Five years ago he turned his doctoral thesis into a book, The Spanish health system. From its origins to the present day (Sphere of books). Juan Abarca, president of the IDIS Foundation (Institute for the Development and Integration of Health), acknowledges that, despite the journey through the evolution of our Health through its pages, “what has happened in recent years has made the system collapses”.

Four years ago it counted that 70% of the articles of the General Health Law were obsolete. Are we still the same? Yes. As stated by the expert in Health Law, Ricardo de Lorenzo, it would be around 74%. Which reflects that we are facing an outdated law. Our health system is negatively characterized by a lack of adaptation to aging and polychronicity. In this sense, the Darias Law (the draft Law on Equity, Universality and Cohesion of the National Health System) came to amend this problem. no no. In fact, he was going to breach one of the articles approved in the Commission for Social and Economic Reconstruction after Covid-19, recognized as the basis for a state pact. Specifically, 2.1, because direct public management, which I was going to promote, is precisely going even deeper into the statutory model. Said article states that the SNS must apply the values and principles of good governance of public health systems, which include, among others, transparency, accountability, democratic participation, integrity and competence; efficiency, quality and sensitivity to the needs, demands and expectations of citizens. And suppressing public-private collaboration is violating all of this. Why do you point to the Framework Statute as an obstacle to making improvements to the system? As long as it is not changed or deleted, it is absolutely impossible to introduce efficiency measures. The system is created to accommodate almost 700,000 people, one of the largest companies in this country. They do not want to break the status quo of the same; do not care. But neither to some parties nor to others. So, how do we measure what the system needs? How do we know where the inefficiencies are? You can't. Not even an HR performance audit is possible. Medical professional records are not complete, 60% missing. And then there is talk of a lack of doctors, but we don't even know how many we have. And it is no longer the number, but rather that they do not want to work in the first level of care, in primary care and the MIR positions have not even been covered. How is this solved? It does not matter if you raise doctors 100, 200 or 300 euros per month. They will not want to work in primary care, because they will go to the first place they find that pays the same. Because it is about working conditions. As there are problems with access to public health, health insurance has fallen and the insured has grown. In the end there are many people in the private too. Does it compensate? Today people buy insurance, some with more benefits than others, but many times people hire them simply because they do not have the capacity to access a medical service. In the end, overcrowding breaks the balance, because the private healthcare system is not made to be an alternative to accessibility to the public healthcare system.. We have to accept the system we have and if we go to one side or the other, which is what happens, total deterioration comes. So, how should the two systems coexist? Without private healthcare, healthcare would collapse because it has neither neither the capacity nor the resources to assume the attention that we currently provide [30% of the total]. This is not about public versus private health. We are talking about public health managed directly or not. Because those who theoretically defend public health what they are defending is the direct public management model and the proof is that they also reject the formulas of private management of public health through independent institutions such as consortiums, foundations or public companies. it is not sustainable. If you want 100% public health, you have to plan well for 30 years. Why? The costs are increasing. The April Martorell Report of 1991 already included everything that has happened up to now and the need to take measures: the aging of the population, chronicity, the incorporation of innovation, the latest generation pharmacological treatments…. In other words, this has already been known for a long time. Of course.. And nothing has been done. It's too late; the entire system must be changed. What solutions would you put on the table? In addition to a profound reform of the system based on a renewed General Health Law, it would be necessary to impose co-payments adjusted to the level of income. Obviously, whoever can't, well, they don't pay. But whoever, at a certain moment, makes use of public health having the resources, I think that would have to be closed, because the demand is unlimited and the resources are not. Not in the ER, but in scheduled care, why not? There are already people who pay for health insurance. There is no money to cover all benefits. In the end, people increasingly have to pay more money out of pocket, either through an insurance payment or directly through their pocket.. Because there are innovations that are not covered by the public administration or insurers. For example, which ones? In the field of advanced therapies there is a delay in the arrival of drugs in our country. Many of them arrive through special mechanisms [Royal Decree 1015/2009 that regulates access to medicines in special situations such as those not authorized in Spain, but marketed in other countries] that do not depend on clinical judgment, but on the decision of an official. This is adulterating and violating the right of the patient. And it is because the Law of Guarantees also fails. Given this scenario, how should good management of the SNS be? We have a fantastic Health model, but now the system is going in the opposite direction. Now more than ever, a long-term, ambitious State pact is necessary. It is a strategic question and an imminent necessity.