The Government initiates the processing of the health equity law to eliminate co-payments and guarantee universal access to health

The Council of Ministers this Tuesday has approved the preliminary draft of the Law of Equity, Universality and Cohesion of the National Health System. The department of Carolina Darias intends with this new rule to address three challenges in the health system above all: to guarantee universality —today thousands of immigrants and Spaniards living abroad face bureaucratic obstacles in obtaining free assistance—, to eliminate the co-payment of non-urgent health transport and prosthetics and orthopedics (insoles, crutches, girdles…) for vulnerable people and prioritizing direct public management, limiting referrals to the private sector to the essential minimum and minimizing the difference in benefits depending on the autonomous community.

The President of the Government, Pedro Sánchez, advanced the approval of the regulation at a rally this weekend and promised to “shield equity, cohesion and universality of public health and, therefore, not be privatized by no right-wing government in any autonomous community”. Health sources explain that the idea is to unify the portfolio of services throughout the country so that all citizens enjoy the same benefits, regardless of where they reside.

After its approval in the Council of Ministers, the norm will begin its legislative journey in Congress, where it must be amended and ratified. It involves reversing a variety of regulations, among which some aspects stand out the General Health Law of 2003, which was approved with the Government of José María Aznar, which included certain co-payments.

Both the government partners of the PSOE and the activist organizations of public health are skeptical about the scope of the new law. The secretary of Institutional Action of Podemos, María Teresa Pérez, has doubted that the project avoids the privatization of public health. “We have serious doubts that this law will really serve to prevent the privatization of public health and the dismantling that the right is doing in many autonomous communities,” she said at a press conference, EFE collects.

The Minister of Health, Carlina Darias, responded to these statements at the press conference after the Council of Ministers: “The law improves, expands and restores rights to citizens.”

Universal access to healthcare

One of the objectives of the law is to guarantee free access to healthcare for all people residing in Spain, regardless of whether they do so regularly or irregularly. It is something that in theory should already happen, thanks to a rule approved by the first Sánchez government shortly after coming to power. However, there is a legal loophole that allows the autonomous communities to deny this right to people who have not been living in Spain for more than three months or who cannot prove it.

It also extends the right to people of Spanish origin who live abroad and their families during their journeys to the country.

The operation is very disparate according to the community. There are some that do not take this obstacle into account and others that involve a delay of months. According to sources familiar with the content of the new law, the text will eliminate this possible ambiguity: “What it does is that it requires the immediate attention of everyone who requests it, and later it will be possible to verify what situation that person is in. [si es turista y procede aplicar algún convenio, por ejemplo]. It also guarantees care for victims of human trafficking or prostitution networks. It will cease to be something that can be interpreted by the communities because it will be in the law.”

Organizations that defend universal assistance are suspicious of the result. “With the text of the draft bill [que se publicó en noviembre] there were still the same cracks that already existed. We ask that they be resolved in the final text and in the parliamentary amendments, ”explain spokespersons for Doctors of the World and the Yo Sí Sanidad Universal platform.

End to copays

The rule will put an end to co-payments for non-urgent medical transport and orthoprosthetic products for the most vulnerable groups: people receiving the minimum vital income, pensioners with lower incomes, minors with recognized disabilities and people with low incomes per dependent child. The Government calculates that it will benefit some six million people, for whom these products will be free.

Until now, there were some minimums set to subsidize the prostheses, but the portfolio varied between autonomous communities. An example would be some adapted templates: depending on where you live, the user may or may not have to pay their price, which can exceed 100 euros.

The idea with the new norm is that there is a catalog of free products in all the autonomous communities for the most vulnerable groups, as has happened with medicines since 2019.

Direct public management of services

The Government intends to give priority to public health care over concerted care. Referral to private care is systematic in some autonomous communities, where the patient is not even informed that he is not going to be treated in a publicly owned center. Health wants this to become an exception for situations where it is absolutely necessary.

Public administrations must meet a series of requirements and motivate outsourcing. According to the minister, it will be the Interterritorial Council of the National Health System that determines the common guidelines or indicators to approve that public services are provided by private companies.

The Spanish Alliance for Private Health (ASPE), the sector’s employers, denounced this Monday that the future law “would make Spain the only European country that bans private health from its National Health System.” “Communities are being limited in their management capacity, eliminating a possibility of collaboration that is a great relief at times of specific demand for some surgical interventions,” ASPE president Carlos Rus said in a statement.

The Institute for the Development and Integration of Healthcare (IDIS Foundation), which brings together the majority of healthcare companies, has also spoken out against it: “It is urgent to turn the page on the demagogic and sectarian discourse that does not contribute and see in the private sector an increasingly essential strategic ally to meet the needs of the population”.

Government sources defend that what the norm will do is “shield” the public health system, identifying direct management as a model.

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