Aser Garcia Rada: The end of a public healthcare system in Spain

Aser Garcia RadaIt is 11 months since the conservative People’s Party came to power in Spain, and in that time there has been a distinct lack of clarity and transparency in their aims, particularly with regard to their healthcare plans.

Spanish president Mariano Rajoy does not seem to have the word transparency in his dictionary. Spain has one of the highest levels of unemployment in the developed world—close to 25%—there are growing and previously unthinkable cuts everywhere, and Spain is about to face a bailout. Rajoy’s appearance in the Congress of Deputies is rare and the number of press conferences he has given since coming into power can be counted on my fingers. Most of the ones he has given have been mandatory as they were at bilateral international meetings.

It is a similar situation with Ana Mato, minister of health, social services, and equality, who took almost four months to give her first press conference. Since then, apart from a few interviews given to friendly media, the occasions for journalists to ask her something have been rarer than known contacts with alien life forms.

And it is not because things are going smoothly. Our National Health Service has recently been degraded to a social security system, undocumented migrants have been excluded from public healthcare as have and citizens with incomes from investments higher than €100 000 per year, and the ministry has just suffered a 22.6% budget cut for 2013 added to previous reductions.

Mato is also considering excluding certain benefits from public financing, for example screening programmes and implants, genetic diagnostic tests, and assisted reproduction or rehabilitation. Changes in healthcare workers remuneration is also being considered. These issues were supposed to be set on 3 October at the last Interterritorial Council of the National Health Service—the meeting attended every three months between the ministry of health and the regional healthcare authorities. The decisions were delayed until the next regional elections, which took place yesterday in Galicia and the Basque Country, and will take place on 25 November in Catalonia.

The only decision taken was to offer those recently excluded from public healthcare some kind of public insurance costing from €710.40 to €1864.80 per year depending on age to maintain public care, but it won’t even cover drugs expenses. That means that an undocumented migrant with HIV may have to add more than €10 000 to this insurance for his/her treatment.

It is “an insurmountable barrier for access to healthcare for thousands of people” according to the NGO Doctors of the World, who have denounced this public insurance as more expensive than private ones. With the strikingly high increase in private insurance adverts on radio, TV, or advertising billboards, it is easy to see that private companies are going to make the most from this whole nonsense.

And again, although a joint press conference after the meeting of the Interterritorial Council of the National Health Service has been the norm, Mato refused to appear this time. This has led the Spanish National Association of Health Journalists (ANIS) to complain of a “lack of respect for citizens and journalists.”

I fear the government is hiding further plans from us. Just before the last national elections the daily El País revealed Rajoy had requested a report about reforming healthcare from FAES, the People Party’s think tank, whose current president is the former Spanish ultraconservative president Jose María Aznar. The report talked about things that are already happening such as growing co-payments, but nothing else is known about its contents. In fact, the report has never been made public. I have asked the ministry and one of its contributors, a congressman of the People’s Party, about it, but I didn’t receive an answer, which makes me fear the worst.

My worry is that the government will progressively exclude more and more people from public healthcare—for example continuing with those earning more than €80 000—until most of us end up having to decide between public insurance or a private one. It will also mean the end of our public healthcare because once the middle class is excluded it will have become a welfare system.

Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.