Welcome the public recognition of the need to reform our healthcare system. Welcome, in addition, the terms in which it was made, in terms of integrating the three subsystems to seek more efficiency in the use of resources. Nobody has raised nationalization, for example, a ghost that continues to stir to cause confusion. But we need to start giving a genuine public discussion about it.
Well, as I have argued for decades, the health reform that we need implies an arduous political agreement with citizen participation and, of course, all health actors, to reach a gradual negotiation (and not a magical and instantaneous consensus). But the issue should not be limited to a corporate showdown focused on resources (or, in plain terms, money).
Understand it well, private, economic and political interests are part of the problem and should be part of the negotiation. But the central axis should not pass through there, much less even precede an official proposal that still does not exist.
The heart of the matter, we regret to recall, is health. Efficient, timely and equitable access to health care for our people. And how to modify some issues of our particular healthcare structure, with its vices and virtues. It is not about modifying everything or imposing anything overnight.
A possible reform supposes the permanence of the three subsystems (public, private and social works) but with a greater articulation, which implies an advance in coordination and regulation (which in a very partial and defective way already exists), with the aim of enhance your resources. The general idea is mutual benefit, and not “zero sum” competition.
To give a simple example: if one sector has an underutilized tomograph and another sector has the professional trained to use it, both would benefit from its complementation. But above all, and this is the most important thing, the patients would benefit.
Of course, the change may imply the modification of certain prerogatives, but the final objective must always be the health care of the patient, and not the (valid) profit benefits of a company, the political representation of a union, or even the conditions work of doctors and other health professionals.
All of this is part, and must be taken into account. But the purpose is health, and neither is it understood as a vague, laudable final objective, but rather as the complex process of health production, which must be permanently incorporated into the design of the reform sought and the subsequent public policies.
Primary care, prevention, rehabilitation, medication, surgical interventions, hospitalization, medical specialties, and a long etcetera, where many times the issue does not go through the lack of resources, but through the correct efficient use of resources. resources that we already have, but scattered in a couple of lack and waste.
To be clear, we could take the argument to the extreme: without moving a single weight from its current place, many changes could be made in management, logistics, control, monitoring, and others that result in greater efficiency.
Or put the other way around: if resources were simply redistributed (and even increased) without modifying the healthcare structure, management strategy and work culture, the same problems would reproduce (and even get worse).
It should be striking that both the union leadership of the social works and the private sector businessmen go on the defensive, to demand money and defend their handling of the pandemic, while recognizing that the system must be reformed. Let’s talk about Public Health, then, not (only) about economics and politics.
Ignacio Katz is a doctor of Medicine (UBA)