Carlos Rus: "Healthcare in Spain is a social achievement and private healthcare is an option in the healthcare model, both at the management and user levels"

As president of the Health Commission of the CEOE and highest representative of the Alliance for Private Health (ASPE), Carlos Rus defends the role of the private sector...

As president of the Health Commission of the CEOE and maximum representative of the Alliance for Private Health (ASPE), Carlos Rus defends the role of the private sphere as a part of the whole of Spanish health.

He shies away from the mantras that want to pit the public against the private -"if public health goes badly, so does the private one"-, given that the collapse of one has repercussions on the other: "We have seen it with the increase in waiting lists and in the demand of emergencies".

In the middle of the health crisis and in the middle of an election year, Health is once again at the center of the debate.

And one of the mantras that is heard is the privatization of it.

Is Spanish society aware of the role of the private sector? I think so.

People on the street get to understand it.

Another very different thing is that today the private is demonized because it is a thrown weapon, we are in the middle of a political process.

Removing extreme approaches that occur in any society, all citizens have seen, for example, that during Covid we treated 30% of patients.

We have always said that there is only one National Health System (SNS).

These patients were hospitalized and treated in the private sphere as if it were public.

And our management autonomy has been respected.

People know the meaning of privacy within the SNS,

I think that this message has had to be fairly clear: we are one. But for some time now, public-private collaboration models have been questioned and looked at with a magnifying glass, although unequally in the autonomies... We always collaborate, as we have shown in the pandemic.

Although what is being considered now is either one or the other, the competition between the public and the private.

If one is doing well, the other is doing badly.

This is what doesn't make sense. Why?

In the end, there are 12 million Spaniards who pay for health insurance or who choose to receive private care [Muface].

But, aside, you have another series of people who pay for it out of their own pocket.

And, in addition, there are public users who are referred to the private when necessary.

In the end, more or less one in three Spaniards is a private user.

There is a health that is public, universal, free and to which you always have access without any type of limit.

In addition, we are one of the countries where the insurance policy is more accessible.

The difference, for example, between Spain and Germany in monthly insurance is practically multiplied by 10, that is, here the average is 35 euros, in Germany, 350. There are 12 million Spaniards who have double insurance.

In other words, in the end it is a decision as a patient, but it is also a decision as a consumer.

This is freedom of choice.

And where is this?

In our Constitution.

And why is there entrepreneurship?

Because there is free enterprise and as there is a demand for this service, it is given.

But, at this moment, the collapse of the Health is not only in the public.

In the private sector, delays in appointments are also noticeable.

Has the crisis spread to all areas?

If it goes wrong for one, it goes wrong for another.

In the end, we must be able to provide quality healthcare, regardless of ownership.

For us, healthcare in Spain is a social achievement that must be preserved, one of the main virtues of our welfare state, but this does not mean that there is a private healthcare model and there are those who can choose it.

About the health crisis, is it all because of Covid?

No, there are different cases.

We have another health crisis to face as well among all of us.

So, has this crisis also affected them? In the private sector, equal in quality, equal in excellence in patient treatment, the difference with public health is accessibility when the public is saturated.

The private healthcare model grows with policies

low cost

For 30 euros the whole family enters.

But then the queries are limited.

If we subtract accessibility, we lose meaning.

An example of this situation occurs with waiting lists.

The saturation of the public is transferred to the private, where there had never been this problem.

And now we have professionals who are much busier and you have to find others to provide that care.

Then, there is our primary care, which is urgent, it has points where there is a saturation that is complex.

Before this only happened on Friday and Sunday, now it is more common. How is this solved? We will be able to adapt to the circumstances, but we need time.

We think this is temporary.

We have to get through the downpour and, like the public, we have to focus on people.

Because we are finding patients with a higher level of complexity.

Because?

Because they are late and, when the forecasts are late, they require more resources, more time and more hours. So, do we collect the consequences of the Covid crisis?

It is a different crisis.

Covid has exacerbated existing problems.

And even so, the healthcare model in Spain is a good model.

But what is happening?

That we have been dragging the diagnosis of the situation since the Abril Martorell report, more than 30 years ago.

We have problems because we lack professionals and the system requires more flexibility.

They are the same obstacles, but sharpened years later.

So, the model is not bad, you just have to tackle the casuistry.

And we as a sector always make ourselves available.

You have to care for the patients.

must be managed with all available resources.

And this is not done here, because ideologies predominate.

And it is a mistake.

Because?

In the end, the patient is interested in good medicine and cares very little about the ownership of the center if it is public or private, what he wants is to be treated as quickly as possible. But the purpose of the private one is always questioned, more like a business than a health care service... Right now, it's about putting a counter on the table or creating enemies.

If public health goes badly, also private.

We are happy if you (public) are doing very well and I am doing very well.

That would be perfect and it is feasible.

I don't need you to do badly (public) for us to do well (private).

Because with everything going perfectly, the insurance policies grew by about 350.

000 a year;

one more example of the welfare state, of purchasing power, of the possibility of choosing, that is, it is a good indicator, even from a social point of view.

And now they are growing more, yes, but not in a healthy way for us, but with type policies

low cost.

Doesn't it make up for them?

