Again, queues at clinics. Again, strike announcements in the health sector. Nurses on the warpath; also movements of auxiliary professionals and others. What is happening in our health system? Plain and simple, the money mobilized with the covid has been applied to a greater extent to expand staff than to improve salaries. And furthermore, they have done it in a non-symmetrical way; New hiring of complementary specialties has been opened but not to the same extent in the areas of those who suffered the most from the shock of covid and who are now suffering from different forms of flu: the resources of outpatient clinics.
It’s all health spending, true, but qualifications matter: whether in personnel or consumables; in primary, social health or specialized care; in equipment or remuneration. When it comes to spending, it is the old dilemma between whether it has to be applied in quantities (increase in workforce) or in unit costs (better salaries in real terms). In practice, in our country we have chosen to hire more professionals, so much was the union pressure for the entry of new doctors and not to pay better and compensate the productivity of the professionals already hired. And so we find that, although the increases in staff may have improved the system as a whole, those who caught the covid crisis at the time, if there is one thing they have seen, it is the decrease in their salaries in real terms in view of the high inflation experienced. Many applause but little salary effect has been the residue left by the pandemic that ‘burns’ the sector today.
Certainly the increases in staff should have improved the healthcare response to the pressure of demand (now, due to the flu). But defining productivity in healthcare is difficult (supply always induces demand) and to the extent that the increases have not been allocated to the hard core of care (to doctors and nurses in health centers), but in related areas (to psychologists and socio-health workers), neither workers nor users experience the present situation as an improvement; potentially it is, perhaps for the system as a whole, but not for its individually affected parts. Especially in the field of primary care, which is where the child always cries.
Covid, despite its importance and contrary to what might be expected, has not helped to improve the perception of the relevance of primary care as a shock frontier for the pandemic. In fact, the image of many citizens still today is that of the resolution capacity shown by ICUs and hospitals, in the face of queues and chaos in outpatient clinics. It’s unfair, but it is what it is. A primary of civil servant doctors equipped with limited resolution capacity, in the face of an admired hospital specialization that still today attracts the best MIR students in the country.
In the phase, finally, of evaluating the experience of the pandemic, results reports have begun to be published, as requested by The Lancet and other publications at the time, given the chaos of the responses to many European countries, with the aim of learn in future crises. The center that he directs has developed one for Spain, led at the European level by the London School of Economics. More recently, the OECD has also done so in its Assessing Performance of health systems, and FEDEA from its Observatory of the Spanish Health System.
The evaluation commissioned by the Spanish Ministry itself has been presented in recent days and, despite its content, it is suspected of acquiescence with the Government that had appointed the evaluation commission. In any case, let us forget, from the outset, the idea that these evaluations can serve at this point to correct errors but rather to serve the purpose of evaluating to learn. And we will see that the result is not good: the health system has not become more resilient in any case; primary care has not changed for the better, gaining resolution capacity; Professionals continue to be anchored in the idea of ??charging as on behalf of others for an activity that they want to carry out on their own, and the robustness of the required financing is not guaranteed.
The overall record of the experience has been, in general, diverse. With the initial macro response (that of the army generals and the declarations of states of emergency) the result was bad because it was improvised and because of the concern generated in the population, highlighting the fragility of the national public health and epidemiology centers. of the State; It improved with the ‘meso’ response, the intermediate one, when the autonomous communities were involved in closely monitoring the confinements; and we could consider that it was, finally, satisfactory with the ‘micro’ intervention, when the professionals acquired the commitment to do what was not written in order to protect the patients.
However, once the storm had passed, upon returning to winter quarters, these professionals found themselves with an increased army, but with their salaries impoverished. Those who can, therefore, continue to calm the situation by making professional practice in public and private assistance compatible, a compatibility as dubious as it is necessary for many. And, here, as always, the areas in which this compatibility is less suffer: rural areas and primary care. The gap is structural and is not fixed, at the moment, by the extra compensation that the Catalan government proposes. It is about giving prestige to primary care in its resolution capacity and about that, we have not learned.
