Hola,

Bajo estas líneas os exponemos la intervención en la 11 Summer Schooll (celebrada el pasado mes de julio) hace de nuestro compañero Favila Escobio, miembreo d ela Junta Directiva. Participó en la sesión inagural, exponiendo las siguientes ideas, todas ellas relaivas al impacto que la crisis está teniendo en nuestro sistema de salud público y, por ende, en nuestra salud.

IMPACT OF ECONOMIC CRISIS ON HEALTH

With the title of this conference and this summer school IMPACT OF ECONOMIC CRISIS ON HEALTH, the first question that it comes to myself is:

Is this economical crisis affecting the health of the people?

And yes is the answer from my point of view, and from the scientific societies and organisations I belong to It is affecting people. Especially those in a more vulnerable situation, but not just for the crisis itself, but for the drastic and ineffective decisions took with the excuse of austerity. We need a new model, but a model based on the improvement of society.

I would like to extend myself about what happened in Spain one year ago.

Introduction
On the last years Spain as other European countries is facing big changes in its health system changes justified in front of the general public due to the actual economical and social situation. I would like to highlight some of this changes like the black future of the youngest healthprofessionals, many of them in a compulsory migration process searching for a quality job abroad. Privatization of some health services or the change in the concept from citizen with the right to a universal health coverage to the concept of worker with a health insurance.

The impact and consequences that all this changes can produce in the society and in the perception of healthcare as a right are still unknown, and it makes necessary a deep study of the actual situation.

On the 20th of April 2012 it is published in Spain the royal decree RD16/2012 about urgent measures for the sustainability of the NHS and measures for the improvement of the quality and security of its services. After its publication , and since the 1th of September 2012 it is redefined the public health assistance in Spain leaving uncovered those people without an insurance within the NHS.

This royal decree affects specially people in an irregular legal situation able to receive medical assistance just in three cases:
Childs under 18 years old
Pregnat women
Emergency care

This leaves unprotected those sectors of society who are already in a situation of higher vulnerability or in a risky situation of social exclusion as migrant people without residency permission or other people without resources. It is anyhow the end of a universal and public healthcare model that paid through general taxes and with high levels of excellence has resolved the health problems of citizens in the Spanish territory through a universal coverage.

What do we think about it?

From the vision of scientific societies as the Sociedad Española de Medicina Familiar y Comunitaria or Organitarions working for the right to healthcare as Medecines du Monde we understand that this changes are not justified.

Not from the health rights point of view: health is not a luxury item, it is a recognized right by international organisms.

Not from an economical point pf view. Urgent healthcare is more expensive than primary healthcare and preventive programs.
Not from a public health point of view. Leaving without assistance vulnerable populations can result
in a higher risk for the general population.
Not from the medical ethics, it is against the Hippocratic and deontological ethics. We want to highlight that the application of this changes undercover a change in the health system model changing from a universal health coverage to a model based in insurances justified by political discourses of austerity.

And also justified under false arguments:
It is not true that migrant people use more health resources
The economical argument used in the Usa where there is a population of undocumented migrants around 12 million against giving health coverage ,it is refuted by scientific evidence that shows that these populations pay the same taxes, insurances and does not use or are more expensive in relation to the health services in relation with national 57.7% of the Spanish population had attended his primary healthcare doctor at least one time in the period of one year , compared with 12.7% of the immigrant population.

Secondly in this change of the health system it is constantly mixed irregular immigration and health tourism, both of them two different collectives with very different profiles. Illegal immigrants are usually young and healthy people coming in our case from Africa or South America searching for a way of life to survive. Meanwhile the health tourist is an old person with a good economic support from the European region and who comes to Spain attracted by the good name of its health facilities and the easy wayto access its services.

It is just in this point where strangely the royal decree does not resolve this big problem to obtain the money from this European bills.

On a third level it has been created a very big confusion on the public opinion about how the national health system is financed Since 1999 94% of the health system needs are paid by general taxes that all people living in the national territories pays, which is independent from the social security. It means that even the undocumented migrants are paying for the medical attention they are not receiving.

What is happening?
After one year of the application of the Royal decree we just can make a negative balance We believe there is a damage on the management of the health sector.
Creating confusion in the way this RD must be applied, not just in the general population, but also between the health proffessionals, social and administrative services carrying to a lack of coordination between different ¡ levels. And also carrying to an arbitrary application of the royal decree in the different regions of Spain.

There is a damage also of the medical assistance, and not about hypothetical cases. There has been a rupture on the following of chronic and serious diseases ( HIV, cancer, psiquiatric pathologies, chronic diseases, people attending for elective surgeries). There is not a follow-up on the preventive, health education, community care or vaccinations
programs , and even there is not a follow up of serious infectious diseases). The significance of the risk that this rupture represents, not only for the patients, but for the general population is really high , and also it increases the costs for the health system due to the rise of hospital admissions due to complications.

Finally I want to remark the excess and failures of the application of the royal decree. One of the main consequences as I said before is the arbitrariness of how this new royal decree is applied, depending on the region of Spain and depending on the administrative and personal barriers the patient faces. We have registered more than 300 hundred cases in Mallorca, included barriers for cases that even with the application of the RD should not happen.

Children under 18 years old not attended, Pregnat women with difficulties for the follow-up. Impossibility to access sexual and reproductive services. And serious infectious diseases not detected and not treated.

After one year, there are still not created special agreements for those who cannot access to the Spanish health services as it was promised after the royal decree was launched and neither the special commissions to follow up the most serious cases.

Conclusions
The application of this RD it is showing us how a big mistake of previsions and decisions is creating a clear violation of human rights and a change of the health model that the Spanish society was not asking for.
Promoting racist attitudes against vulnerable populations, and damaging the medical assistance, with the consequent loss of effectiveness from the health system.

On the other hand with the creation of different observatories ,scientific societies and non governmental organizations are proving that we are not talking about sporadic cases resulting of bad medical practices or human errors, but the consequence of an ineffective confusing and unfair decree.

For all this, we are actually requiring the end of this royal decree.

We need the implication of all statements of society, politicians, academics, scientific societies, organistations and society in general. We need to bet for our own future and take responsible decisions.

We hope that after these days sharing knowledge and experiences during the summer school we can continue working designing and adapting strategies in this economic crisis context, for developing sustainable health programs and to go forward a universal and quality health coverage system that can guarantee the right to access the health care for all the people living in the national territory, and to be proud of it.

And tit is something that certainly we need

Favila Escobio
Council member of Doctors of the World (Medecine du Monde) Baleares Spain
Chairman and member of the immigrant research group Balearic Society of Family and Community
Medicine

 

 

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