The open debate between the announcement of the Anteporyecto de Ley de Gestión Pública e Integridad del Sistema Nacional de Salud aims to ask a recurring question in the Spanish health sector: the relationship between public and private.
It’s a legitimate debate and even a necessary one, but that risks straying from ideological terrainforgetting the really important thing: attention to patients.
It is obligatory to start from the incalculable reality of the whole world. The national health system currently does not have sufficient resources (no people, no material, no installed capacity) to respond only to all the health needs of the population.
The lists of surgical tests, diagnostics and external consultations are frankly alarming in many autonomous communities, although not outright unacceptable. Denying this reality will not make you disappear.
In this context, cooperation between the public and private sectors cannot be interpreted from a purely ideological point of viewalso as a necessary helper in the household.
It is not about privatizing the system or renouncing its public, universal and fair character, but about the intelligent use of all available resources to guarantee that patients wait on time and in good condition.
By deviating from the new forms of health care management, Royal Decree 15/97, in order to adopt a model of cooperation in the health sector or specific indirect management (as in concessions), cannot be expected to create obstacles for other forms of cooperation that from now on work normally.
This is the case of concerts, which are expressly recognized in the superior norm that is part of our current health care system: the Ley General de Sanidad of 1986.
“Cooperation between the public and private sectors cannot be interpreted from a purely ideological point of view, not even as an essential assistance system”
The problem of anteproyecto can therefore arise when introducing the concept of “exceptionalism” into other forms of indirect management.
Imposing additional, ambiguous or ideologically motivated barriers to tools as everyday and necessary as healthcare, especially in a scenario of confusing hope lists, would be a real disaster.
Not for the operators, but for the patients.
It is worth noting: Cooperation is not privatization.
Public-private collaboration in healthcare has been part of our system’s ADN since its inception. This allows the health administration to plan, finance and control aid while relying on external providers to reduce morale, absorb demand peaks or overcome structural deficits.
The patient does not have the correct pier. On the contrary, gana lit. Therefore, we must not permanently question these models for one reason only: there is no other alternative.
There is indeed broad agreement on something fundamental. Indirect cooperation must take place with clear rules. With transparency, public control, the need for quality assurance, evaluation of healthy results and full legal certainty for all parties.
There is no reasonable debate in this.
If the “exception” is interpreted in a rigid, dogmatic or maximalist way, the practical effect will not be more integral health, unless there is more failure, more territorial inequality and more avoidable suffering. Just the opposite of what is claimed.
Anyone can justify it from paper or a political agenda. But the reality for those who hope, for those who have no other alternative in the private healthcare sector and cannot colored in public health it would be very clear.
Therefore, more than general principles, it will be important to clarify exactly what the “exception” really means. When is it applied, how is it justified and, above all, how to prevent it from becoming an automatic brake on assistance solutions that are necessary today.
En Hello, ideology cannot push boundaries. And there can only be one limit: the patient.
*** Juan Abarca Cidón is the president of HM Hospitales.
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