Experts in economics and health services propose a guide for action to advance the solvency of the national system of health.
Madrid, 2011 November- A group of experts of the scientific society Health Economics Association (AES) has submitted the last Thursday in Madrid document: public health before the crisis. Recommendations for a sensible and responsible public performance ”, in which propose a series of actions that the national system of health (NHS) to cope with the current economic situation at the same time ensuring the efficiency, equity and solvency of public health.
At the indiscriminate pay cuts, the number of employees or the health activity experiencing some autonomous communities indicate that it has to start from the idea of clinical effectiveness and point to the budget in health care setting should move toward selective financing of medical benefitsmedicines and technologies. To this end, proposed disinvestment ” in everything that does not add health; IE leave funded partially or completely drugs, devices, equipment, procedures or services that add a little clinical value. In order to perform this action based on scientific evidence, suggest to follow the example of the National Institute for Health and Cilinical Excellence (NICE) English, with an assessment agency Spanish State level with management autonomy and distanced from the central and regional governments.
Among the first steps pose a new transparent management of waiting lists, based on mechanisms of prioritization based on the severity of the patient and the expected benefits of the clinical performance. They also indicate that change the current pharmaceutical co-payment by inefficient and inequitable, eliminating the arbitrary distinction between assets and pensioners, to evolve towards a system based on income, but corrective factors to improve the fairness of the current system as they would be setting ceilings on annual contribution, total exemption from the lowest incomes and special conditions in cases of chronic disease or multipatologÃa.
With regard to the working conditions of health professionals abound in a progressive and non-traumatic desfuncionarización of professional activity, with a greater weight of variable remuneration linked to objectives and propose also to avoid the payments by Act in the case of employees (the so-called peonadas ”). In the case of primary health care indicates the need to reorient the existing structure towards a model of grouping of health professionals to take economic risks arising from their greater or lesser efficiency. They also allude to the need to clear the medical specialties to promote collaboration among them. They also opt for decoupled management and senior management positions of the electoral boots ” and professionalize those posts through competitions of concurrency and periodic evaluation of the performance. In the general area of professionals, they also indicated the need to correct the current handling of conflicts of interest with meticulous implementation of the incompatibilities, and with strict requirement of compliance with the contractual obligations of all public employees.
Also in the above proceedings, emphasizes the need to move towards the efficient management of fragile, chronic patients and terminals, requiring changes in the structure to organizational network health, enhancing strategies of link between primary and care specialist, developing new case management services, and creating perfectly coordinated hospital centres mothership and subregional networks. They also emphasize the urgency of linking in real healthcare to the public health (collective reduction policies risk environmental, work, school, road, nutritional, personal habits, etc.).
From his point of view, must be reformed the governing bodies of the SNS, avoiding the duplication of structures and efforts, which should articulate consensus between the General Administration of the State and the autonomous communities in any agency of a technical nature with equal representation of the regional health services. On the other hand, they point out that it is necessary to redefine the role of private initiative, but in doing so, they stress the need previously a depoliticized, independent assessment.
The experts signatories of the document considered that the detailed proposals, given the current economic climate, are delayed ”. In his view, only a restructuring of the public health in the directions mentioned above, can be avoided that cuts will inevitably lead to an erosion of the SNS and a loss in the quality of care ”.
Firmante:
-Enrique Bernal Delgado, doctor. Policy and health services research unit. Aragones of the Health Sciences Institute. IIS Aragon.
-Carlos Campillo Artero, medical. Conselleria de Salut i Consum of them Illes Balears.
-Beatriz GonzaÌlez LoÌpez-VarcaÌcel, catedraÌtica of MeÌtodos quantitative in EconomiÌa and management of the University of las Palmas de Gran Canaria.
-Ricard Meneu Guillerna, Vice President of the Foundation Institute for research in health services (IISS)
-Jaume Puig-Junoy, Professor of the Department of Economics and business of the University Pompeu Fabra.
-José Ramón Repullo Labrador, head of the Department of planning and economy of the health of the national school of health of the Instituto de Salud Carlos III.
-Pink urban Garrido, Professor of applied economics. Universidad Complutense de Madrid.
