Marciano S. Bayle, Carlos Ponte, Manuel Martin, Hixinio Beiras and Felix Payo

The privatization policy of the National Health Service in Spain

Federacion de Asociaciones para la Defensa de la Salud Publica, Spain

Spain is endowed of a powerful National Health Service with free and universal coverage, with a high degree of equity as the most relevant aspect, and health expenses that are found in 5,8% with respect to the GDP (Gross domestic product) (1,3% the private health). Through the last ten years, in Spain several initiatives clearly addressed to the deregulation and privatization of the parts of their public health services have been developped.
The analysis of these initiatives is the object of the present communication.

The first warning on a new direction of the health policy came from the hand of a parliamentary commission, created in 1991 with the purpose to analyse the economics problems of the Spanish National Health Service with the support of all the parliamentary groups. The conclusions, known as the ” Abril Report” were favourable, between others, to the following points: to the division of the financing and the purchase of the health service, to promote the private management of the public health services, to increase the contracting capacity with the private medicine (particularly the high-tech) and to the extension of the copayment of drugs prescriptions to the retired workers, that already exists for the active workers. It is important to notice that in that year the Socialistic Party was in the Government and that previously it had played a positive role in the development and consolidation of the National Health System.

In spite of the recommendations of the “Abril Report” were not put in effect, it is true that it was an important ideological reference towards a mixed sanitary model, which was significant in the further development of the events. Thus, in the 1993, in the context of a strong restriction of public expenditure, some drugs prescriptions were eliminated from the public financing . (Real Decreto of selective financing of the drugs prescriptions).

After 1995, when the Popular Party obtain the Government, the trend towards the internal market and a mixed model is stressed. The hegemony of the right, in the state and in several Autonomous Regions ( Comumidades Autónomas, CC.AA), permits to be approved the recommendations of a Parliamentary Subcommittee for the Consolidation and Improvement of the National Health Service (1996) giving legal coverage to private management of the public health services and to the insurance.

Political interventions in a neoliberal perspective:

1. To privatize the insurance:

  • Law of reform of the Taxes. Permit that the companies contract private health insurances with workers, with tax allowances and other fiscal advantages.
  • Greater state subsidies to the private medical services of given collective of workers (public officials, journalists, judges and military professional).

2. To privatize the financing:

  • Cutting in financing of drugs prescriptions (a new restrictive decreto of selective financing), proposals of copayment (recent statements of the Health Ministry) and limitation of the health services.

3. To privatize management of the public sector.
The new hospitals are endowed of their own legal personality and with administrative structures of private character (the foundations). Let is take one example like the hospital of Alzira, in Valencia, which has transferred all the specialized assistance to a private company.

Global valuation.

In the last years it has been stressed the trends to the mercantilization and privatization of the health public system. The political opposition on the left political spectrum and several forms of social opposition have made possible, in most cases, that these legislative reforms may have had a limited practical effects. In the last months, the Government seems to give up this initiatives and its health policy has been focused on the devolutions process to the 17 Autonomous Regions (Comunidades Autónomas, CC.AA.) These devolutions have to be made with criteria of equity and economic sufficiency, otherwise, it is sure that they will cause an important problem for the immediate future of the public health service.