Aser Garcia Rada: Protests against the privatisation of healthcare in Spain

Aser Garcia RadaOn 17 February thousands of people demonstrated in Madrid, and in 15 other Spanish cities, against the growing privatisation of public healthcare. Although ongoing cuts have caused protests in many regions it was the first time a nationwide “white tide” demonstration—referring to protester’s white coats—has taken place.

The large protest began in Madrid after a plan for reform was announced on 31 October by the regional ruling conservative People’s Party (PP). The plan proposed the full privatisation of six hospitals and 27 primary healthcare centres. It also included a one euro per prescription tax, which has been in force since January. Concerns have also arisen in Catalonia where private management is already strong for historical reasons, after the newspaper El País revealed that the Catalan nationalist group, Convergència i Unió (CIU), had asked PriceWaterhouseCoopers to evaluate the privatisation of 18 hospitals and  46 primary care centres, which treat more than two million people.

Healthcare professionals complain that the reforms are happening without technical backup and they fear that there will be job losses. I made a request at a recent debate organised by the Spanish National Association of Health Journalists (Asociación Nacional de Informadores de la Salud) for a technical report to back up the government’s planned reforms.  Manuel Cervera, the ruling PP’s spokesman for health in the national Congress of Deputies, has so far not provided any such technical report to support the suitability of the privatisation that has been running in regions governed by his party since 1999.

Cervera only referred to high levels of satisfaction in surveys about privatised centres in regions such as Valencia, where the first fully privatized hospital opened in 1999, or in Madrid. “The Autonomous Community of Madrid is making efforts to explain its measures,” Cervera added. But if they had a technical report to support their plan, they wouldn’t have to make any special effort to explain what they are doing. In a following debate, the head of the regional health department of Madrid, Javier Fernández-Lasquetty, followed the same script as Cervera’s.

Fernández-Lasquetty was asked several times about the outcomes of Madrid’s health centres, but he said “I don’t have them here.” Just one more example of what “transparency” means in Spain.

It is not all bad news. The awareness of the importance of public healthcare is growing. Though Spanish doctors have not traditionally been very concerned with how our healthcare system works, now they debate it. And awareness has extended to the general population. For good or bad, according to official polls healthcare has become the fifth issue Spaniards are most concerned about after unemployment, corruption, the economic situation, and the politicians.

Our young democracy—not even four decades old—is beginning to demand solid arguments instead of dazzling slogans, something many politicians have not yet realised. As Spaniards become more critical, this is being reflected in the health sector. It is the first time we have questioned the traditional liberal-conservative message stating that private management is always better. Editorials criticising privatisation have appeared in major dailies such as the social democrat El País or the liberal-conservative El Mundo, something I have never seen before.

And a few achievements can be celebrated. Until a final decision is taken, the Constitutional Court recently suspended the one euro per prescription tax that, in a Kafkaesque move, had been appealed by the national government also ruled by the PP. The court, that had already suspended a similar tax established in Catalonia last June, argued that drug prices are the responsibility of the national government.

Nevertheless as the conflict takes hold, protesters are becoming tired. The most recent “white tide” that took place in Madrid on 17 March was attended by fewer people. The stubbornness of the Madrid regional administration to fulfil their plan at all cost is getting on the nerves of many who are beginning to feel that their efforts are useless. But at the same time, concern is growing that private companies’ may not be willing to take over the public centres if broad discontent persists. The Spanish Socialists Workers’ Party in Madrid have said that they will expropriate the privatised centres if they get to power. Madrid’s government has unofficially offered to privatise just one of the six hospitals—something unions have refused—and has announced that only four out of the 27 primary healthcare centres will be privatised, presumably after realising that the private sector is not keen to take them over.

That is a great success, but at the cost of 50 000 cancelled consultations and 6 500 cancelled surgeries cancelled due to strikes. Although alternative proposals have been presented, Fernández-Lasquetty has said he will not negotiate on privatisation. The union leading the protests AFEM (Asociación de Facultativos Especialistas de Madrid) is being quite inflexible as well taking into account that, after all, the regional Government has been voted in by the citizens. Spaniards are already living through a difficult time. If we all really want to protect healthcare, a little more decency from the administration and humility from all parts would be desirable.

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