One of the questions that arise when listening to the Government of Juan Manuel Moreno Bonilla (PP) to grandly sell the, in effect, millionaire budgets for health is the following: How with increasingly higher budgets does the deterioration of Andalusian health continue, which has once again led thousands of people to defend it in the streets this weekend?
Several points of analysis have been extracted from the work carried out by the tides that work in the defense of public health and that have launched a Popular Legislative Initiative (ILP), which contribute to explaining and understanding the situation: the system needs more funds, end outsourcing to the private sector and return to a 100% public system.
On the one hand, the system suffers from underfinancing that comes from the decade between 2010 and 2020, after the fall of Lehman Brothers, which led to cuts from which it has not yet recovered.
In the ILP, a shock plan is included that responds to the following approach: “The public system presents [en Andalucía] a accumulated deterioration situation of the quality of care and personnel deficit in public health services”.
The underfinancing is estimated by the tides at a “cumulative amount of 19,000 million euros due to the cuts made in successive budgets.” So they demand, as stated in the second additional provision of the ILP, from the Andalusian Government “a Shock Plan for said amount, prorated in the five successive budgets, with the exclusive purpose of recovering and strengthening the public health systemspecifically to the increase in staff and public health infrastructure”.
The health budget that has been written into the law Moreno Bonilla’s cabinet for 2025 amounts to 15,247 million euros. What the tides ask for would mean an increase on that figure of 3.8 billion each year, considerable amounts, very difficult to access, around 24% more.
How do the tides arrive at this figure of 19,000 million? They put inflation into the equation. This is how they explain it: “In the period 2010-2020, the cuts made in the Andalusian Public Health System reached the amount of 19,000 million, estimated as the sum of the annual differences between the 2009 budget adjusted by the CPI —inflation— corresponding to each year and the actual budget for that year. Taking into account that the budget in 2009 was 10,275 million, the cuts in the following decade represent the loss of almost two years.”
“The effects of these cuts were enormous: loss of staff (nine thousand professionals), with increasing precariousness and temporary employment (a process that has not stopped), decrease in instrumental resources and care activities; These events have a consequent impact on citizens, who see a decline in the quality of the assistance received. These cuts have never been restored,” they state in a work entitled Reasons that advise the processing and approval by the Parliament of Andalusia of the bill presented by the Andalusian coordinator of white tidesto which you have had access Public.
The effect of the pandemic
In addition to this underfinancing produced after the Lehman crisis, for the tides the second relevant external factor that has affected the current situation of Andalusian healthcare has been the covid-19 pandemic. “The solution to this serious situation —explained in the study—fell exclusively on the shoulders of a saturated Andalusian public health system and exhausted by the cuts.
“Despite the logical aid provided by the national government, The pandemic showed the deterioration achieved by the Andalusian systemplacing it at various times on the brink of collapse,” they analyze.
“This caused,” the work adds, “that Waiting lists for non-covid pathologies will worsen even moreleading to the establishment of care methods of dubious clinical validity, such as the generalization of telephone clinical consultations or so-called reception consultations”.
“Once the pandemic is over, these measures continue to be maintained and even have spread and worsened with the current increase in privatizationwhich has consolidated the chronic and progressive deterioration of the system,” the document reads.
Privatizations and the PP Government
In this study, the tides argue that 100% public healthcare is the “most beneficial for the population”. They point out that the system today is not universal – “it is known that there are still systems of exclusion of migrants” – nor is it equitable: “The fact of living in rural areas in Andalusia marks enormous differences in accessibility, transfers and waiting times “.
For the tides it is important to note that they also There are also ideological factors in the equation which, in his opinion, aggravate the problems: “Although some of the essential problems that affect Andalusian public health currently come, as has already been pointed out, from previous governments, the situation has worsened substantially since 2019date on which the Andalusian government has passed into the hands of right-wing parties, clear defenders of neoliberal ideology.”
The tides apply their calculation criteria and consider that the 2023 and 2024 budgets, prepared by the PP cabinets, are insufficient to improve the system: “It is not true that the budget has increased. The budgets for 2023, 13,823 million, and 2024, 14,294 million, are in the range of 2009 plus the adjustments due to the variation in the CPI“.
For the tides, these accounts therefore “do not include any refund of the cuts of the previous decade.” Furthermore, they point out, “They do not take into account that the number of Andalusians over 64 years of age (those who consume the most health resources) has increased since 2009 at 377,626, reaching the figure of 1,602,301 in 2023 (INE).
And then they add: “The problem is not only the small amount of the budget, but also how it is used: increase in public funds derived from the private sectorwhich do not apply to public centers”.
For Mares, “the continuous, unresolved deterioration of public health since its arrival in 2019 has led to a clear increase in the number of people with private health insurance.”
At the same time, the transfer of public funds to the private sector has increased. “The official data is clear. “The Andalusian public system’s spending on concerts with private medicine centers has increased significantly.”
The tides give more examples of this privatization: “The suppression of spending control measures from the system for purchasing health products from the private sector has increased its benefits; a clear example is spending on pharmacies [tras] eliminate the auction of drugs and other control methods.
“Another clear fact,” the tides ask, “is the tendency of the Ministry of Health of the Regional Government of Andalusia to appoint executives from private medicine centers as top-ranking officials. What are the criteria for designating these people as public officials?”
This “privatizing intention” is also demonstrated, for the tides, in other “complementary measures designed by the current government, such as: eliminate the exclusivity of the public health professional; eliminate the public/private incompatibility of intermediate health positions; promote the education of health workers in universities and private vocational training centers, and introduce private companies to the boards of the R&D foundations of public hospitals.”
The conclusion of the tides is: “There is a clear neoliberal political intention on the part of the current Andalusian governmentwhich manifests itself in not resolving the Andalusian health situation, as demonstrated by the failure to correct the existing deterioration, and in the increasing diversion of public funds to the private sectorwhich increases the difficulties of public centers in fulfilling their mission.
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