Spain plans to privatise more healthcare- is this the way forward?

 I do agree that privatisation is not the way forward.  We (at the insistence of a GP who was more interested in getting the money in rather than the patients - and there are some like that but thankfully in the minority) started a private travel vaccine clinic.  This meant a GP and a nurse giving up NHS time to deal with the private sector.  Less time for those having it on the NHS.  Those who have worked in hospitals will have many stories of consultants working about 8 hours for the NHS but 30 hours for private patients.  

Being "free" is not necessarily a good thing, especially if someone hasn't paid into the system.  And now the NHS bosses (very few of whom are medics) have decreed that GPs in UK must treat all foreigners regardless of resident status as it would be against their human rights not to do so.  No wonder the system hoovers up money like it grew on trees.  

But, back to the original post.  What, exactly, is Spain going to privatise?  If it is the computer system (which works very here in Valencia province which GP records linked to hospital records and vice versa) then that may free up medical staff to treat patients.  If it is carrying out routine blood tests, diabetic monitoring etc then, again, free up the Spanish NHS might not be so bad.  If it is, however, making decisions on treatment then, no, that should be left to the doctor who has no vested interest in making a profit but who has the best interests of the patient at heart rather than balancing the books.  

So saying, the Spanish NHS is in trouble.  Chemists in this area are going on strike next week as they haven't been paid for prescriptions in over six months.  Some have mortgaged their homes and businesses to keep going but have decided enough is enough.  Just like UK, the doctors can be wonderful, it is the system that needs a complete overhaul.

The prospect of someone - perhaps a FOREIGNER! (ugh!) - getting something for free really seems to infuriate some commenters.

Does the prospect of charging for NHS services and thus causing the very poorest in our society - many of whom will be British born and bred, as if that's the important thing - to postpone or even forgo necessary medical treatment really not give you pause?

There are people in the UK who are struggling to survive from day to day. There are people whose disposable income is a few pounds a week. I know that the tabloids and the Tories pretend that everyone on benefits is rolling in it, but this is an obvious lie. These people have a hard enough life already without being forced to choose between basic human rights such as food and healthcare. If we start charging for healthcare we may as well give up any pretence of being a civilised or developed country. No society that allows its poor and needy to sicken and die can call itself civilised.

 And that is why the poorest should always be supported.   I have seen nothing on here which would contradict that basic concept.  The reality is though, that the NHS cannot make progress unless it starts to change, and people need to take some responsibility for themselves.   That might mean NOT getting a prescription from the doctor when you want basic products, JUST because you can get a FREE prescription.   Or it might mean tightening up and not having so many free prescriptions.  But changes are needed and will come.

 Where, anywhere, does anyone say charges will be made on the NHS?  Privatisation does not necessarily mean charging for the service, merely that some services will be provided by outside agencies.  Much as it is now.  The objection is people coming to a country, any country, and getting a service that they have neither paid for or have made any contribution to that country for doing so, in the form of taxes or insurances.  No country, UK especially, can afford to be the world's doctor.  Finisterre starts talking about foreigners and then goes on about those born and bred in the country.  There is a difference to being born and bred and hence not a foreigner.  Those coming from, say, Africa by plane when they are 8 months pregnant or have AIDS etc and having free treatment is a totally different matter.  

The point about free prescriptions made by Roly2 is also very pertinent.  A pack of paracetamol is as low as 28p in UK but people will take up an appointment, a doctor's time, the processing cost and so on just  because it is free.  Things you used to buy, cough medicine - pain killers - bonjela - calpol - antacids and so on - are now being asked for on prescription.  Since Wales introduced free prescription in 2007, the number issued has risen by 2.5 million a year.  

And none of this is actually "free".  It is paid for by taxes, by NI contributions, by VAT and so on.  The only ones actually getting it for free are those who abuse the system.  

 It seems that most people agree that the costs of privatisation will outweigh the benefits. So, if privatisation is rejected (as it should be), how could the costs of the current system be lowered. That is what this is all about, isn't it? Savings? Or, is it about costs versus funds available? 

 Going off thread -sorry . 66d35- Why on earth would anyone want Romney to be president? Obama has tried to make health care for all in a fair way- it'll be a disaster if he doesn't get re-elected.

 On the subject of bringing in money for the health service- how about a rule- no fiscal residency=no free health care? Many ex pats still don't get the message that you have, by law, to register on the tax system in Spain, even if your income is below the tax threshold. There are many wealthy ex pats not paying tax  in Spain on their pensions,savings etc in UK (yes, we know about crown pensions, but many have several  other pensions taxable in Spain) I think the threat of withdrawing free heathcare would soon bring them to their senses. Why hasn't the Hacienda introduced this already?