That is not our model, we were happier with the previous one, with a natural, organic growth.

This is a stressful time for both parties.

This mantra is added to the one he mentions: the private company does not care about health, only the income statement.

This does not work like that, it has a demagogic point that is complex.

If I don't do my job right, I'm out.

If there is an economic payment, is he no longer a good professional with a vocation?

And is it wrong for a businessman to decide to invest in this sector and create wealth with qualified employment?

We employ 400,000 highly qualified professionals.

Then we are already an evil being.

But it is that if I do not do things well in my hospital, if the patient experience is not good, without a good level of technology quality, if the professional is not well trained,

if the cafeteria is not good... If we don't cure the patient, he won't come back and no one will want to come.

The benefit is that if he comes out well, cured, fast and happy, more will come.

And then your business will go well?

Yes. Because in the end we do have a sentence as businessmen in the field of health if at the end of the month we do not manage to pay the salaries to the suppliers, workers... we have to close the blind.

And this is so.

So, are we facing a management efficiency problem to make the system sustainable? Yes, we have to be efficient.

Lack of flexibility.

And that has been achieved on many occasions with mixed models of public-private collaboration.

Spain is a leader in many things, for example, in cancer care due to the number of clinical trials that are carried out, 50% in the private sphere and in the initial phases.

This serves to attract professionals and retains talent.

This attracts user-patients because a hospital that is a university, that carries out research, clinical trials, is a model that works.

The system needs to be more efficient, there is no doubt about that.

We, for example, have carried out a study when we collaborate with the public sphere, the autonomous communities establish rates on what the public service costs and also when they collaborate with the private sector.

There are a number of processes that are very common and we have compared them at the national level.

So, on average the saving is 50%;

This represents a minimum annual saving of 2,700 million euros.

Is this privatizing healthcare?

No, this is adaptability and flexibility.

When there is a problem in the Sanitation and the standard demand rises,

attention is overwhelmed.

If I am in the public sphere, when a point of demand is suffered, it cannot face it.

That is the lack of flexibility.

Within the models of public management we have the classic one of administrative law that is the traditional hospital, but also the foundation or the company;

These models are all public models.

Public-private collaboration is also a public model, because it is a tool that the public manager has to be flexible and efficient.

Does it mean that they are one more resource for public health?

Clear.

But what we cannot do is want to select the management capacity of the administration.

Because in the end if this possibility is limited, which is public management, the public model is forced to lose solutions and opt for less adaptable, less flexible resources.

As regulated, public-private collaboration is not an obligation, it is an availability that the public sphere has.

The regional manager or the manager of a hospital also have to balance the accounts, like everyone else, either because the money comes from the pocket of the citizen, because he is paying for his public health, or from the pocket of the businessman, because he has to pay the bills.

An example of this would be... Proton therapy.

Three years ago patients were sent out and now there are two centers in the private sphere to which they are referred from the public.

This is a risky bet that the sector makes, because it does not know if it will receive patients or not.

A proton therapy system, between the cost of the machine and the investment made in adapting the facilities, is around 40 million euros.

And then there are the years it takes to get it up and running and train professionals.

If they assumed that part it would take longer.

Meanwhile, the public can count on it thanks to the private sphere;

this means that it has adapted to the circumstances, has done so at a lower cost and has achieved a rapid response for the patient.

What do they make available to public health?

Some 456 hospitals and 430,000 health centers.

This means that we perform 42% of surgical interventions, we assume 31% of emergencies and consultations and 24% of deliveries.

All this downloads and frees resources.

This is adding value to the system, if we were not there everything would collapse and if the public were not there, the private would.

In other words, we need each other, it is a symbiosis.

But we are in an election year and the health issue is one of the concerns of the Spanish.

What are those health challenges that need to be faced?

Good news is that we are living longer.

But that translates into a bad one: there is an increasing number of chronic patients, 80% of health spending is made by people over 60 years of age.

And what is needed?

Betting on technology as a lever that helps us to be increasingly efficient.

We need to take into account the needs of the private sector, for example, when it comes to finding jobs for professionals.

And also modify the skills of professionals.

Because?

For example, in Nursing, which has had the same competencies for 21 years, they have gone from being a diploma to a degree,

now he has an increasingly excellent training and it must be taken into account that he can develop new attributions.

More patients and fewer healthcare professionals to care for them, don't the numbers add up?

The training places have come out (8,550 medicine places).

We proposed reaching 10,000 because many are going to retire and we need to anticipate that moment.

We realize that every year a series of positions remain that no doctor chooses, family medicine.

And yet, there are many other specialties where there is a greater demand by professionals.

It is necessary to take into account not only the places in the public sphere but also in the private one, because if there is only one place and we need two, we are going to fight for it and this does not make sense.

The possibility of making their activity compatible in both areas must be made more flexible. The model is good at caring for acute patients, but, as he points out, we are at a time when chronic patients are in the majority.

Is it necessary to reformulate the assistance model? The answer is yes.

In other words, the acute care model is still necessary, but it is true that it is a system where the best techniques and so on mean that hospital stays are shorter each time.

Models must be sought in which chronic patients, medium-stay patients and then long-distance patients are cared for without collapse, this is the dependent institutionalized patient.