The Tribune Interactive Open Physician , Marciano Sanchez Bayle explains, much better than I The previous post , the problem of cohesion in the public health system and inequities in providing access to health services for the citizens of our country. As access to the document, although free, requires subscription, I present you presented below:
OPEN FORUM: The cohesion of the National Health System
Marciano Sanchez Bayle, president of the International Association of Health Policy and FADSP spokesman
Since the transfers were completed, there has been a drift in the National Health System which has primacy over-particularism of the autonomous regions, facilitated by the absence of effective systems of coordination and inability to articulate a common policy line in health between the Ministry of Health and the Health Departments of the Autonomous
Madrid (02/01/1911) .- The lack of cohesion in the National Health System a fairly clear that highlights some abracadabra situations such as the absence of a routine immunization schedule despite the evidence that the epidemiological reality and knowledge Scientists do not respect the boundary lines of the CCAA, but also in other less known facts, but no less important for the implications this has for the design of health policies, such as lack of updated information and approved at the NHS . There
course differences in health indicators of the CCAA, differences that appear to be mediated primarily by socioeconomic status. So the maximum difference in life expectancy at birth is 2.4 years between Navarre and the Canary Islands (mean 79.6 years) in the percentage of population with poor health expectancy at birth is 5.5 per cent between Galicia and La Rioja (mean 24.8 percent), and on the rate of potential years of life lost per 1,000 inhabitants, the maximum difference of 9.61 between the Canary Islands and Castilla y León (average 39.68).
is known that the influence of the health system on population health is limited (explains about 14-20 percent of it) and also their impact will occur in the medium to long term, it is likely differences are detected now only produce identifiable differences of 15-20 years (one study shows that an increase in health spending $ 100 a decrease in mortality of 0.01 per cent).
The large differences in resources between the ACs have basically two explanations. The first related to the financing model not being a finalist allows health funds to be decided by each autonomous region and end up being very different. If we look at per capita budgets for 2010 we see that there is a difference of € 556.71 (on average € 1443.94) and that this difference between the highest and lowest per capita funding does not have a tendency to decrease.
Congruently, resource differences are striking, both in hospital beds per 1,000 population (1.8 beds with an average maximum difference of 3.6), as well as professional resources in primary care (1,067 inhabitants per doctor maximum difference on an average of 1,410) and technology, and logically active (vaccination coverage for children and over 65 years, offering diagnostic and therapeutic procedures, etc) which also generates large differences in waiting lists (over 130 days in the first consultation of the specialist and more than 15 percent in the percentage having this consultation with a delay exceeding 15 days) and surgery rates and the delay access to them. A major problem is that the expected delays are not public disaggregated by regions, preventing evaluation. Obviously
this is already producing inequalities in access to health care and end up having repercussions on the health of the population.
The second reason has to do with the health care model is advocated from each region. Some ACs are betting so decided by the health privatization funds and consequently reduce the public health system, as well as the PFI model and administrative concessions to private companies that produce inflexible financial commitments in times of cuts further reduce funding of schools public.
What can be done? It seems obvious that the first thing is to ensure coordination the NHS as a whole, it is indispensable to provide the Inter-Territorial Council the ability to make common decisions binding on all, then establish health objectives for the NHS as a whole, or, which is, to adopt the Integrated Plan Health is still pending since 1986 is contained in the General Health Law and the RD 938/1989 and never saw the light, making good that claim Sánchez Albornoz that Spain is characterized by good laws that routinely fail. Should also make sure the final character of health financing and establish minimum standards of health provision (infrastructure, personnel, etc) and of course, two key issues: an approved health information, disaggregated by regions and public (can not steal from the public knowledge of what is done with their taxes) and the intervention of the Ministry of Health where, as in the case of privatization, is called into question the essential characteristics of public health system.
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