The Confederation of Employers of Spain (CEOE) is welcomed to the healthcare debate

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Review the document “Health White Paper”, CEOE, May 24, 2016

Raid on the health sector by the CEOE

A document called “Health White Paper” published by the CEOE has recently come to light. We must congratulate this institution and its main promoter, Carlos González Bosch, for this foray into the health field.

Although there are many associations that exist in the sector, each cares about its specific problems, avoiding general statements. It seems as if they were a little reluctant to discuss general issues and feared that their particular approaches and positions could be weakened if they got into global battles. But this is a mistake; there is no way of defending specific approaches without a general approach to the sector.

Despite development efforts, we note that the “White Paper” is mostly a compilation of the positions of each of the employers’ associations linked to the health sector, and that perhaps an analysis of the problems in the public sector is missing. In this sense the title is perhaps a bit ambitious and instead of ” Health White Paper ” it could be called “White Paper on Private Health”. In any case, it represents a relevant achievement.

However, when rightly asked to reinforce public/private collaboration, perhaps further analysis of the public sector is missing. There can be public/private partnerships if the private sector is not fully aware of the situation, problems, challenges and values of the public sector and the same can be said regarding the public sector with respect to the private sector.

The document is largely an expression of the extraordinary employers’ associations in the sector which are undoubtedly one of its main assets. We refer to Farmaindustria, AESEG, FENIN, Asebío, UNESPA, AESTE, AMAT, to name but a few.

The document is highly descriptive and contains very interesting information. Let’s directly analyze the proposals, which are divided into general and sectoral.

General proposals

Health 

The most important elements in this section are:

  • Depoliticization of health. Although it is understood why this (making decisions for political or electoral reasons) is said, we can hardly ask for the depoliticization of health in a sector with over 75% of public funding. Rather, what we have seen is the near absence of debates on health policies in the last general election campaigns, which is negative. A good healthcare policy and good analysis and proposals for the healthcare sector from politicians are what we  must ask for, not the depoliticization of healthcare.
  • Support for a public, universal and equitable health system, which is very valuable as a Spanish employer statement.
  • To promote cohesion and fairness of the system
  • The need to review budgets and health investment. The significant decline in public health spending entailed by the economic crisis and austerity measures is accurately described in different parts of the document.
  • To support  public/private collaboration formulas. This is a critical issue and considering the strong criticism attracted by the current public/private partnerships, often without knowing the results, employer support is very important.
  • Valuing the drug, medical technology and pharmaceutical services.

Socio-health coordination

  • Integrating social and health resources. To address chronicity as the major challenge facing the health system.
  • Active aging policies.

Social Affairs and dependency

  • Necessary review of the financing of dependency .
  • The need for common requirements for accreditation of health centres in compliance with the Market Guarantee Act. This should be a genuine priority, as this situation is causing serious problems for companies unable to set up a supply globally.

Sectoral proposals

Sectoral proposals are more where the “hand” of the various employers’ associations in the sector is perceived. As befits the difference among associations,  some of the proposals are more strategic, others are more immediate in relation to the interest of the subsector or companies operating in it.

Perhaps the broader approaches are those relating to the pharmaceutical industry, medical technology, insurance and everything related to the development of dependency care.

Pharmaceutical industry

This is one of the most general and strategic proposals, as befits the usual mature approach adopted by Farmaindustria.

  • Recognize the health and pharmaceutical sector as real engines of economic and social development.
  • Consider the fact that more than a third of the pharmaceutical sector’s investments in R & D are carried out in collaboration with public centres
  • Enhance global investment in health, Spain cannot continue to lose relative weight in the public health budget (as proposed in the stability program), as has been occurring in recent years. It should recover in 2020 to 6.5%.
  • Reforming regional funding, so that common and sufficient standards for maintaining a similar level of quality in all regions are guaranteed.

Pharmaceutical distribution

Various technical measures are proposed to improve the functioning of pharmaceutical distribution companies.

Pharmacies

  • Functional integration of pharmacies as  private health facilities in primary care.
  • Regulatory development of a portfolio of services that incorporates a payment mechanism (this approach, so common in the sector, is really difficult to assume given the financial tensions in the public system).

