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  • Health Reform seeks to guarantee access to the same treatments in all Autonomous Communities with the legislative reform

  • Law repeal The Council of Ministers approves to prevent new co-payments and that public management prevails in health

The Council of Ministers has approved, in the second round, a bill that modifies several health regulations with the aspiration of plugging the holes that still remain in the universality of health and, according to the Government, eliminating co-payments and shielding itself from privatization of public health.

"It is a norm that is born from the fulfillment of the government program of progress and that will especially serve to expand rights and return them to citizens after previous governments that had taken them away," said Darias about the new law after the Council of Ministers held this Tuesday.

The first version of the future norm actually passed through the Council of Ministers in November last year and despite the new approval received this Tuesday, it will still need to pass the parliamentary process in Congress and the Senate, for which it may suffer significant changes through parliamentary amendments.

What rules will you change?

This draft seeks to introduce modifications in eight different standards:

- Law 14/1986, of April 25,

General Health.


- Law 50/1997, of November 27,

of the Government.


- Law 16/2003, of May 28,

on cohesion and quality of the National Health System.


- Royal Decree-Law 16/2012, of April 20,

on urgent measures to guarantee the sustainability of the National Health System and improve the quality and safety of its benefits.


- Consolidated text of the

Law on guarantees and rational use of medicines and health products, approved by Royal Legislative Decree 1/2015

, of July 24.


- Royal Decree 8/2008, of January 11,

which regulates the benefit due to necessity in favor of Spanish residents abroad and returnees.


- Royal Decree 1506/2012, of November 2,

which regulates the supplementary common portfolio of orthoprosthetic benefits of the National Health System and establishes the bases for the establishment of the maximum amounts of financing in orthoprosthetic benefits.


- Royal Decree 931/2017, of October 27

, which regulates the Regulatory Impact Analysis Report.

- Repeals, in particular, Law 15/1997, of April 25

, on the authorization of new management formulas for the National Health System;

articles 8 bis, 8 ter and 8 quater of Law 16/2003, of May 28, on the cohesion and quality of the National Health System and the second final provision of Royal Decree-Law 7/2018, of July 27, on universal access to the National Health System.

Holes in the universality of healthcare

The text aspires in theory, on the one hand, to cover the gaps that could still remain in the universality of the health system, guaranteeing the right to free public health care for Spaniards and their direct family members who reside abroad during their stays in Spain and certain groups that cannot prove their residence in Spain or have the right to healthcare by other means, as well as victims of human trafficking.

In addition to covering the holes in the universality of health that remained after the reform undertaken by the socialist government itself in the summer of 2018 to amend the exclusion of undocumented immigrants that the PP had decreed in 2012, the rule also aims to eliminate co-payments .

Specifically, the rule will eliminate co-payments for prosthetics and orthotics for vulnerable groups who are already exempt from pharmaceutical co-payments (recipients of the minimum vital income, pensioners with lower incomes, minors with recognized disabilities and people with low incomes due to dependent children), which means about 6 million people.

Copays and prices beyond drugs

Along with this elimination of prosthetics and orthotics co-payments, the idea of ​​a single common portfolio of healthcare services would be recovered, including not only healthcare and socio-health care but also urgent and non-urgent healthcare transport, orthotics and diet therapy products and trying to eliminate differences between regional benefits and to shield themselves from the establishment of new co-payments for these benefits.

This will also imply the preparation of a

common catalog of orthopedic, diet and accessory services with

maximum financing amounts and

final price.

In addition, according to the latest drafts of the standard, "personalized, predictive, preventive, participatory and population-based precision medicine" would be expressly included in the specialized services portfolio.

The

highlight of the future standard (and the most controversial)

lies, however, in the

direct management of public health

.

The President of the Government already launched this idea at the end of the electoral rally, announcing that the rule will shield "the equity, cohesion and universality of public health and that, therefore, it will not be privatized by any right-wing government in no autonomous community.

The small print of the legal formula that the Government has finally chosen for this

shield against privatization

is crucial to know the real implications that the norm will have.

In the initial draft of the law, the one seen by the Council of Ministers in November, there was hardly any real change with respect to the current legal situation.

Specifically,

a new article 47 was added to the General Health Law in

which it was detailed that health would be provided "preferably through the direct management formula of a public nature" but "the exceptional use of other management formulas" was allowed. previous "report that justifies the need to go to them from the social and economic health point of view".

After this draft of the new regulation, another more resounding text has been circulated which, according to what Darias explained in the press conference after the Council of Ministers, is the one that would have finally prospered.

In that text it was expressly stated that "

the management and administration of

the public structures and services that make up the

National Health System will be carried out directly" by

the administration, the entities among those that make up the institutional public sector and through the creation of consortiums by several public administrations.

It would only be allowed "in

an exceptional and justified manner and

whenever the direct provision of public services" is not possible to resort to concerts or other formulas covered by the

Public Sector Contracts Law or Law 40/2015 of Legal Regime of the Public Sector

, including health consortiums.

And to be able to resort to these concerts, it would be necessary to

previously justify an optimal use of public resources

, insufficient own resources and the need to resort to said formulas.

According to these latest drafts of the law, in addition, for equal quality and cost, non-profit entities will have priority in the provision of concerted healthcare.

And in the case of mutual societies, the text makes an exception, referring them to their current regulations.

In the absence of knowing what fine print the Executive has finally decided to keep this Tuesday

after the last reading in the Council of Ministers

, the private sector had already responded to Sánchez's words that ventured an armor against privatization.

"

It is urgent now to turn the page on the demagogic

and sectarian discourse that does not contribute and to see in the private sector an increasingly essential strategic ally to meet the needs of the population. It does not seem fair that, after the role that health has played during the pandemic, the same discourse is maintained as before", said the

IDIS Foundation

, which integrates the interests of the main private hospital groups and health insurers.

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  • Carolina Darias