Budget reduction puts Catalan healthcare in the spotlight

Barcelona (ACN).- The Catalan healthcare system has been in the spotlight over the last number of months. The current economic difficulties are making the rationalisation of the public healthcare system a necessity. The Catalan Government is implementing its budget austerity plan, which is provoking protests from doctor and nursing unions. In addition, some health services have been temporarily or partially closed in order to save money. Waiting lists have increased as a consequence. Many citizens feel that the attention they receive in the healthcare system may have worsened, and have been protesting on several occasions over the last number of months. On Monday, the Catalan Health Minister, Boi Ruiz, announced new criteria for waiting lists for surgical procedures by fixing maximum waiting times by law in relation to the type of surgery. On the same day, the Catalan Health Institute (ICS), which owns and coordinates many of the public hospitals in Catalonia and belongs to the Catalan Health Ministry, asked the unions to accept its last proposal in order to prevent the lay off of 1,500 interim staff. In addition, Bellvitge hospital –in Greater Barcelona- announced it will reopen six of the surgery rooms it had closed during the summer to save money. From now on, in the mornings, 23 of the 25 surgery rooms the hospital has will be opened, while 6 will be available in the afternoon. The quality and sustainability of the Catalan public healthcare system is in the public spotlight.

The Catalan Government, which needs to reduce public deficit, is implementing a plan to reduce public spending by 10% in general terms. The budget austerity plan affects all government areas, but in different degrees. Public healthcare does not escape from the spending reduction. The salaries of healthcare professionals might be further reduced, working conditions modified and some staff could be temporarily laid off, according to some of the plans that are being discussed at the moment. The Catalan Government is defending its plan that spending on healthcare needs to be lowered, as currently the system is far from sustainable and has a large deficit and a debt accumulated over many years. The Catalan Health Ministry has given some autonomy to the different health centre networks and hospitals to implement the budget reduction according to their specific needs. Therefore, different plans are on the table and are being negotiated with trade unions. However, the situation is becoming tenser, as professionals disagree with the proposed austerity measures and unions are carrying on with their mobilisations.

In addition, some hospital services or community health centres were temporarily or partially closed during the summer, in order to save money. For instance, some surgery rooms were shut down in August or in the afternoons, or the emergency rooms of some community health centres were closed at night. The Catalan Health Minister insisted that no patients were left unattended, as other options were offered –such as ambulances or  neighbouring centres-. Regarding diagnostic explorations and surgical procedures, waiting lists have increased.

Waiting lists expanded

Waiting lists for surgical procedures increased by 30% from June 2010 to June 2011, passing from 53,610 patients waiting to go into the operating room to 69,967. According to the Ministry, the most urgent surgical procedures were given priority while those deemed non-urgent were put down the list.

Many are the citizens who disagree with this approach and who think that the Catalan public healthcare system, which is among the best in the world, is now under stress and its quality is decreasing. In addition, there is an ongoing debate about if all the services and treatments should be included among those free of charge, as it is currently happening, or if some sort of symbolic payment should be included. Citizen protests, of different sizes and nature, have been taking place over the last number of months.

Maximum times fixed by law and speed tracks

On Monday the Catalan Minister for Health, Boi Ruiz, announced new criteria to organise surgery waiting lists. Ruiz guaranteed that all cancer surgery but prostate would be carried out within a maximum of 45 days. Prostate cancer and heart surgery would have a maximum waiting time of 60 days. These cases are part of the speed track illnesses, which will be given priority in all cases and will have a maximum time fixed by law. For the rest of the cases, several factors will be taken into account but the clinic criteria will prevail, stated the Minister, as the doctors will be those making the final decision. The new model will have to be debated with the sector and Ruiz hopes it will be approved.

The Ministry proposes a model that will consider several factors, and will give a different weight to each of them. The priority of the surgical procedure in a given patient will be decided upon the following criteria: the illness’ impact over the patient’s living quality (it will weight 38% on the final decision), the risk due to the waiting time (30%), the waiting time the patient has already suffered (8%), the effectiveness of the surgery over the patient’s illness (13%), and the use of healthcare resources (11%).