Health technology

In these approaches, the expert input from FENIN is to :

  • Position Spain as an innovative pole in health technology internationally.
  • Improve integration between the field of administration, hospital research and companies.

Biotechnology

  • Maintain access to innovation through long-term cost-efficient formulas
  • Promote bio-entrepreneurship

Orthopaedics

  • Update the orthoprosthetic portfolio through the service portfolio of the National Health System.

Hospitals and private clinics

  • The conclusion of agreements with the public sector is a measure that is mutually beneficial for the sector and the health authorities.
  • Efforts to improve public sector debt and shortening payment terms.
  • The industry claims the consolidation system “fee- for- service” from private insurers, against “per capita”payment systems.

Insurance

Approaches to insurers are very relevant and UNESPA’s contribution is noticeable:

  • The growth of private insurance companies that can provide doses of rationalization in the overall management of healthcare should be enhanced, in the middle of a global scenario of budgetary deterioration and severe shortages in the  Public Health System.
  • Consider expanding the coverage of the “Mutualismo Administrativo” model (Special insurance scheme for Civil Servants of the Central Public Administration) to other civil servants as well as the self-employed groups.
  • The model of administrative concessions, implemented in Valencia, can serve as an example of beneficial formats of public-private partnership in the management of healthcare.
  • You can gradually increase the proportion of the population served by private insurers. For their solvency and specialization, these entities are able to propose a gradual process of replacing public insurance. This is the most important bet placed by healthcare private insurers in our country. This is the most important bet placed by healthcare private insurers in our country.

Mutual societies

  • Disseminate their important social role, little known.
  • To value the contributions of mutual societies in the sense of occupational accidents or diseases that have been avoided.
  • Public authorities must recognize the importance of institutions that manage health care for workers who require it, given that there are over 1.1 million accidents at work and occupational diseases.

Medical transport 

  • Keep linking health transport to the health field, considering that is a benefit.
  • Continue the provision of medical transport in the form of concession agreements between the government and private companies.

Prevention services

  • To influence, even in occupational diseases, promoting prevention rather than rehabilitation.
  • To promote prevention programs in respect of health in the workplace.

Hydrotherapy SPA-social tourism, health and health care to foreigners

  • Regarding health tourism, joint effort to promote the country as a destination for health tourism.
  • Work at European level for the effective implementation of the European Directive on Patients’ Rights to Cross-Border Health Care.

Socio-healthcare sector

  • Effort in achieving a social and healthcare covenant through a joint agreement of the Interterritorial Council of the National Health System and the Territorial Council of Social Services and Dependency
  • Work on defining the profile of the person in need of geriatric care.
  • Use of uniform criteria in the accreditation of centres and geriatric services.

Development of dependency care

This proposed section is one of the most elaborate:

  • The commitments of the Law Unit do not correspond with adequate funding.
  • The Law has been approved as a law of services, not grants, and it is necessary that it is enforced as such.
  • The system requires the homogenization of the professionalization of the teams evaluated.
  • Need for a fair system of accreditation.
  • They should not remain with the title of “residential” centres when they house people with high health needs, but should be considered geriatric centres or intermediate care and not mere home substitutes.
  • Dependent care services (residential centres, day centres, telecare services and home care) and services should be considered as first necessity centres and, as such, a super-reduced VAT rate of 4% should be established.

Dependency insurance

General development of private insurance covering the risk of dependency.

Final assessment

We must make a very positive assessment of this document. It gives an overview of the positions of different employers’ associations linked to the health sector.

Furthermore, after reading the proposals, it can be said that more than 90% of them are subscribable not only from the perspective of employers, but also from the perspective of general sector interests and population health.

Obviously, alongside these general approaches there are others more linked to specific interests (such as when the increase in the portfolio of services paid for pharmacies is defended, or when private hospitals demand that they continue being paid by insurers “by act” and not “per capita”, etc.). But these legitimate claims, though controversial and very specific, are the exception. What predominates are the proposals  based on the interests of the sector as a public service and defending a strategic vision in order to view the National Health System not only as the public part of the system but as the set of medical institutions and resources, publicly or privately owned, engaged in public service.

Congratulations, then, to this incursion by the CEOE into the healthcare sector. Continue.