Health care in Spain after the crisis - FSS-CC.OO reports cuts and denounces deteriorating pay and working conditions

(Madrid, 26 October 2015 / Brussels, 28 January 2016)

A presentation given by Antonio Cabrera González, Secretary General of FSS-CC.OO (Federación de Sanidad y Sectores Sociosanitarios de CCOO) end of October 2015 in Madrid at the EPSU Constituency Meeting for the Mediterranean Countries/Southern Europe, well illustrates the difficult and partly dramatic healthcare situation after the crisis period in Spain, mainly caused by the austerity policies put into place in Spain since 2010. It covers financial and employment issues, working conditions and some recommendations. This articles highlights some major findings:

According to the EGSP (Public Health Spending Statistics) in 2015 the Spanish initial health budget, the staff expenditure and the investment budget are 9.6%, 7.2% and 62.2% less compared to the ones in 2010 respectively. Regarding to the budget related to public and private services, in 2013 the total public health spending has been reduced by 11.3% compared to 2009, while the cuts in the private health sector are up to the 2.9%. Another relevant data is that according to the SCS (Health System Accounts) the health spending in the public administrations per inhabitant dropped by 12.6% whereas the expenditure of households for health rose by 14.6% compared to 2009.

The cuts in the public health budget have strongly affected the employment levels and working and pay conditions. According to the SIAE (Information System of Specialised Care) the autonomous communities have reduced employment in the health institutions of the SNS (Spanish National Health System) by around 4% compared to 2010. From personnel hit by the cuts, 58% were medical staff and the other 42% were non-medical staff. The most relevant findings are that from 2010 the number of medium-level medical staff was cut down by 6.1%, office staff by 18.1%, other university graduates by 24.3% and other medical staff (excluding doctors) by 57.4%. We can retrace salary cuts between the 18% and the 23% (depending on the Autonomous Community and the professional category).

There are numerous consequences from these cuts. According to the OCDE data, the ratio of hospital beds per 1000 inhabitants dropped from 2010 by 4.7% until 2014 and from 2012 to 2014 the average waiting time increased by 23%, and the number of patients per 1000 inhabitants rose by 9.7%. In 2014 the lowest grade of satisfaction of patients in the period covering the years 2009 to 2014 has been reached. In addition, governments in the Autonomous Communities have opted to privatise services and work centres. In this period many catering services (kitchens, laundries..), diagnosis support services (labs, X-ray services…) and auxiliary services (administrative, guards…) have been privatised, but also thanks to broad mobilisations from the civil society and the trade unions (for example, La marea blanca), the planned privatisation of 8 hospitals and 27 health centres in the Madrid Region was stopped.

The proposals from CC.OO to tackle this situation are 1) the derogation of the Law 15/97, which allows to transform the health public sector in a market (thus this sector would become an opportunity for commercial providers to look for profit making agreements), 2) to stipulate common minimum criteria or requirements with regard to questions of employment and public funding, 3) to elaborate a report on the privatised centres and services in the sector, 4) to obtain information on the duration of the contract of the privatised centres and the financial compensations promised to them, 5) to promote inspection services and quality control activities and – last but not least – 6) to prioritise the restoration of the public services which provide more advantages for the whole society.

For more detailed information you can have a look at the presentation by Antonio Cabrera González (in ES only).

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