The more than twenty organisations behind the #AfterApplauding campaign—including the Sociedad Española de Médicos de Familia, Médicos del Mundo, Salud por Derecho and the Federación de Asociaciones Defensa Sanidad Pública, as well as the major trade unions and platforms for the defence of public health—are asking Congress for a stronger commitment to strengthening the National Health System. In view of today’s debate and vote on the final conclusions of the Commission for Social and Economic Reconstruction, the signatory organisations find the preliminary text insufficient on matters such as funding and pharmaceutical policy and recommend the inclusion of specific measures to strengthen and protect public health, which has been an international benchmark for so many years.
The request for an increase of 1,000 euros per person per year with a final view to the budget line for health is one of the key demands that the organisations have communicated to the members of the Congress in view of today’s plenary session.
COVID-19 has revealed how the cutbacks in health over the last decade have weakened our healthcare system, putting the health and lives of the population as a whole at risk, particularly those of healthcare professionals. Consequently, the organisations behind Más Sanidad consider the work of the Commission for Social and Economic Reconstruction as an opportunity to reverse these failed policies and build a new consensus around a strengthened model of public and universal health care. However, “the preliminary decision being voted on today in the plenary session has not only failed to achieve broad support, but also evidences significant shortcomings in key areas.
Therefore, the organisations that promote #AfterApplause would like to present a series of assessments, with the hope that they will be included in the debate in the plenary session of Congress.
The vast majority of the commitments set out in the Commission’s final decision require an adequate budgetary allocation. However, the section on the funding of the National Health System is notable for its lack of specific commitments. In this respect, the organisations note that:
- It is a mistake to link the increase in the healthcare budget to GDP. The signatory organisations believe that this approach is ill-suited, as it is liable to result in a significant decrease in budget allocations in times of recession. On the contrary, they support a standard based on euros per person per year, setting as an objective to reach the EU average by the end of the legislative term. In absolute numbers, this increase translates into 1,000 euros more per person/year than current spending.
- A percentage of the healthcare budget should be allocated to under-resourced areas. Specifically, 25% of the public budget should be allocated to primary care, 2.5% to public health and 2% to health research, three areas that have proved critical in the current pandemic.
- The reconstruction fund should prioritise the contracting of primary care staff and increase the creation of beds for medium- and long-term care in publicly managed centres.
Universalization of the right to health care
The Commission aims to strengthen and consolidate the universality of health care as an objective, but its findings suffer from two major omissions:
- The urgent nature of the measure: making this measure subject to a future bill means jeopardising the health of many people who are still excluded from health care.
- To respond to the special vulnerability of reunified families. That is, to include older people who come to Spain through the process of family reunification, people who, due to their advanced age, are in an at-risk group in this pandemic and who currently lack any right to health care.
The importance of prevention
The current crisis created by COVID-19 has made clear that when it comes to public health, action must also be taken to tackle those social and material conditions that are determinants of health. In this sense, the Más Sanidad platform suggests:
- The creation of an expert, independent, protection- and action-oriented State Public Health Agency.
- Promoting the coordination of public health services with social services.
- Creating, strengthening and developing an Observatory of the Spanish National Health System with a special focus on the analysis of inequalities and the study of social determinants.
- Boosting research in Public Health.
- Strengthening the Health Information System by incorporating health outcome indicators.
- Promoting the patient safety strategy, the “Do Not Do” recommendations and clinical excellence.
Pharmaceutical policy, public production and intellectual property in health R&D are lacking.
This applies both to pharmaceutical policy and intellectual property in the research and development of medicines. The Commission for Reconstruction has missed the opportunity to further explore many changes that are urgently needed if access to and affordability of medicines and health technologies are to be ensured. Missing are:
- The commitment to implement the much-needed reform of medicine pricing processes, particularly for the newer and more expensive medicines.
- Measures to rein in the increase in pharmaceutical spending, specifically in the hospital sector.
- Specific proposals to boost public production of medicines and health technologies beyond advanced therapies.
- Open science and innovation through open, non-exclusive licences and data sharing. This is the only way to make medicines or vaccines that have been developed with public investment accessible to everyone who needs them, free of the current intellectual property barrier.
No provisions to protect the Spanish National Health System from privatisation
The pandemic has exposed the need to increase the resources of publicly managed health centres, as the clinical management of the pandemic has hinged on these points of care. According to the signatory organisations, “this decapitalisation of the public sector is not only a consequence of the budget cuts of the last decade, but also of the commitment to privatisation models that divert a significant proportion of scarce resources to the private sector. These models have not only proved to be more inefficient than direct public management, but also aggravate inequity, weakening everyone’s right to health protection”.
In light of this situation, these organisations request:
- The guaranteed end of the privatisation of health centres and services, and that systems be established to ensure the evaluation of the privatisation processes.
- Strict control of compliance with contracts and licences.
- Legislation that favours the recuperation of whatever has been privatised and a timeframe for its completion.