Begins the Salvador Illa legislature in Catalonia and the president has already said that the health It is one of the strategic points on which the work of his government will focus in the coming years.
To achieve this, he has placed an experienced and renowned health professional at the head of the Department of Health, Dr. Olga Pane. At the same time, he has created a working group made up of 11 independent professionals of recognized prestige led by another excellent manager, Dr. Manel del Castillowhich they have called Cairos. They are the acronym for Committee for Assessment, Innovation, Operational Reform and Sustainability.
The new organization will have the objective of leading the implementation of those organizational reforms that allow for a better response to the needs of citizens.
It is no coincidence that the name chosen refers to the Greek term kairoswhich means “the opportune moment”. True, we are before the now or never of our public health system as the main guarantor of the welfare state.
The British Prime Minister, Keir Starmerrecently said about the lack of adaptation of his country’s public health system to the current needs of the population (the NHS) that we must choose between reform or death. Here, the reality is that we are not much better.
Thus the Catalan Cairos was born with the mission of advising the department, proposing the roadmap with the measures that must be carried out, executing the work and coordinating its implementation. Of course, inform the sector and the population about all this.
The Catalan health system starts with a certain “advantage” compared to the rest of the autonomous communities to redirect the situation.
Historically, health care in Catalonia was based on dozens of publicly owned hospitals – through consortia and foundations – which, when the time came for the construction of the current system, were incorporated into the public network, now the CatSalutunder a model of concerts.
This historical uniqueness highlights the Catalan healthcare model. Unlike most regional health services, of the more than 100 hospitals in the CatSalut network, only eight are regulated by the umbrella of the Framework Statute, which governs labor relations in the Spanish public health sector.
The rest of the centers are covered by private labor law. This condition gives them performance, agility and productivity superior to those operated under the civil service regime.
I am not going to go into the cause of the underfinancing of Catalan healthcare. However, it is a reality that all these centers are assigned an annual budget and if it is consumed they have to purposely reduce their performance and productivity in patient care.
To put it another way: we see how the health budget for the rest of the autonomies increases every year, with the vast majority of public centers under the Framework Statute regime, without this resulting in better results in accessibility for patients.
On the other hand, in Catalonia, when the hospital budget runs out, the only thing they can do is slow down and prioritize what is urgent or what is important. Like when a car slows down because it runs out of gas.
If they had more money, all these Catalan hospitals could produce and work much more.
Furthermore, there is another circumstance in the Catalan system that hardly exists in the rest of the regions. Thus, in the 80s of the last century the program was created Life with Anys. Its objective was to provide global and integrated care to those who, due to their age and health status, required special attention to improve their quality of life. Part of the health services of older patients, those in need, was directly financed, which was later called socio-health.
From the evolution of that program the following circumstance occurs today: of the almost 100 medium and long stay hospitals of our country, the 64% are located in Catalan territory.
It is objective and fair to recognize that Catalonia finances many more expenses of patients with social and health needs from the Department of Health than the rest of the autonomies. In the rest of Spain, patients have to resort more to their own money.
These wicks on which Catalan healthcare is based have historically meant flexibility in management that favored measures in favor of efficiency. For example, the concentration of health services or other actions promoted at the time of the 2010 crisis under the mandate of the counselor Boi Ruiz. In other communities, precisely due to the rigidity of the Framework Statute, currently the rights of workers are prioritized over customer service. This second option would simply be unthinkable.
In my opinion, these well-exploited resources can be the basis, the driving force, for Catalan healthcare to lead the changes that the Spanish healthcare system needs. What’s more, it can constitute the mirror in which the rest of the autonomous systems and the central government itself can look.
But this “opportune moment” in which we find ourselves implies the implementation of realistic measures that do not generate direct social rejection and necessarily entail a large dose of investment – effort and patience – in health education and training of the population. It is advisable to explain that we are truly in a “critical moment” and that they are necessary reforms to aspire to the best health system we can afford.
A care that, due to the aging of the population, polychronicity or the need to refocus resources on prevention, cannot be the same as we have known it until now.
And I really believe that it can still be redirected. You just have to start doing it.