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Catalan public health faces its future without doctors

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The Catalan public health have a background problem in which, when it comes to diagnosing it, both unions and medical associations coincide: the chronic underfunding. The Ministry of Health has carried out measures to promote, for example, the primary care. But it is difficult to build something from a base with a rather small budget.

Added to this lack of budget are other no less important difficulties, such as the demographic crisis: there is a whole generation of toilets they will retire coming soon and for whom there are no substitutes because much of the trained in Catalonia They decide to go abroad.

face the demographic Problem, strengthen the primary care, equip means to the system and give the mental health the space and investment it deserves are the big challenges of public health.


DEMOGRAPHIC CRISIS

For some, the system stands before the “Perfect storm”. After two years in which the pandemic has made an “already precarious” situation even more precarious, the medical profession now faces a demographic problem. “A decade ago, schools and unions warned about it. In the next five years, 20% of the profession will retire and the Administration has done nothing”, points out the general secretary of Metges de Catalunya (MC), Xavier Leonart. “This, in a situation where there is already a lack of professionals, is a debacle”.

Training a specialist in the health system takes about 10 years. What, according to Lleonart, should have been done long ago, is “plan very well” these retirements, to form to a sufficient number of doctors and, above all, to offer “some working conditions and remuneration to retain them.” “At the gates of this massive retirement, there is a 60% of the staff of the Catalan Institute of Health (ICS) that is in interim”, warns.

“We are importing doctors from poorer countries and consolidating precariousness in the sector”

Jaume Padros

President of the Col.legi Oficial de Metges de Barcelona

“We are importing doctors of poorer countries and consolidating the precariousness in the sector”, points out James Padros, president of the Col.legi Oficial de Metges de Barcelona (COMB). Catalonia does not have all the doctors it needs, according to Padrós, and that is why in the last 15 years “The most imported group is that of doctors trained in non-EU countries”.

Furthermore, despite the training in Catalonia it is “very good”, many Medicine graduates decide to leave when they finish their studies. “We know that half of medical students of the University of Lleida and the Rovira i Virgili they will not stay in Catalonia, that they will go to Aragón or Valencia”, says Padrós. Padrós asks for a “national and state pact” with a long-term view.

In addition, it is also committed to taking short-term actions. “Now there is many doctors about to retire at age 65 who would continue working two or three more years if they were well incentivized.

CHRONIC UNDERFINANCING

Economists such as Guillem López Casasnovas put the 15,000 the millions you would need Catalan public health. This 2022, the ‘conselleria’ directed by Joseph Maria Argimon took 11,200 million, of which 1,500 must be subtracted because they will go to pay the covid-19 invoice, as the Metges de Catalunya union warns. Thus, Salut is left with a budget of 9.7 billion, a level not much higher than that of 2008, 14 years ago, when the budget was 9,096 million.

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The lack of investment in healthcare It is a general problem in Spain. was seen with the coronavirus pandemic. All the autonomies faced the crisis with a public system weakened after a decade of cuts. It was revealed the material shortage and the huge lack of staff. Catalonia had to recruit retired health workers Already Medicine and Nursing students.

However, according to Lleonart, from Metges de Catalunya, there are communities, such as Valencia, Aragon and Euskadi, that they are “better than Catalonia”, since there is “less pressure” and the conditions are “better”. “They are communities that allocate more investment per capita per year”, He says. The president of the COMB, Jaume Padrós, agrees with him: “You have to put more money”, insist.

The lack of funding for public health, which Catalonia has been dragging for years, is sending patients to private mutuals

In addition, the weakening of public health is parallel to the enrichment of private and, specifically, mutual. From the start of the cuts in 2010, private health insurance in Catalonia have been receiving the high of citizens tired of the waiting lists and the slowness of the public. Mutuals continued to gain clients (those who can afford them) during the covid-19 crisis, since in the worst moments of the pandemic primary care was absorbed by the virus and stopped treating other pathologies.

In 2020, year in which the pandemic broke out, the private mutuals of Catalonia earned nearly 49,882 more customers, according to data from the Spanish Union of Insurance and Reinsurance Entities (Unespa). According to Unespa, a 31.82% of Catalans (a total of 2,436,133 people) had in 2020 (last year of the offers figures) a private insurance. This is a moderate but constant growth year on year.

PRIMARY CARE

Covid-19 highlighted the importance of strengthen primary care. Primary care centers (CAP), especially after the first wave, led the management of the pandemic. “We have realized that an efficient response for capitalizing on CAPs not only as capillary structures, but also from a human point of view”, points out the president of the Catalan Society of Family and Community Medicine (Camfic), Antoni Siso. Family doctors and nurses have attended and cared for patients, they have been in nursing homes, in the ‘Salut hotels’ and have vaccinated against covid-19.

Since September 2020, Salut has invested 127 million more annually in primary care. It is the plan to reinforce primary care, which ends this year and through which they have contracted 3,811 more professionals. The problem is that, of these, there are only 306 doctors Y 220 nurses (The others are clinical assistants, social workers, psychologists and nutritionists), a figure that the entities consider insufficient.

According to Camfic figures, in Catalonia there is a ratio of 7.5 primary doctors for every 10,000 inhabitants. The EU average is 9.5 per 10,000 inhabitants. In Catalonia, between 800 and a thousand family doctors would be missing. As for the nurses, According to the Satse nursing union, Catalonia needs around 24,000. The ratio of nurses in the territory (same as in Spain) is five nurses per thousand inhabitants, while the European average is eight per thousand inhabitants.

Camfic calls for a primary care law that guarantees universality and financing. He also criticizes that in 1996 the family and community medicine had the 43% of all the MIR vacancies in Spain, while now it only has the 28%. “Needed human Resources and that is achieved with MIR positions. The ministry must increase these places,” says Sisó.

Along with primary care, the pandemic also reinforced the figure of the nurse. “Increasingly, the nurse attends to the chronic patient. Chronicity will end up falling into it”, warns Raul Porras, member of the Association of Family and Community Nursing (Aificc). “We have the same resources than before, but the effort is greater, because for example now we also vaccinate”, says Porras. He concludes that, “on a human level”, there is “a lot of discouragement and emotional suffering”.

MENTAL HEALTH

In addition to highlighting the importance of primary care and the role of nurses, The pandemic has put the spotlight on mental health problems, on which a great stigma always fell. He has helped make more public awareness but, above all, mental health has entered the political agenda. The Ministry of Health has incorporated 150 psychologists to the primary (although Camfic denounces that they are not clinical psychologists) and is reinforcing mental health for children and adolescents.

“A study commission has been set up in Parliament and Congress has already processed a specific mental health law. But we are waiting,” say the entities

“There are elements that make us think that now is the time for mental health. study commission in Parliament and Congress has already processed a specific law of mental health”, values Martha Poll, director of Mental Health Catalonia, which brings together different associations. “But we are in expectation” precise.

Mental health entities value positively the context of “chance” that is lived, but they will not finish believing it until they see “concrete results”: public policies implemented and targeted budgets to these needs. In Catalonia, Salut has increased its budget for mental health by 80 million more.

Still, Poll warns that adult mental health centers (CSMA) and child and adolescent mental health centers (CSMIJ) is it so “collapsed and for this reason “we must review the number of professionals”. are still missing human Resources, as the entities warn. Mental Health Catalonia also claims “social accompaniment” for people with mental disorders and “improve” tools of teachers in the educational field.

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