6 Dec, 12 | by BMJ Group
Spain is currently experiencing the biggest protest by healthcare workers ever known. It has been triggered by a plan by Ignacio González, a member of the conservative People’s Party (PP) and president of the government of Madrid. He plans to privatise regional public healthcare further as part of the regional budget for 2013.
The plan involves a new charge of 1 euro per prescription—which has even been criticised by Mariano Rajoy, the Spanish prime minister, also from the PP. It also involves the full privatisation of six regional hospitals currently run under private finance initiatives, and the privitisation of 10% of primary healthcare centres and all regional auxiliary services. It also suggests that La Princesa Hospital, a large specialised hospital, should be transformed into a “superspecialised” facility for those older than 75, and that the Carlos III Hospital, currently specialised in infectious diseases, be transformed into a facility for chronic conditions.
Though González argues that these changes are necessary to face the current economic crisis, he has not shown any technical support for his plan. Scientific evidence doesn’t back up the usual slogan “private management does it better,” neither does international experience in countries such as the UK, or Italy. When asked in a recent interview, the head of the regional health department, Javier Fernández-Lasquetty, could refer only to the report of a consulting company that has several private insurers and providers as clients. He also called the protesters liars including the 80% or more of doctors who have been on strike for a few days. González stated that the changes are unavoidable.
However, some have suspicions that there are other reasons for this plan. First, González needs more than €400 million from the allocation of hospitals to private entrepreneurs, because he would like to reduce the large regional public debt of around €16.5 billion. Secondly, the plan seems to be to pay the private hospitals a fixed amount from the public budget every year, depending on the number of citizens they have in their catchment area. So if they treat fewer patients, or if their patients have less complicated diseases or require fewer resources, they will make bigger profits. There are concerns that these hospitals will transfer the patients that require more care or more expensive treatments, or who would have to remain in hospital for longer, to the large public hospitals. These patients are usually elderly or have chronic diseases, so a lot of people think that the idea of transforming two public hospitals, La Princesa and Carlos III, into facilities for treating these groups has something to do with it.
I wonder if an agreement has not already been struck with the private sector. The Spanish Society of Public Health and Healthcare Administration (SESPAS) has just denounced the “excessive proximity between authorities and private management dealers,” and on 2 December, the daily paper El País, commented on the “revolving door” between public healthcare management and the private sector.
The most striking case is that of Antonio Burgueño, currently the general director of Madrid’s public hospitals and the brain behind this new privatisation plan. He set up the Hospital of La Ribera, better known as the Alzira model, the first Spanish public hospital that was fully privatised, and that needed a public bailout four years after starting business because of ongoing losses. He has long worked for the private sector, notably for the two main private companies controlling most public providers with private management in Spain: Capio and Ribera Salud. A video of a talk Burgueño gave sometime ago has become most popular. He states that the doctor-patient relationship would be “more endearing” if patients had to pay up to 50 euros for a consultation with their GP.
This move has been the straw that broke the camel’s back for healthcare workers. It is remarkable that doctors are protesting, as in the past they have not been especially inclined to do so. Clearly something began to change among healthcare professionals on 15 May together with a broad democratic revolution affecting our whole society driven by the 15M movement. Something that has now turned a workers’ protest into a citizens’ one as stated in one of its slogans: “We are doctors, we are patients. We defend public healthcare.”
Our magnificent public healthcare is the most valued base of our social welfare state, but over the past few years, while growing cuts intend to demolish it as well as education or justice, that we are becoming truly aware of its importance. These recent events have created such unity that it is almost accurate to say everyone opposes Gonzalez’s plan.
Almost one million citizens—in a region of 6.5 million—have signed a petition to demand its withdrawal, enthusiastic protests take place daily in many hospitals, and thousands demonstrate every week. A new poll states that 87% of the population oppose privatisation. To find a similar percentage of unanimity we must look back to 2004 when Spanish citizens opposed our involvement in the Iraq war.
Healthcare workers are taking now picking up the baton from other professional groups, such as education workers, who have been protesting hard over the last two years. It took us longer, but we are finally opening our eyes, and our political leaders are bewildered.
Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.