Web-economic-crisis-health-systems-and-health-web

Country profiles of health system responses to the crisis | Spain
491
that are to be reimbursed the difference between retail price and patient copayment
for prescriptions; the pharmaceutical industry providing drugs
directly to hospital pharmacies; as well as the medical goods and devices
industry that services primary health centres and hospitals. Delays have
ranged from 6 to 12 months, cumulating a debt that, for small business
such as pharmacies, amounted to risk of default. In 2012, the central
government implemented a specific fund for public administrations to
borrow money to meet their pending debts with private providers.
Overhead costs: restructuring the Ministry of Health and purchasing agencies
• Creation of a national centralized purchasing platform for medical goods
aimed at fostering economies of scale (2012).
Provider infrastructure and capital investment
• Implementation of the following changes in provider structure at the
regional level (2010 onwards in Catalonia; 2011 and 2012 onwards in
the other regions):
àà
àà
àà
total or partial closure of facilities (both primary care and hospitals);
plans for intensive implementation of private partnerships in the form
of cession of full exploitation rights of hospitals and primary care centres
to private insurers (notably in Madrid); and
further externalization of certain clinical and complementary services,
often centralizing the provision for a given area.
• Regarding capital investment, based on estimated budgets there has been
a 16.5% reduction in investment in 2011 compared with 2010 and
figures for 2012 show an additional 35.3% reduction in investment.
Priority setting or protocols to change access to treatments, coordination
of care and patterns of use
• At the regional level, revised service hours are intended to eliminate
evening and overnight walk-in services in urban areas and emergency
wards in rural areas (Catalonia in 2010; other regions 2012 onwards).
Waiting times
• Criteria established for regions to regulate maximum waiting times for
surgical procedures through Royal Decree 1039/2011 (2011). Enforcement
still pending in many parts of the country at the beginning of 2013.
Health promotion and prevention
• Sharp increases in tobacco taxes (2011 and 2012).