My apologies too for moving the spotlight to the USA. My intention was to show an option for Spain to stay with the current system. So back to Spain.

When I visited Malaga during Summer 2011, I bought health insurance. It cost me (then 63 years old) $160/month. Fortunately I didn't have to use it. My Medicare health care benefit here in the US (now that I'm 65) costs me $225/month. 

Spain should enforce a requirement that all (non-EU citizens) foreigners have insurance. That would lower some of the burden the system has to carry currently. 

Roly2 -  How do you reconcile your insistence that charges must be ointroduced to the NHS system with your statement that "the poorest should always be supported". By definition, the poor will not be able to afford the fees, and thus would be excluded.

 The poorest do not now, and nor should they pay for healthcare.  ???????    No one has suggest this.   The welfare state was set up to support the vulnerable, I continue to support that aim.

Just as Campsol  says:-    yes, we know about crown pensions, but many have several  other pensions taxable in Spain

For Brits, only Crown pensions and income from rental property in the UK are excluded from Taxation in Spain. 

ALL other income is taxable in Spain, without exceptions. 

You cannot chose where you pay tax it is determined by the double taxation agreement between Spain and the country you are from.  They vary considerably.

 Firstly, camposol, many Americans believe social healthcare is socialism by the back door and are against it.  In my mind, they are wrong and it should be a governments first priority to care for the health of its citizens.  Those who object point out the waiting times for surgery in the UK and Canada (where private healthcare is banned) especially for cancers and cataracts.  They also point out the poor dental hygiene in UK (a bit of a standing joke) and the difficulty in actually getting to see a doctor in the first place.  They also point out that doctors would be removed from the private sector and they would see standards slipping. They also point out there is nothing "free" about it as taxes would be diverted to pay for it and the USA already pays more per head into healthcare than the UK or Canada  It is, I suppose, something they are used to and are frightened of change.  

Secondly, the non-fiscal residency in Spain.  The Spanish government have tried to bring this in (for non-EU citizens) but doctors have objected saying it would be against their wishes not to treat people who need it (a lot of Moroccan immigrants for example).  The rules on EU citizens are already in place but the number of people using EHIC cards (for emergency use) time and again shows people will always find ways around it.  I pay tax in Spain on my non-government income, my wife pays tax on her pension and we have transferred cover from UK via the S1form.  I know a lot of people don't do this but still expect free treatment.

 And talking of dentistry - that is an area that should be outside of the NHS.  No other country (that I know of) includes dental care in with the national system.   And the fact that the teeth of the British should be such a joke is a sorry indictment of a system which has failed.   

Do doctors even prescribe paracetamol? I've never heard of them doing so, and in any case, paracetamol is cheap as chips so I don't really see why anyone would bother making an appointment to see the doctor and getting a prescription, for which most people have to pay anyway, rather than just paying 80p for a packet at the chemist. The only way I can imagine someone going through all that hassle for such a pathetic saving is if they are truly desperate. Which in my view is precisely what the NHS is for.

Bobaol, you and others have talked about health tourism. Do you have any statistics to show how common this is? You say "Those coming from, say, Africa by plane when they are 8 months pregnant or have AIDS etc and having free treatment is a totally different matter.", but actually we have extremely tight immigration laws now and people coming from Africa are generally not even allowed into the country unless they have citizenship rights, in which case they are entitled to healthcare. I just don't accept that the *numbers* of people who are genuine 'health tourists' is a significant burden. I'm sure there are some genuinely cheeky people who really do just want to take advantage, just as there are a few people who fiddle benefits. But thousands? I doubt it. And unless you have some evidence to back up this claim, it does just seem like recycled media scare stories to me.

Roly: charging everyone except the poor for healthcare is a great way to (1) make more people poor, and (2) kill off the NHS. Look at what has happened to social housing since the Tories sold off all the council houses. As soon as it became 'only for the poor', it was stigmatised and attacked and now council estates are a byword for deprivation and 'problem' families. In the past you had people of all social classes and genuine communities; now it's a ghetto. The same would happen to the NHS; increasingly terrible care as the media encouraged everyone else to feel hard-done-by that "their" taxes were "paying for other people". It would be a tragedy.

 Not true, johnzx.  If you use your EHIC then the UK will be billed.  This may never happen or it may happen very, very occasionally.  Do it permanently and the UK pays £3000 a year for everyone.  So someone living here for 5 years and never using the EHIC will bring nothing into the Spanish economy.  Someone living here for 5 years but transferring their health care will bring in £15,000 to the economy.  This will offset those who do use the system a lot and costs more than the £3000 that is paid in.  Bit like taking out an insurance policy.

 I hink you will find that an awful lot of prescriptions - probably most - actually are free, and a lot of people therefore will ask for basic drugs on prescription.  

