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Spanish health system unsustainable

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Spanish health system unsustainable


For more about the Spanish welfare state, euronews spoke to Guillem López Casasnovas, an economics professor at Barcelona’s Pompeu Fabra University who is also on the Bank of Spain’s board of directors.

María Piñeiro, euronews: Mr López Casasnovas, the welfare state has undergone the biggest cuts ever seen since the restoration of democracy in Spain. Was this inevitable? Have the Spaniards been living beyond their means, as German Chancellor Angela Merkel suggests?

Guillem López Casasnovas: That’s right. Spain has spent, consumed, at a level that its generating of income and wealth did not sustain. We can estimate this spending at around ten percent of our external deficit. This fed social spending that, like in all countries, rises with gradual development. This led to conditions that are barely sustainable. More than cuts, what we have seen for the moment is rather a slowing down of growth projections. The pace of that growth a few points above the country’s income at the moment will not be sustainable. Our social spending has been much faster than the rise in Spanish taxation.

euronews: Public health, one of the welfare state’s fundamental pillars, has been the object of serious cuts. Is universal, free access to medical care in Spain guaranteed or viable?

López Casasnovas: We know that in any country the idea of everything for everyone free is a rather hollow message. In countries with social insurance roots there is a defined catalogue of things that are paid for entirely or in part. Where taxpayers’ money doesn’t cover something completely, the individual user has to pay the difference. Under national health service systems — anglo-saxon and nordic systems — there is a very strict catalogue of what is covered, classified according to cost-efficiency. Whatever is not in the list of publicly-financed things is really a 100 percent out-of-pocket expense for the patient.

Spain started out with a national health service that became very, very generous, without a strict catalogue of what would be paid for, with the limits based on cost-efficiency, and we now end up with an unsustainable system. It is a somewhat intermediary generous insurance system with complementary contributions. We have a generous system without those complementary contributions. We do not have a national system like Britain, whose basic catalogue of coverage gives priority to things according to cost and effectiveness.

euronews: What do you think the solution is?

López Casasnovas: It’s a political decision. It’s not up to academic judgement. The politicians have to choose between the rule established by national health services like in the UK or the nordic countries, and they would create an agency to classify services offered and set up a very strict catalogue of what can be paid for in each situation, conforming to, I repeat, cost-efficiency criteria, or we go for a health insurance system like France has, or Holland, Belgium, Austria, Germany, etcetera, who are in general more generous, who classify services by their effectiveness and therefore less by effectiveness plus a complementary payment.

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