FOCUS: Why Spain’s hospitals are not better prepared

Emergency room of the Hospital La Paz in Madrid, overflowing with patients. Photo: @URGENCIASLAPAZ via Público
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In a televised address Saturday evening on the state of Spain’s coronavirus crisis, President Pedro Sánchez made crystal clear that the primary reason for the country’s ongoing “state of alarm” lockdown is to slow the rate of contagion in order to save Spain’s once-proud and robust public healthcare system from collapse.

“We need to buy time to better prepare our healthcare system,” Sánchez told his TV audience, begging the question as to why Spain’s healthcare system — just last year credited with helping raise Spain to the top of a Bloomberg annual ranking that named it the “healthiest country in the world”.

So, what has gone wrong with Spain’s public healthcare system that it’s unable to cope? Is it, as proponents of privatized healthcare are already claiming on social media, that “socialized medicine” models are bankrupt, and that the high rate of coronavirus contagion in Italy and Spain are evidence of that?

What that argument conveniently ignores is the fact that Spain’s healthcare system was seriously weakened as a result of draconian spending cuts implemented from 2011-2016 in tandem with privatization and outsourcing of hospital facilities, all part of the nationwide austerity measures enacted by the the conservative Partido Popular governments of former President Mariano Rajoy.

As a result, government spending on public healthcare in Spain was slashed by as much as 21 billion euros from 2009-2018, as the PP governments of Rajoy successively cut spending on healthcare from 6.77 percent of Spain’s GDP economic output in 2009 to just 5.9 percent in the country’s current operating budget. By contrast, across Europe today the average expenditure on public health — just the average, not the most spent by any country — is 7.5 percent of GDP.

Spain’s current Socialist-led coalition government has been trying to increase healthcare spending levels since coming to power in mid-2018, but has been hamstrung by its inability to marshall support from opposition parties in Congress for a new budget so as to avoid having to work within the constraints of the rollover of the last PP budget austerity budget of 2018.

The effect of the Rajoy-era cuts to public healthcare expenditures have been disastrous in the face of the current coronavirus crisis, with Spain’s 17 autonomous communities that administer their own regional healthcare having been engaged over much of the last decade in a race to the bottom as they tried to balance local budgets and decide what services to cut.

Particularly hard-hit have been regions governed by the PP or, in the case of Catalonia, by the centre-right separatist Junts per Catalunya (JxCAT) party and its predecessor, Convergencia Democratica.

► News Sources: El Periódico, Público and InfoLibre …

Take primary point-of-access healthcare, for example. While the World Health Organization (WHO) recommends that the minum budget for primary care should amount to 20 percent of the total public health budget, in Spain the regional community that invests the least in primary care is Madrid, governed continuously since the 1990s by the Partido Popular, dedicating just 11.64 percent of public health spending to primary care.

Catalonia, the seventh ranked in terms of least spending, has increased expenditures in the past three years but still falls short of the WHO recommendation at just 14.78 percent of all health spending.

But, it’s when it comes to staffing and hospital beds that the worst of the Rajoy-era job destruction and cuts to healthcare operating budgets are now showing up in the system’s inability to cope with the current coronavirus epidemic.

A European Commission (EC) report on Spain’s “National Health Profile 2019” notes that “a significant part” of health professionals in Spain are forced to work on temporary contracts that increases the rate of staff turnover. In addition, the EC said that the percentage of nurses to population ratio in Spain of 5.7 per thousand falls “well below” the average across Europe of 8.5 per thousand.

According to the CCOO labour federation, some 30 percent of all public healthcare system employees were working on temporary contracts as late as 2017, and that in itself represents an increase over the 27 percent on temporary contracts at the height of Spain’s economic crisis in 2012.

► More News Sources: El Confidencial Digital, Izquierda Diario and Público …

In practice, this means that Spain’s autonomous regional communities have relied on continuous hiring and firing of doctors, nurses and administrative staff in their public healthcare systems. Shockingly, in January and February, just as the coronavirus pandemic was heating up in Asia and spreading to Italy and Spain, the country’s regional healthcare administrators were reportedly in the process of laying off 5,000 temporary healthcare professionals so that they wouldn’t have to put them on full-time contracts with benefits.

Under the past several PP administrations in the Madrid community, the slashing of healthcare expenditures was made seemingly without any planning, simply with an eye to balancing the regional budget. During the Rajoy years, seven new private hospital concessions were granted and built in the Madrid community, at the same time that cutbacks led to a reduction of nearly 3,000 hospital beds, from 15,531 as late as 2012 to just 12,565 in 2018.

But, it is the cuts to healthcare staffing in the Madrid region that bring into sharpest focus the region’s inability to cope with the coronavirus crisis, considering that nearly 4,000 healthcare jobs were slashed from the Madrid budget in recent years, from a total of 75,489 healthcare workers in the Madrid community in 2010 to just 72,193 healthcare workers in 2018.

Catalonia, under successive governments led by JxCAT, is among those regional communities that currently spends the least on public healthcare, dedicating just 3.9 percent of the its annual economic input to expenditures on healthcare, when the European-wide average stands at 7.5 percent. In 2016, the Catalan regional government set aside just 13.38 percent of its budget for healthcare spending, seventh lowest of Spain’s 17 autonomous communities and down significantly from 2010 levels of 14.78 percent of the regional budget.

According to the Metges de Catalunya union of doctors, in recent years Catalonia has lost some 900 primary care doctors and a thousand intensive care beds in hospitals across the region. And, according to the Consejo General de Enfermería (General Nursing Council), the region needs to hire nearly 17,000 nurses to bring the region’s nursing workforce up the the pre-crisis levels prior to 2010.

► Click to read more news about Spain’s Coronavirus crisis …

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