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Back to 2019-10-26-Opinión-CIMA-Sanidad
Francisco Errasti, Director general of the Foundation for Applied Medical Research research
Once again, healthcare
To say that healthcare or, more precisely, the attendance healthcare of our free public system is in vogue is a cliché that is so repetitive as to be irrelevant. Only the repetition of manifestos, rallies and strikes by healthcare professionals (how fed up they must be to come to that!), together with media alerts, awaken us from our indifferent lethargy.
The recent report -it is the seventh- by VP&R consultants, entitled "Ten burning issues in Spanish healthcare in 2019", makes an analysis of the reality that is as nuclear as it is necessary. The effort that this well-known consultancy firm has made to synthesize the main problems of our healthcare is B and analyzes issues that undoubtedly require far-reaching decisions. Not only does topic itself require it, but we have not had the lucidity and courage to face them for many years without anyone from the decision-making groups -especially politicians- having had the lucidity and courage to do so.
The high school de Médicos de Navarra itself has recently presented (Diario de Navarra, 15.X.2019) the twenty proposals that they consider "key" to improve healthcare. Both reports coincide in some of them.
Among the hot topics mentioned, there are some that are key and any neophyte would consider them as such. Let's look at just a couple of them:
Patient centricity - what does this mean? First and foremost, the solution to two serious issues: sufficient dedication of time to patients and the solution to the serious problem of waiting lists.
The technification of medicine and the fragmentation of medical specialties have led to depersonalization and a lack of dedication to listening to the patient. A chilling fact: in the United States in 1975, a physician in the United States spent one hour on a patient's first visit to enquiry and thirty minutes on a check-up. Now they spend twelve and seven minutes, respectively. The report does not provide this information for our country, but it must be something similar. What satisfaction can a patient have when he expects to be listened to by his doctor and finds that he does not get it?
It cannot be said that the patient is the center of the healthcare system when undergoing a colonoscopy, with suspected pathology, can take three or six months. Or a revision of a breast cancer has a delay of 6 or 8 months (Saray, Diario de Navarra, 18.X.2019). Not to mention the cost to the Economics of the incapacity to work of many workers who are at leave waiting for surgery.
Someone may claim that this is due to a lack of physicians, as we repeatedly read in the media. But this is not the problem, as the report explains. In Spain we are above the OECD average in terms of doctor ratios: 3.9 doctors per 1,000 inhabitants, above Great Britain, with 2.8; and France, with 3.3 and which has no waiting lists. We have 0.95 Schools of Medicine per million inhabitants, while the United Kingdom has 0.46; France 0.44 and Germany 0.45. And in Spain we continue to open Schools of Medicine.
But physicians are not to blame, far from it, for the status in which we find ourselves. In my opinion, it has to do with the organization and policy of human resources in healthcare. Doctors in our country -and it must be said clearly- do not deserve the attention they receive when the responsibility required of them is so great: they have a low level of remuneration in relative terms with other European countries; the rate of job insecurity is also alarming in public healthcare (when this is an evil that, mistakenly, people want to blame solely on the private business ) and the high level of burnout among Spanish physicians is of increasing concern.
A profession that should be pampered by society is cornered, depersonalized and on the verge of emotional exhaustion. And what is worse: it is a bargaining chip in the constant and sterile political diatribes. In spite of this, a large majority of physicians possess a genuine spirit of service to their patients, a deep sense of compassion and strive to work well, beyond the strict fulfillment of their duties. Has anyone seriously wondered why so many doctors go abroad every year (and are received with open arms), well trained, after an eleven-year degree program (including the year spent studying the spanish medical residency program) and the consequent cost to our country? It is simply a waste that no one should afford.
Primary Care. At this point, it is obvious to stress the importance of primary care as the backbone of the healthcare system. But at internship it is not, nor have decisions been taken to make it so. Primary Care, in which the team and coordination at network play a central role, is a determining factor for better health at a lower cost and contributes to greater social cohesion.
However, unrest among physicians -demonstrations, strikes and resignations- is a constant. The causes? Increased delays, shortage of professionals, shortage of time dedicated to patients, lack of motivation due to job insecurity, lack of incentives, especially in isolated areas and in saturated urban areas, and a long list of other causes.
There has been no shortage of reports that seriously analyze a status that calls for an in-depth reform. For example, sample: Our country has 7.5 primary care physicians per 10,000 inhabitants, a far cry from the 17.2 in Germany or the 15.4 in France and Portugal. There are 22 countries in the European Union that have more primary care physicians per inhabitant than Spain.
Perhaps another day I will talk about the ambivalent relationship that exists in our country between public and private attendance . Just one enlightening fact: there are ten million people in our country who have private insurance. Can you imagine what would happen if they all decided to go to the public healthcare to which they are entitled and which is also free of charge?