Paying something towards care at the point of service will not make most people poorer - and given the choice an awful lot of people do pay.   Where walk in centres have opened for minor procedures e.g. sprains, the average worker has chosen NOT to waste the time he or she could be earning money standing in NHS a and e  but they pay for a quick consultation and a walk in service.  

Whatever you say, and no matter how much anyone jumps up and down - the NHS has to change.  

Of course we are talking about thousands of health tourists - it is whether it goes into tens of thousands that there might be a doubt!!

 Finisterre, you missed the point.  Yes, in places where prescriptions are free, people will see the doctor for a prescription.  I worked in the NHS for 14 years and many parents (not the poor, just those who knew their "rights") would make appointments for things like that and for Calpol.  They would complain and play merry hell if the doctor prescribed a generic prescription instead of the brand name.  Bonjela, Gaviscon, Rennies and others were many instances of what people made appointments for.

Reference those coming in to have babies.  You really should visit Ashford Hospital near Heathrow.  My daughter worked there as a nurse and it was well known that people were coming by taxi straight from the airport.  Just a couple of examples from very recently:  

http://www.telegraph.co.uk/health/healthnews/9494485/Nigerian-health-tourist-flew-to-UK-for-caesarean-birth-on-NHS.html

http://www.guardian.co.uk/uk/the-northerner/2012/aug/23/health-tourist-nigeria-manchester

I personally think that the NHS estimated figure of £200 million a year is a burden and the NHS tends to play these figures down. 

Conservative MP Chris Skidmore carried out a study of 118 health trusts which has revealed that up to 3,600 foreigners run up debts to the NHS of £1,000 or more each year.  There are 303 trusts in UK 

Over one third of hospitals treating patients did not even check on the entitlement.  Those that did raise bills failed to recover over £40 million.  

 I wanted to clarify information about healthcare in the US.  As an American who lives in Michigan (USA) and Spain (as I said earlier), I am very well versed in US Healthcare.  First, the national healthcare that has been passed here (to go into effect in 2014) is not free.  It is AFFORDABLE.  All people here will be required to carry some kind of insurance.  The huge uproar here is because Americans don't want to be told that they "HAVE" to have insurance..okay, nevermind that we have to have car insurance to drive a car, pay state and federal taxes, etc.  Emergency room visits are NOT free and unless the person comes in with a life threatening injury, they can be turned away.  If they are treated and cannot pay, then the rates go up either at the hospital or for insurance or both for everyone who can pay, so the hospital doesn't  lose money and now virtually all hospitals in the US are "for profit".  Everything here is very expensive when it comes to healthcare.  For example; I had an out patient surgical procedure done this year.  It took 3 hours and then I went home.  Prior to the procedure being done, I had to sign a document stating that if my insurance did not pay for it, I would be responsible for the bill of $24,500 and that did not include my doctor or the anesthesiologist!  My husband's asthma medication that he takes everyday cost $672.00 for 3 months, our insurance company recently told us that they would not pay anything on my blood pressure medication unless I started using generics...my doctor was totally against this change but we had no choice..if I didn't change, my bill would have been $300 per month.  We have the MOST expensive prescription medicine costs in the world!  Without insurance (also very expensive) some people cannot even afford the medications that they need just to live!  I personnally think this is just outrageous and I am totally in favor of a healthcare system where everyone has to pay in something but it is affordable for everyone.  

As for NHS in the  UK, I have no knowledge of it.  I have to think that all people who are British must pay for this in their taxes, so, FREE may not be totally accurate.

 And that, cowiz, is the main reason I would not advocate private healthcare for all.  However, I was under the impression that those whose income did not exceed $400 a month would get free health care at a county hospital.  It may depend on state by state but was certainly the case in Louisiana and Illinois.  (I think that figure also depended on the amount of children you had).

But, you are right.  None of it is free.  Either taxes have to go up to pay for it or corporations have to pay for it.  Spain has introduced a 10% prescription charge for pensioners but children and pregnant women don't have to pay (yet).  UK prescriptions are now, I believe, £7.95 for each item unless you have a chronic disease and need the medication monthly.  When Harold Wilson stopped prescription charges for all in 1964 ;

As a result, more prescriptions were issued for cheap products that patients had previously bought for themselves - such as painkillers and dressings.

In 1968 Labour reintroduced prescription charges, but created exempt groups for the old, the young, people on benefit, and people with chronic diseases such as diabetes.

As a result the number of prescriptions fell again, and people increasingly bought common household remedies across the counter.  (From BBC History of Prescription Charges)

At the moment, charges for prescriptions on the NHS only applies to residents of England as all the other UK countries issue them for free (again, not free, subsidised by those who pay taxes).