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Guidelines for revamping Spain’s healthcare model

Parallel to the profound changes contemporary societies are undergoing, humans are developing new tools that can help them to adapt. Healthcare is not exempt from this trend. In Spain, the aging population and increased life expectancy, among many other factors, are raising a number of challenges that will have to be confronted in order to avoid a collapse of the health system. Identifying the main problems of the current healthcare model and some key reforms to strengthen it were the focus of a round table debate that took place in the medieval chapel of Santa Àgueda, in Barcelona’s Gothic Quarter, on May 25.

Octavi Planells | 27 may 2010

Soon it will not be necessary to talk about “urban” problems since cities will be home to the bulk of the world’s population and exception will be to talk about issues affecting rural populations. In fact, since 2007 more than half of the world's population lives in towns and cities. Global problems will therefore be urban or generated in the city. Due to the increasing importance of the city, hardly a week goes by when there is not a conference, debate or publication discussing the challenges posed by the growing urban society. The round table in question was a perfect example. It was organized by ESADE and Siemens in conjunction of the exhibition “Cerdà and Barcelona: the First Metropolis 1853-1897,” at the Barcelona History Museum.

The seminar, entitled “The Twenty-First Century City: the Future of Urbanization,” focused on urban development discussed from the point of view of energy and infrastructure with the goal of ensuring the quality of life of future citizens and overcoming the current economic crisis. But the seminar also included “Urban Health: Health Economics. The Future of the Healthcare Model,” a round table where three experts discussed the major health challenges in Spain and made proposals to address them. Josep Maria Piqué, deputy director general of the Hospital Clínic of Barcelona, Albert Jovell, president of the Spanish Patients Forum, and Luis Cortina, director of Siemens Healthcare Diagnostics, were the protagonists of this round table.

Piqué provided arguments from the viewpoint of hospital management. Generally speaking, he said that to adapt to the changes the globe faces today, the world needs a change of its economic model. “Over the past 50 years, the economy has been based on the power of the dollar generated from the exploitation of natural resources,” he said. But today, according to Piqué, there has been a change of course and now the economy needs to “go towards something else, which is the power of knowledge exploitation in order to preserve the planet.” The speaker transposed this paradigm shift to the economic aspect of healthcare, “until now, the power in hospitals has been that of volume, and the doctor was more powerful if it had more beds, more patients.” But now, Piqué argued that power lies in achieving the best results at a sustainable cost.

The Hospital Clínic has already begun to change the hospital's organizational model to achieve this goal, in which the very same medical professional will also be primarily responsible for the economic sustainability of the center. Piqué said that the change in model would give these professionals a certain degree of autonomy and that they have already begun to train for better cost efficiency in relation to the quality of the process of each patient. In short, the physicians of the center will be more responsible for the proper management and cost/benefit analysis of hospital processes with the ultimate goal to maximize, not the number of cases, but their success and quality.

The deputy director general of Clínic also stressed the need in the health system for greater involvement by the user: the patient should be offered information so that he or she has some ability to decide between the solutions that are proposed. In relation to this view, Pique said, “we need one very important thing, which is the transparent information and education for both professionals and the users themselves.” And to improve on these aspects, the speaker highlighted the enormous usefulness of information and communication technologies.

A possible healthcare breakdown

Cortina began by stating the facts, by 2050 the world will be populated by nine billion people and with a higher average life expectancy than we currently enjoy now. He said the aging population, spending increases due to chronic diseases and the ratio of retirement (40 years ago there was a retiree for every 8 workers, today there is one for every 2.7) could trigger a breakdown of the healthcare system. He added that investment in healthcare in Spain is tilted almost completely to therapy and the care of the sick, while in comparison there is almost zero investment in prevention or early diagnosis. Cortina emphasized the importance of prevention in reducing costs and improving the quality of the system, coinciding with Piqué, and highlighted the opportunities offered by new technologies for early detection of diseases using DNA microarrays, for example.

For Jovell, Spain’s health system faces an increase in demand, needs and innovation, along with a drop in trained professionals (among other reasons, due to their flight to other countries), the need for greater information on clinical outcomes, and the emergence of a more active, more involved patient. Jovell claimed the need for altruism among professionals, a motivation to be transmitted over a career in medicine which allows physicians to bypass economic incentives. He also stressed the importance of the implementation of information and communication technologies to optimize efficiency. These technologies also allow the establishment of social networks of people sharing diseases and are tools that will invigorate users with more participants throughout the process. At the end of the day, users are the focus of health.

Despite everything that was stated at the roundtable, the three speakers agreed that both Spain and Catalonia have very good health systems that excels in comparison to the European average. Catalonia is an incubator of professional excellence, but often these professionals end up emigrating to other countries where they find better opportunities. Jovell highlighted these issues and proposed making Barcelona a model of higher education in the health sciences for other countries of the continent. The president of the Spanish Patients Forum is convinced that the city has this capability and that it is in an excellent position to achieve this and to position itself, in terms of healthcare, above the European average.

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