sector that has so far never come to fruition.

Hospitals, both public and private, and primary care centres compete fiercely to recruit doctors and nurses. Their priority is to cover for the increasing number of staff on sick leave, as well as replace workers going on holiday. These professionals have been on the front line during the most dramatic moments of the pandemic. The problems is there are no more doctors and nurses to hire. And the professionals who are available will not accept the conditions offered to them, they are exhausted from stringing together temporary contracts or, having recently finished their training, they would rather start working when the summer is over.

The curve of the sixth wave of covid grows progressively, without causing the explosion of new infections of last summer, when 50,000 cases a week were detected, and without saturating the health system. Or at least hospitals, because the primary care centres are noticing the pressure of this increase in positive. They now receive twice as many visits related to covid than fifteen days ago, and only in the last week visits for suspected infection or moderate symptoms have grown by 38%. Health Secretary Carmen Cabezas has described this increase as "very serious and important", because primary care already carries virtually the entire burden of the pandemic: vaccines (both flu and covid), care for respiratory problems and screening tests. At the same time, it s trying to recover face-to-face consultations to treat other diseases.

The pandemic's growth in Catalonia is already undeniable: the curve of infections began to grow around All Saints, at the beginning of the month, and twenty days later it has reached 7,758 new cases a week, i.e. more than a thousand cases a day on average. And this increase in new infections is already affecting the health system. In primary care there have been 9,000 consultations related to covid in the last 24 hours, about 41,000 in the last week. In Catalan hospitals the number of hospitalisations due to the virus has also grown by 60% in a week and this Wednesday there are already 565 admitted to hospital (48 more than yesterday), 127 of them in intensive care units (ICU), eight more than on Tuesday. The vast majority are over 50. However, while admitting concern about "the significant increase" in activity related to coronavirus since the weekend across the country, Catalan Secretary of Public Health Carmen Cabezas claimed that the impact of this new onslaught is much lower than that of previous waves. "At the moment it has a similar behaviour to the fifth wave, which reinforces the idea that vaccination is very useful to prevent the severity of the disease and deaths," she said.

The Catalan health system was already in dire straits before the pandemic broke out, but covid has highlighted the shortcomings that for a decade its professionals have tried to compensate with sacrifices and, at the same time, visibilize with protests at the gates of the Department of Health. The system continues to be weakened by the cuts that began in the time of Minister Boi Ruiz, in the midst of the economic crisis.