|Implemented in this survey?|
A group of experts was commissioned by the regional Catalan government to analyse the actual situation of the regional health sector. This initiative is embodied in the political process of negotiations between the regional governments in Spain and the central government, in order to achieve a new system of financing the decentralised regional public health services. Apart from intending to have a better public health system, this initiative is a way of trying to get more funds.
Main objectives are:
The instruments are going to be varied, depending on the measures finally adopted. They affect the regional organization of the public/private health system in Catalonia and the system of payment
to providers, the labour conditions of some doctors and GPs of the public system, the fiscal relations between the central and regional governments, etc.
Depending on the measures finally implemented, various actors are going to be affected. For example, consumers/citizens through greater participation on the costs of the services, doctors and GP through changes in their labour conditions; patients if quality is finally improved; local administrations because of regional reorganization of the health services system, etc.
Regional and central governments, Patients/citizens, Doctors, Providers and purchasers, pharmacy sector
|Medienpräsenz||sehr gering||sehr hoch|
The change of the political parties in power in the regional government took place early in 2004, and short after there was also a change in the political party in power in the central government. Both are left-wing, and more close to each other than previously (before the elections in 2004). The central government has agreed to have a new system of financing of the regional health systems by 2006.
|Implemented in this survey?|
The issues of the efficiency and quality levels of the public health system are not new, neither the issue of not having sufficient resources to finance the ever increasing health expenditure.
However, the change of the political party governing the central level, by march 2004, has made for a re-initiation of conversations between the central government and the regional ones, about the
financing of the regional health services.
Moreover, it seems that the system implemented by the previous central government political party in power, does not provide enough resources for the regional health services, and many regional authorities are demanding more resources and a reform of the system.
Within this context, some regional authorities have also done or are doing now an exercise to look for other alternatives to increase the efficiency, equity and sustainability of their health systems, in a similar way as the Catalan government has done.
The measures proposed by the Catalan experts committee are quite large and broad in scope. They provide a large array of measures for the government to choose. They are divided into two baskets: one related to an increase in funds; the others are related to increases in efficiency and quality.
The approach of the idea is described as:
renewed: This time the initiative is coming from the regional governments and is embodied in a new politicacal context.
Some associations and professionals do consider that the proposals of the "Informe Vilardell" (which is the name commonly given to the report or white paper of the experts committee) are in
general a good starting point for making reforms (e.g. the "Unió Catalana d'Hospitals" which is an association of Catalan hospitals; also "Médicos de Catalunya" which is a doctors labor
union of Catalonia, or "CCOO" an important trade union).
However, they think that more work has to be done in terms of concretizing the general proposals to more specific ones, e.g. to define the benefits' basket of the public health system, which is important in order to know what amount of financing are we talking about.
Pharmacies do disagree with the proposals concerning drugs distribution: liberalizing the distribution and dispense of drugs and the possibility that the primary care centers and also the geriatric centers may be able to dispense drugs. Until now, pharmacies have the monopoly (there are around 3,000 pharmacies in Catalonia, for a population of around 7 million).
|Regional government health minister||sehr unterstützend||stark dagegen|
|Regional government minister of finance||sehr unterstützend||stark dagegen|
|GP and specialists, for the report in general||sehr unterstützend||stark dagegen|
|GP and specialists, for increasing labour hours||sehr unterstützend||stark dagegen|
|Academic experts||sehr unterstützend||stark dagegen|
|Health sector experts||sehr unterstützend||stark dagegen|
It is expected that some of the proposals of the experts committee will be implemented in the near future but it is still not known which ones. However, some proposals, even though not necessarily in the same way as they have been proposed, are already being implemented. These are:
|Regional government health minister||sehr groß||kein|
|Regional government minister of finance||sehr groß||kein|
|GP and specialists, for the report in general||sehr groß||kein|
|GP and specialists, for increasing labour hours||sehr groß||kein|
|Academic experts||sehr groß||kein|
|Health sector experts||sehr groß||kein|
For the implementations of the broad array of measures proposed in the experts committee report, probably large agreements are going to be required with different actors, if the measures are to be successful. For example, with doctors and GPs in what concerns their labour conditions; with the central government in order to modify the actual system of financing of the regional health services, and probably also with other regional governments; with the regional agents involved in the provision, financing and organization of health services within the Catalan system (e.g. with Consortia and local governments) in order to reorganise the system in a territorial base; with the drug industry in what concerns the measures affecting reference pricing, generics and others related; etc. The government will also need to well justify to citizens and patients those reforms affecting the distribution of the burdens of the financing of the system (e.g. through greater co-payments). Of course the regional government may act without taking into account all this actors affected, but this would probably not be the best way to achieve the objectives.
It seems obvious that reforms have to be taken in the public health system, in terms of the distribution of resources between the central government and the regional ones, to tackle the problem of
sustainability of the health system, but also reforms are needed to increase its efficiency, effectiveness, quality and equity. However, it is not an easy issue, and many political forces are working
in this process. In fact, reforms of the health system that give higher prominence to the private health sector or introduce private management within the public sector are not well received by part
of the society. Politicians are also reluctant to change the actual co-payments system, because it may have high political costs. Reorganizations within the sector are not easy, because they affect
the acquired rights of different agents (e.g. doctors).
Even though all this difficulties, it is expected that some reforms will be implemented, and it seems that the political party in power is quite decided to do some of them. However, it is still early to assess their expected results, since it is still not known which ones are going to be implemented.
It is worth saying that even though if an agreement will come out between the central government and the regional ones to increase the financing of the regional health systems, an increase in the ratio public health expenditure/GDP will probably also mean in practice, that more effort will be demanded to consumers, either in the form of higher fiscal pressure and/or larger and broader co-payments.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
It is expected that quality will be improved, as well as its equity. However, it will depend on which and how different measures are implemented. In any case, it seems obvious that greater involvement in the costs of the system will be demanded to citizens and patients.
Martínez, Esther (CRES)