Cabinet approves bill limiting private management of public health


New rule must pass parliamentary procedure and provides exceptions for direct management of public health

Carolina Darius
Carolina DariusJJ GuillanoEFE

The council of ministers, in the second round, has approved a bill that revises several health regulations with an aspiration to close the holes that still remain in the universality of health and eliminate co-pays, according to the government. and protects itself from privatization. of public health.

“It is a criterion that is born out of the fulfillment of the government’s program of progress and which will work specifically to extend rights and return them to citizens after previous governments that took them back,” said Daryas. Said about the new law after the council. The ministers held this meeting on Tuesday.

The first version of the Future Criterion actually passed through the Council of Ministers in November last year and, despite the new approval it received this Tuesday, it would still need to pass parliamentary process in Congress and the Senate, for which it suffered significant losses. Changes can be made through parliamentary amendments.

Which rules are you going to change?

The draft seeks to introduce amendments to eight different standards:

– Law 14/1986, April 25, health normal.
– Law 50/1997, November 27, Of the Government.
– Law 16/2003, May 28, About the harmony and quality of the national health system.
– Royal Decree-Law 16/2012, April 20, Urgent measures to guarantee the stability of the national health system and to improve the quality and safety of its benefits.
– consolidated text of The Law on the Guaranteed and Rational Use of Medicines and Health Products approved by Royal Legislative Decree 1/201524 July.
– Royal Decree 8/2008, January 11, which governed the advantage due to necessity in favor of Spaniards living abroad and returning.
– Royal Decree 1506/2012 of 2 November, which regulates the general portfolio to supplement orthoprosthetic provision of the National Health System and establishes the basis for the establishment of the maximum amount of funding in orthoprosthetic provision.
– Royal Decree 931/2017, October 27which controls the regulatory impact analysis report.

– Repeal, in particular, Law 15/1997, April 25, on the merits of new management formulas for the national health system; Article 8 bis, 8 ter and 8 quarters of the Law 16/2003 of 28 May on the harmony and quality of the national health system and the second final provision of the Royal Decree-Law 7/2018 of 27 July, the national health system on universal access.

Holes in the universality of healthcare

The text seeks, in principle, on the one hand, to cover the gaps that may still remain in the universality of the health system, by guaranteeing the right to free public health care for Spaniards and their direct family members who live in Spain. live abroad during their stay in And some groups who cannot prove their residency in Spain or otherwise have the right to health care, as well as victims of human trafficking.

In addition to covering holes in the universality of health, which remained in place after the socialist government in the summer of 2018 amended the exclusion of undocumented immigrants, which the PP settled on in 2012 , the rule also aims to eliminate copies.

Specifically, the rule eliminates co-pays for orthoprosthetic products for vulnerable groups that are already exempt from pharmaceutical co-pays (recipients of minimum significant income, low-income pensioners, minors with recognized disabilities and dependent children). low-income people), which means about 6 million people.

Copies and prices beyond drugs

With this abolition of the orthoprosthetic co-pay, the idea of ​​a general portfolio of health services will be recovered, including not only health care and socio-health care, but also urgent and non-urgent health transport, orthotics. And trying to eliminate differences between diet products, and services. To protect themselves from regional benefits and establishment of new co-pays for these benefits.

In this a. will also include the development of General list of orthopedic, dietary and allied services with quantities Financing Maximum and final price. In addition, according to the latest draft of the standard, “personalized, predictive, preventive, participatory and population-based precision medicine” will be explicitly included in the portfolio of specialized services.

The Main Course (and Most Controversial) of the Criterion of the Future However, remains in direct management of public health,

The government’s president launched the idea in the middle of an election rally late last week, declaring that the rule would “shield the equality, cohesion and universality of public health and, therefore, would not be privatized by any right wing.” Government in an autonomous community”.

A small print of the legal formula that the government has finally chosen for it shield against privatization It is important to know the actual implications of the standard.

In the initial draft of the law, which was seen by the Council of Ministers in November, there were hardly any real changes in relation to the current legal status. In particular, add A new Article 47 in the Common Law of Health The one which elaborated that health would be provided “through a formula of direct management of a public nature”, but allowed “extraordinary recourse to other management formulas” to “prior” reports that social and economic health. justifies the need from the point of view to approach them.”

After this draft of the new norm, another groundbreaking text has been circulated, which, as Darius explained at the post-council of ministers press conference, is what would ultimately prosper. In that text it was clearly stated that “Management and Administratione structures and public services that make up The national health system will be directly “run by” Administration, among them the institutions that make up the institutional public sector and through the formation of associations by various public administrations.

Only “D” will be allowedand in an extraordinary and reasonable manner and Whenever it is not possible to provide public health services directly, resort to concerts or other formulas that are protected by Law on Public Sector Contracts or Law on Public Sector Legal System 40/2015including health associations. and it would be necessary to be able to resort to those concerts To justify in advance the optimum use of public resources, insufficient own resources and the need to resort to the above sources. According to these latest drafts of the law, for equal quality and cost, nonprofits will be given priority in the provision of integrated health care. And in the case of transcendental societies, the text makes an exception, referring them to their current rules.

In the absence of knowing that the executive has finally decided to stick with this TuesdayAfter the last reading in the Council of Ministers, the private sector had already reacted to Sanchez’s words that acted as a shield against privatization. ,It is now imperative to turn the page to the democratic discourse and the communal which does not contribute and sees an increasingly necessary strategic ally to meet the needs of the population in the private sector. It does not seem appropriate that the role that health has played during the pandemic has since been maintained the same discourse as before.” IDIS Foundationwhich integrates the interests of major private hospital groups and health insurers.

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