Spain budget cuts strain healthcare system

Patients at Madrid’s Princesa hospital try to force their way into the emergency consulting room, impatient after hours of waiting. A security guard restores order. Some yell at the nurse. Budget cuts are undermining universal healthcare in Spain, prompting some regions to outsource hospital services and raising fears that one of the main pillars of the country’s welfare system will be privatised.

“Until now, Spain’s free public healthcare system was among the best in the world,” says doctor Marciano Sanchez Baile, spokesman for the Federation of Associations to Defend Public Health (FADSP). Austerity measures have prompted cuts in staff, equipment and services at hospitals and health centres.

Several regions have already started outsourcing hospital management. In Madrid alone, services at six out of 30 hospitals will be outsourced. “The savings obtained this way will allow the public health system to continue functioning,” a spokesman for the Madrid regional government told dpa.

Prime Minister Mariano Rajoy’s government is struggling to trim the budget deficit from nearly 7 percent of gross domestic product (GDP) in 2012 to below the EU limit of 3 percent by 2016. Budget cuts have hit schools and universities, cultural institutions, public investments – and healthcare, which has lost more than 7 billion euros (9.1 billion dollars) since 2010. That is more than 10 percent of its budget over three years.

Spain’s public health system, which is based on social security contributions by workers, is managed largely by the country’s 17 semi-autonomous regions. They have applied different cost-cutting measures, ranging from closures of hospital wards and night-time emergency services, to higher drug costs.

Payment has been introduced for previously free services, such as pensioners’ drugs or ambulance transport. “We are down to only four doctors at my hospital’s pediatric ward, from the previous seven,” Sanchez Baile, who works at Madrid’s Nino Jesus hospital, told dpa. The average waiting time to undergo surgery more than doubled to 72 days between December 2010 and June 2012, according to the daily El Pais.

Health Minister Ana Mato has described the public health system as “absolutely unsustainable.” She called for “rationalisation of costs, improvements in the system and removing overlapping.” Private hospital management increases productivity and reduces absenteeism, a former manager of the healthcare company Capio told El Pais. But health professionals are furious about steps toward Privatization and have staged demonstrations against the plans.

“Privatization makes healthcare worse and more expensive, because the companies running hospitals will try to make a profit at patients’ expense,” Sanchez Baile said. Those defending the budget cuts say the universal healthcare system encourages people to seek treatment and medication they don’t need, and opens the door for “health tourists.” Spain is negotiating with other EU countries to get full compensation for free treatment given to their citizens.

In several regions, the budget cuts have left undocumented immigrants from outside Europe – among the poorest segments of the population – without healthcare. With unemployment at 27 percent, a growing number of Spaniards can no longer afford any kind of private health insurance and are left entirely dependent on the public system, which excludes dental and eye care. “The effect of the budget cuts will be seen in the long run, when people’s health deteriorates,” Sanchez Baile said.

Milagros J, a Cuban immigrant in her late 40s with no savings or private health insurance, recalls her 2010 breast cancer surgery with gratitude. “I received first-class treatment from a surgeon who reconstructed my breast without charging me anything,” she said. “Without the public health system, I would have had to find the money for a trip to Cuba, where they would only have removed my breast without reconstructing it.”