Spain’s Health-Care System Needs Surgery
Arruñada, Benito (1994), “Spain’s Health-Care System Needs Surgery,” The Wall Street Journal Europe, August 2.
Most users of the Spanish National Health System (SNHS) agree that it is mired in a deep crisis. But while massive reform efforts have been underway in Spain for several years, the system's deficiencies — mismanagement, chronic shortages, long waiting lists — only seem to be expanding. The SNHS, financed by general taxation, provides health assistance to almost 100% of the population. The system does not charge fees to patients, except for a co-payment of 40% for medicines prescribed to non-pensioners. Freedom to choose providers, either public or private, is very limited. Par of today's crisis is a result of a switch from the cost-containment policies of the first half of the 1980s to the dramatic expenditure increases over the last decade Budgets have become meaningless. Ever increasing salaries and lower labor productivity have been major factors behind cost inflation. At the same time, the quality of health care is declining. Waiting lists for both primary and hospital care are expanding and reports of public discontent with health services available in Spain appear regularly in the Spanish media. As a result, new private services are competing with the national service. People who can opt out of public health care (one in 20, mostly civil servants) have chosen private alternatives, and one in 10 have purchased a second insurance policy to secure coverage. The most disparaging feature of the current organizational status quo is the power enjoyed by employees. The labor relations framework of the SNHS resembles the civil service. Labor is organized by several statutes that differ across categories and regions and that specify employees’ rights and duties. The structure suffers from inefficiencies typical of large government bureaucracies.