Cash registers in the hospital

At this stage of the game, any new cutback is painful for Spanish citizens, especially the more disadvantaged. But introducing an austerity measure without offering appropriate explanations or carrying out due analysis to demonstrate its effectiveness is more than just painful; it could well be a profound error that causes injustice. The Health Ministry has just announced that the medicines that hospitals currently dispense for free to outpatients will now enter into the copayment system. In the larger scheme of things, this is not a massive issue: there are only 150 drugs on this list compared to the 6,000 prescription medicines that the state subsidizes and which are already included in the general copayment system, and for which people, including seniors, are now paying more than previously. It is, however, a new turn of the screw in terms of the sacrifices being demanded of chronic patients or those who suffer serious diseases. What’s more, the economic advantages of the measure have yet to be demonstrated.

Several experts have already warned of the difficulty and expense of creating a new payment system within hospitals, obligating healthcare centers to charge for drugs and set up some kind of commercial infrastructure with the relevant staffing, plus the concomitant security measures. None of these costs have been considered. Among the skeptical voices are health commissioners from various regions — including some run by the governing Popular Party — who are responsible for managing the public hospital system. But their arguments have not been heard in the ministry headed up by Ana Mato, who has not only failed to explain the measure, but has also neglected to draw up an economic breakdown of how it will pan out. The change has not even been debated at the Territorial Health Council, the body on which the regional healthcare authorities are represented.

Policy on pharmaceuticals is a state power, and in that sense, the government has right on its side in its recourse to the Constitutional Court to prevent Madrid and Catalonia’s regional governments from introducing their own one-euro prescription charges, and stop Andalusia carrying out its own tenders for drug contracts. But this latest initiative weakens the government’s own arguments. It cannot claim that it is merely trying to encourage a more rational use of medicines in a case where patients do not choose their treatment. Nor can it argue that its objective is to reduce costs, due to the fact that it could introduce other measures which are less prejudicial to the sick and which promote greater efficiency, such as the Andalusian pharmaceutical tenders it is so eager to abolish. The executive’s inconsistencies are only serving to endanger the principle of equality and the health of thousands of people.