* Even doctors say system may be too gold-platedBy Paul DayMADRID, Oct 11 (Reuters) - Medical suppliers haven’t been
paid for as much as two years, emergency rooms have been shut
down and doctors in Catalonia have been told to accept a pay cut
or 1,500 medical residents will lose their jobs.Spain’s treasured public health care system has become the
latest victim of the euro zone debt crisis.”We haven’t been paid, but there’s nothing we can do about
it. We need the contracts, so we’re just going to have to wait
it out,” said a representative for a cleaning company who did
not want his or the firm’s name used for fear of a backlash.The company, which says it is owed hundreds of millions of
euros by the government of the Castilla-La Mancha region south
of Madrid, is one of dozens of providers of everything from
surgical swabs to disinfectants struggling to pay workers as
Spain’s regions delay payments to meet tight deficit targets.The debt-burdened autonomous regions’ spending cuts are a
tangible sign of the present and future pain as Spain works to
meet ambitious deficit reduction goals pledged to the European
Union in the midst of an economic downturn.Spain’s political parties have kept their positions on the
issue vague ahead of Nov. 20 general elections, but even the
most passionate defenders of the current system agree there is
scope for cost savings and more efficiency.Spain’s conservative opposition, the People’s Party (PP),
which is expected to win in November, will likely cut into
social welfare programmes the incumbent Socialists have left
untouched.But even the Socialists now say they can find ways to reduce
health spending without harming services. Examples include
forcing car insurance firms to pay for the treatment of accident
victims and sending foreign governments the bill when their
citizens use Spanish hospitals.900-DAY WAITSMultinational pharmaceutical firm Roche says the Castilla y
Leon region north of Madrid is more than 900 days behind on its
bills, which has raised fears here that the company could start
withholding drugs for some hospitals as it did in Greece, which
is fighting off bankruptcy.Spain’s central government makes yearly transfers of income
tax revenue to the country’s 17 autonomous regions, which are in
charge of administering health care and schools.But the regions are being forced to make drastic budget cuts
after piling up debt during Spain’s property boom, the collapse
of which in 2008 sent the country into recession and
unemployment soaring to more than 20 percent.As the regions squeeze spending wherever they can, what they
owe to companies that provide health care services and products
has risen 42 percent in a year to more than 4 billion euros,
according to the Spanish Federation of Healthcare Technology,
known as Fenin.AT Kearney consultancy calculates the system’s long-term
deficit is 15 billion euros, a heavy burden for a government
whose borrowing costs have soared in the euro zone debt crisis.Margarita Alfonsel, secretary general of Fenin, says small
companies in her federation “are suffering to an alarming extent
due to the liquidity squeeze.” She said some will have to lay
off staff or go into bankruptcy.The average number of days providers must wait for payment
has risen in the past year to 415 days, from 285 days, she said.”It was unacceptable before. Now it’s totally
incomprehensible,” said Joaquin del Rincon, Spanish
representative of Boston Scientific, which provides medical and
surgical instruments to Spanish hospitals.”We have to explain to our central offices that this is an
ongoing problem in Spain made worse by the crisis,” he said.DOCTORS FEARING FOR THEIR JOBSThe government in Catalonia, Spain’s wealthiest region, has
shut down some clinics and emergency rooms over the past few
months and has said it will lay off 1,500 medical residents if
doctors refuse to accept pay and bonus cuts.The residents in late September staged marches through the
Catalan capital Barcelona and draped banners around hospitals,
and doctors’ unions have threatened to walk off the job. But
many senior doctors are afraid to make a fuss and possibly lose
their jobs when one in five Spaniards are out of work.”All of this is because of years of mismanagement by the
politicians. The money has run out,” said one Catalan doctor,
who asked not to be named.”We don’t know what is going on. We feel impotent to defend
what we have. There is a huge fear of being sacked for doing
so.”Budget pressures are not going away soon. Spain’s economy
cannot create jobs until it has sustained growth of 2 percent a
year, which could be a few years away, meaning sky-high
unemployment will drag on, restricting growth in income taxes.And, as in many other developed countries, Spain’s health
system is burdened by an ageing population enjoying long
retirements on state pensions, while smaller families fail to
fill the funding gap.Unlike other countries with public health care, complaints
about long waits to see a doctor are rare in Spain. But now
patients in Catalonia are starting to have to wait and doctors
warn the quality of care will decline.”There will be less available budget for patients’ needs
because we may find ourselves in a situation where we have to
spend a lot of money correcting residents’ errors that could
result from not having had the proper training,” said Jose
Blanco, head of hospital education at German Trias Hospital.DEEPER CUTS TO COMEPrime Minister Jose Luis Rodriguez Zapatero has almost
certainly guaranteed humiliation for his Socialists at the polls
by implementing a wide-range of budget cuts to avoid mass
dumping of Spanish debt by international investors.In August he passed a bill to save the public system over 2
billion euros a year on drugs. Drug companies slammed the
measure, which forces doctors to favour generic medicines over
brand names, as inefficient, damaging to the system and badly
thought out.The PP, for its part, says the health sector must be
reformed but are vague on details.Economists at conservative think-tanks that advise the PP
have floated the idea of co-payments — where patients pay some
of the bill to discourage overuse of the system.The system, which is common in many developed countries but
anathema in Spain, is favoured by almost 60 percent of doctors,
according to a study by the Spanish Society of Primary Care
Doctors.TOO GOOD?Spain’s health spending growth has slowed and what it spends
on health care is in line with the average for developed nations
at about 9.5 percent of GDP in 2009, according to figures from
the OECD group of wealthy nations. The lion’s share, 73.6
percent, is funded by the state.The system is so good and so cheap that many people use
their private health insurance for routine care but head to a
public hospital if they are diagnosed with a serious disease or
condition.Cutbacks in the public health care system will force some
people back into the private system, which many see as
inadequate.Silvia Sanz, a 31-year-old teacher with type 1 diabetes, is
planning to give birth at a public hospital after she lost her
first baby at a private clinic just a month before her due date.
She has private health insurance but has been told the public
system is best for a high-risk pregnancy and birth.”In private, if anything goes badly, they don’t have the
means to deal with it properly and, when you go back to them,
they tell you you’re best to go public because they know they
are better equipped to deal with complications than they are,”
Silvia said.Foreigners can walk into 24-hour community clinics around
Spain and get first-rate emergency care. When they
