deficit (pseudo) HEALTH
Article published in El Periódico de Catalunya, 03.02.2011
budget deficit attributed to the Catalan health is just the visible result of initial budgets well below the historical needs and unavoidable expenditure, the high specialized autonomous health budgets, and abuse that accumulated financing system has not being adequately compensated under a decade by a strong demographic momentum and asymmetric (far more people and more older people). Public spending per person covered in Catalonia is lower than the average for the rest of Communities and equivalent to 68% of La Rioja or 85% of Cantabria (figures 2007).
Indeed, the sharp fall in government revenues has uncovered widespread inertia English health expenditure growth in the last decade, well above the GDP was not sustainable and not at the time of economic boom and is only alibi partial demographic change for one of every three euros more spending.
Two out of three euros more health spending are due to factors over which management and organization of services can influence: it is necessary that each year same users of all ages, more frequent health centers, they will find more drugs to the pharmacy and earn more in hospitals and health centers are diagnosed with more and more expensive diagnostic tests and are treated with more drugs and more expensive medical technologies.
This has nothing to do with aging, occurs for all ages. Not justified by health outcomes: not go to the doctor are more healthy (rather is evidence to the contrary), nor is there evidence that accumulate unnecessary or inappropriate diagnostic tests, or at crowded cholesterol-lowering drugs or anti-ulcer much more expensive we will live longer. More consumer health is better health and better quality of life.
must alleviate two major problems: the lack of criteria for benefit coverage and purchasing health services based on health outcomes and the lack of financial responsibility for almost all stakeholders.
Left alone these problems efficiently with quick action but inefficient (high cost in health), financial regulation "blind" to unilaterally reduce the price of all new drugs regardless of their contribution to improving health while galloping continues to increase the number of prescriptions per person, or deleting The latest features recent matching taken unless necessary, or removing arbitrarily fill vacancies or sick leave in hospitals or health centers, etc.
However, it could be more useful to begin by measures acting on the following three directions, making it more "manageable" the two-thirds of increased spending. First, follow the example of countries like UK, Germany, Holland and Sweden and submit the decision-making on health innovations to filter independent agencies and expert committees as a condition to defend the value of effective innovations and effective and ensure that limited resources intended to treatments worth the money.
Secondly, to encourage co-responsibility of patients, prescribers and industry based on scientific knowledge. The industry through risk-sharing contracts (if not effective, no pay) to demonstrate the effectiveness of new drugs or technologies. The patients redistributing current pharmaceutical copayment copayments to avoidable (not paying more for the same and if the patient wishes to pay the price difference), and differential (the more necessary and cost-effective, lower co-payment), the that would exempt only the truly poor. The encouraging prescribers to adjust practice scientific and clinical knowledge to reduce unjustified variations in practice.
And third, paying for health outcomes: pay more for healthy patients not to have more decompensation of chronic patients or more readmissions for complications after surgery or elective surgery excesses, pay more resolute that going visits to the patient between professional forwarding unresolved health problem. This requires integrating compartmentalized budgets of healthcare levels (primary, specialty, social health, pharmacy) with a preset fixed financing all the attention of a person according to their characteristics (risks) to help visualize the full cost of care to a patient by limiting the partial and fragmented today centrifuged and conceal the lack of clinical resolution. Comment
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