In February 1998, the Spanish Government decided to reduce health expenditure by substantially cutting the list of drugs subsidised by the social security system, in order to reduce the public deficit. The trade unions and many interest groups have protested, claiming that the measure affects mainly the lower income brackets.
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In February 1998, the Spanish Government decided to reduce health expenditure by substantially cutting the list of drugs subsidised by the social security system, in order to reduce the public deficit. The trade unions and many interest groups have protested, claiming that the measure affects mainly the lower income brackets.
At the end of February 1998, the Ministry of Health proposed the exclusion of a series of drugs, many of them in very frequent use, from the group subsidised by the national health system. This subsidy is 100% for pensioners and 60% for other citizens covered by the public health system (in Spain there is practically universal public health cover).
The measure was presented as necessary to cut the high public spending deficit and to rationalise the national health system burdened by a large drug bill, which has risen in recent years to 23% of the system's total budget. The proposal has been called unfair and discriminatory by the opposition parties and by many interest groups such as trade unions, consumer organisations, pensioners' organisations and some associations of doctors and pharmacists. Initially, some regional governments and city councils protested stating that they would seek specific ways of financing this expenditure for citizens in the lower income brackets.
Though the unions recognise that it is necessary to rationalise and reduce health expenditure, they have given firm support to the protest and joined the Platform for the Defence of Public Health (Plataforma de Defensa de la Sanidad Pública). They are concerned about the economic pressure that the measure will place on pensioners and the unemployed. Both the CC.OO and UGT confederations state that the revision can be carried out only through negotiation with the Government, the social partners and the people directly affected. Negotiations should seek a rationalisation that introduces necessary measures such as a greater use of generic drugs and the education of doctors and patients in the use of drugs. They should also guarantee equal access to healthcare for all citizens. The unions also claim that the measure may conceal a strategy of privatising part of the national health system.
On 5 March, the Platform organised demonstrations in several Spanish cities, in which pensioners were particularly active. This has led the Government to delay the implementation of the measure and to promise that a consensus will be sought on the drug list. Ten days after the protests, the Ministry of Health withdrew some drugs that were initially on the list, which indicates the possibility that an agreement may be reached. However, for the time being the Ministry is maintaining a substantial part of its proposal, with the support of the regional governments controlled by the ruling coalition at national level (PP) and the regional parties that support it (CIU and PNV).
The health system is a fundamental element of the welfare state. According to the trade unions and the Platform for the Defence of Public Health, any changes that are made to it must continue to guarantee quality of life and offer free, equitable and universal healthcare.
Eurofound doporučuje citovat tuto publikaci následujícím způsobem.
Eurofound (1998), Dispute over public health system funding, article.
