2024-02-08 09:00:00
Madrid.- Amnesty International has carried out an analysis of health spending in which it regrets that in twelve years (from 2009 to 2021, latest data published by the Ministry of Health) public health spending has only increased by 5%, compared to 27% that private health spending has grown. The Public Health System faced the pandemic in a situation of great fragility, as it had lost, in 2019, 6% of public health spending compared to 2009. Even with the presence of COVID-19 still very strong, in 2021, spending Public healthcare was reduced by 1.44% compared to the previous year. Amnesty International warns that although it could be difficult to maintain the level of investment during the pandemic, administrations should not start a downward trend in investment. By communities, Castilla y León, La Rioja and the Community of Madrid were the ones that lost the most investment in 2021 (6.4%, 3.4% and 3.3% respectively) and, compared to them, only the Region of Murcia and the Canary Islands increased investment by 2 and 1.3%.
Regarding primary care, and despite the fact that international organizations have warned for years that this level of care is essential to guarantee people’s right to health and should be the cornerstone of public health systems, Spain continues without recover from the economic crisis, twelve years later, with slightly lower investment levels: 0.25% less. The communities that allocate the lowest percentage to this service are the Community of Madrid, Galicia, Asturias and Aragón. The most, Andalusia, Castilla-La Mancha, Navarra, Castilla y León and La Rioja.
“Not only the pandemic should have set off alarm bells. The climate crisis and its effects on health should also alert us that it is necessary to increase investment in health, and especially in primary care, in order to have a health system better prepared for possible future crises, as As the OECD recalls in its latest report and the WHO,” says Marta Mendiola, researcher on Economic, Social and Cultural Rights at Amnesty International Spain, ahead of the meeting called for tomorrow, February 9, by the Ministry of Health of the Interterritorial Council of the National Health System in a monograph on Primary Care.
The organization demands greater investment from the Communities. “The Autonomous Communities have a lot of responsibility in the situation of primary care. A political commitment and an agreement between the Communities and the Ministry of Health is needed once and for all to increase spending on primary care, increase the ratio of medical personnel and nursing and reduce waiting lists,” adds Mendiola.
Medical and nursing staff ratio
The ratio of medical personnel in primary care per thousand inhabitants is practically the same in 2021 as in 2009 (0.77 compared to 0.74). The same happens with the nursing staff ratio (0.66 versus 0.61).
One of the biggest consequences of the lack of adequate investment in primary care is waiting lists. Spain does not comply with the recommendations that the 2019 strategic framework for primary and community care itself stated: guarantee that non-urgent care requests are made in less than 48 hours. Only 27% of consultation requests are resolved in that time. “It is really worrying that trying to make an appointment with more or less urgency is an ordeal, and finally having to endure the delay with which they give it to you. But there are also communities like the Canary Islands (with only 12% of requests that are attended to in less than 48 hours), Andalusia (17.6%), the Balearic Islands (17.9%) and the Community of Madrid (18. 2%), where this situation is even more alarming,” laments Mendiola.
In terms of spending per inhabitant on health and with respect to other countries in the European Union, Spain occupies an intermediate position, 13th out of the 27 countries of the European Union, with an expenditure of €2,537.76 per inhabitant, very far from countries such as Denmark (€5,642.26), Sweden (€5,260.21), Germany (€5,192.41) and the Netherlands (€5,108.39), according to the latest Eurostat data from 2020, which are presented in current values , that is, without taking inflation into account.
State Obligations
Spain, having signed numerous international human rights treaties, is obliged to adopt measures to the maximum of its available resources to progressively achieve the full effectiveness of the right to health. However, although health spending has been growing since 2014, it has not done so in a manner adjusted to the needs of the Health System, thus failing to comply with its international obligations in this matter.
This was recently recalled by the Commissioner for Human Rights of the Council of Europe, who has stressed that investment in primary care in Spain is insufficient, and has warned of the dangers of budget reductions, also highlighting that the number of health professionals continues to be insufficient, with an excessive workload.
Other international organizations, such as the OECD and the WHO, have highlighted the need to create health systems that are resilient to climate and possible future crises.
Amnesty International petitions
Given this situation, Amnesty International, which has met with Javier Padilla, Secretary of State for Health to convey its concerns, asks:
- Adopt a strategy to reinforce the National Health System, prioritizing primary care, as recommended by international and state organizations and the health sector itself. To achieve this, it is necessary to allocate resources to it progressively each year, through the hiring of more human resources and material resources, and to establish a finalist financing mechanism in the field of primary care and monitoring mechanisms thereof. It is essential that this translates into greater accessibility, reducing waiting lists.
- Evaluate the Primary and Community Care Action Plan 2022-2023 and adopt a new Action Plan in 2024.
- Assess compliance with the 2019 Strategic Framework for Primary and Community Care, publish its results and drive the adoption of a new strategic framework.
- Guarantee that the health professional sector and the affected population are duly consulted and can actively participate in the design of the strategy to reinforce the National Health System.
On the other hand, the regional authorities must:
- Comply with its obligation to progressively achieve the full realization of the right to health and increase health investment, giving special priority to primary care. To do this, they must invest above the health expenditure made the previous year, with the aim of reinforcing staff, improving the infrastructure and material resources of primary care centers and ensuring that, in the medium term, non-urgent demands are resolved in 24-48 hours.
Amnesty International has sent the results of this analysis to the 17 health ministries, so that they can exercise their right to reply. Of all of them, only the Ministry of Health of Catalonia has responded, highlighting the need to “improve the volume of resources allocated to health in the autonomous financing system of the Autonomous Communities”, and that this includes, “at least, all the health services resources that have been added to the National Health System and that the Autonomous Communities provide these 10 years without equivalent financing from the State, as indicated by the law. Likewise, the Catalan Ministry of Health affirms that “the present and future strategic lines of the Department of Health of the Generalitat of Catalonia go in the same direction as claimed by Amnesty International. These strategies are aligned with the needs detected by professionals, suppliers and other actors related to primary and community care in Catalonia”.
More information
This analysis of health spending joins others carried out by Amnesty International such as “The other pandemic: between abandonment and dismantling”. The analysis has been carried out in constant euros, to eliminate the effect of the inflation variable, an economic indicator that cannot be ignored in a study of the evolution of health spending. The organization has launched the campaign defiendetusanidad.org
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