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Spanish health cuts could create “humanitarian problem”
Campaigners have warned that Spain's health cuts could cause serious public health problems as free medical care is reduced for older and immigrant populations. Gonzalo Casino reports.
For the first time since the creation of the National Health System in Spain in 1986, pensioners will now have to pay for the cost of their medicines. Additionally, people in employment will have to pay up to 50% more for medicines, depending on their income. With these and other measures outlined in a new Royal Decree law at the end of April, Mariano Rajoy's conservative government aims to save €7 billion, or 10% of total spending on health in 2011.
The reforms include the co-pay system for medicines, withdrawal of free medical care for illegal immigrants, and several measures to improve efficiency in the health system.
Spain's 8,5 million pensioners, who are responsible for 75% of the €11 billion in drug spending (1,1% of GDP), will be hit hard by the cuts. Under the new measures, only the unemployed not receiving unemployment benefit and retirees on the minimum pension will have free drugs. Retirees with higher incomes will pay 10% of the cost of their medicines, with limits of €8, €18, and €60 depending on their pension. As for workers, those on a minimum income (up to €22 000 per year) will continue to pay 40% of the cost of the their medicines, those earning up to €100 000 will pay 50%, and those with higher incomes, 60%.
The co-pay system has also been extended to orthoprostheses, dietary products, and non-urgent ambulance trips. All these measures shall enter into force on July 1 .
“Co-pay for medicines should be reformed and this is a first step that improves the previous situation, which was very unfair to low-income workers”, said Beatriz González, professor at the University of Las Palmas de Gran Canaria, Spain, and an expert in health economics. “The measures are well-meaning but perhaps overly optimistic about their saving capacity.”
At a press conference held after the Cabinet meeting in which the measures were approved, Deputy Prime Minister Soraya Saenz de Santamaria said that these cuts were the only way to sustain the welfare state.
The Spanish Federation of Associations for the Defence of Public Health (FADSP) sees the new co-pay system as being a tax on disease. “It penalises those with more limited resources and more health problems”, Marciano Sánchez Bayle, a paediatrician and FADSP spokesman, told The Lancet. According to the FADSP, 8,5% of pensioners earn less than €300 a month and 54% less than €650, which puts them “in the position of choosing between paying for medicine or buying food”.
The FADSP also believe that the measures adopted will hardly contribute to reducing the public health deficit. The real intention, they say, is to “break the distributive and supportive character of the public health system and implement payments for health services that until now were financed with taxes, and later extend payments to other aspects of health care: consultations, diagnostic tests, hospitalisations, etc.”
Spain is one of the 15 European Union (EU15) member countries that spends the least on public health. In 2008, the first year of the financial crisis, Spain spent 6,5% of GDP, while the average for the EU15 member states was 7,3%, according to Eurostat, the statistical office of the EU.
“Spain spends far less on public health in relation to its overall wealth”, says Vicenç Navarro, professor of Public Policy at University Pompeu Fabra, Barcelona, Spain, and professor at Johns Hopkins University, MD, USA. In place of cutbacks, Spain would need to spend €13,5 billion more per year on its public health service to match spending in other EU15 countries, according to Navarro.
Another measure approved by the Spanish Government is to limit “health-care tourism” to prevent abuse by foreign visitors who take advantage of Spain's free health-care system. But the most controversial measure will be the removal of the medical card for immigrants. From Sept 1, some 500 000 immigrants will only be entitled to emergency medical care and assistance with pregnancy and childbirth. “This is a humanitarian problem for public health”, according to Sánchez Bayle. Medicos del Mundo, Caritas, and other non-governmental organisations have also criticised this measure.
The Spanish Government has adopted other efficiency measures, including the purchasing of drugs at national instead of regional level, and alterations to the packaging of drugs to only last the duration of treatment. All these measures have been agreed with the 17 autonomous Spanish regions.
The FADSP sees these cuts as being “a weather balloon to gauge the social response” before further cuts are implemented. “All indications are that it has opened the way to doing away with universality in health care”, said Sánchez Bayle.
Gonzalo Casino , The Lancet, Volume 379, Issue 9828, Page 1777, 12 May 2012link 20 de abril de 2012.
«El Consejo de Ministros ha aprobado hoy el Decreto Ley de reforma del Sistema Nacional de Salud. El objetivo principal de esta norma es garantizar la sostenibilidad de la Sanidad Pública. A su vez, será el instrumento que permita generar unos ahorros superiores a los 7.000 millones de euros en gasto sanitario.» linklink
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