Media must understand, explain privatization of health services

Esther Paniagua

About Esther Paniagua

Esther Paniagua is editor in chief of the Spanish edition of Technology Review, published by MIT, and is a freelance health writer for the popular science magazine, Muy Interesante. She manages the Spanish participation in the European co-funded project HeaRT (Health Reporting Training), with support of the European Commission.

One of the points that stood out for me at the first European conference on health journalism was from conference organizer John Lister. “Few journalists understand what [the] health care system’s reforms means,” Lister said during the Health in the Headlines conference at Coventry University in June.

That assertion spells trouble not only for journalists who have to report on this but for all of society. These days, public health systems in Europe are up for debate; only few weeks ago Italy imposed a copayment requiring patients to pay 10 euros (almost $15) each time they visit a doctor and 25 euros (almost $36) if someone goes an emergency room. This may sound normal – even ridiculously low – for an American. However, Europeans are used to “free” and universal care at the point of service and they pay for their systems through diverse taxes. So in effect, copayments make patients pay twice for the same service.

Journalists need to understand the function of copayments and explain all the arguments, for and against. For example, they should know:

  • copayments don’t solve the economic problem of high medical costs because it is a short-term measure that only aims to decrease the patient’s access to the system
  • that bureaucratic spending would be higher than what they could collect in new revenues from copayments
  • there are more effective measures such as reducing expenditures for medicines or focus health services on chronic patients and their self-care

Lister argued for fully discussing these issues. “It is important for journalist to analyze, to question, to demand evidence, to check figures and to look for alternative views,” he said.

Copayments are not likely to be imposed in Spain. The government is against it and so is the opposition party. Ana Pastor, the health coordinator of the opposition party, recently said that copayments are “only a punishment for sick people.” Nevertheless, there are attempts to privatize health services, and this issue is not often discussed or debated in public. In some regions, such as Madrid, regional governments have been accused of constructing and equipping hospitals with public money, and then allow private companies to manage them, even though these companies have not invested in them.

To justify that strategy, as the Anti-Healthcare Privatization Coordinating Platform of Madrid complains, is a health policy aimed at deteriorating the public system to justify its later privatization. The Platform argues they do this by cutting funds (making hospitals unable to cope with population growth) and reducing health staff. In addition, people are referred to private health care for the economically viable services, which has allowed a private sector to thrive off the public sector.

The way to accelerate privatization of medical centers consists of transferring to private management through a concession model. This model, implemented in 2007 in Madrid, introduces private management creating six public companies under the law. Using private mechanisms means the centers escape government regulation and control. These companies have their own funds and can accumulate debt and outsource health services considered cost-effective. This model failed in different European countries and the World Health Organization has recognized these have series drawbacks for both users and health professionals. But these drawbacks do not seem to be a problem for the government of Madrid.

Lister explained, “Governments and their advisers don’t want to draw attention to how controversial their policy is.” Government continues to maintain that private management is more efficient and competitive. But, continuing with Lister’s arguments, it is not true that competition always improves social markets and “we need evidence that it is going to have better value and to cost less.”

This matter is not unique to Spain. As Lister showed in his book, “Europe’s Health for Sale,” presented at the conference, many other countries – the United Kingdom, Germany, Greece and Turkey – are suffering from similar troubles. Health reform is unavoidable but there are many different ways to face it, and not all benefit citizens equally. Because of that, the challenge to health editors is, as Lister excellently summarized, “to address potentially complex and even sometimes obscure arguments, offering backgrounders, identifying key issues missing from a statement or potential changes has not flagged up and showing the opinion from group interests.” That is, “to report it with the same rigor as medical research.”

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