Summary of Situación de la atención primaria en España

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00:00:00 - 01:00:00

The video discusses the current state of primary care in Spain, noting the lack of investment in the system and the consequent decline in quality of care. It explains that this is due in part to the fact that primary care is not considered to be as important as specialized care, and that the number of people accessing primary care has remained unchanged for the past few years. The video also points out that if primary care were to catch up to specialized care, it would require a larger investment in personnel.

00:00:00 The video discusses the situation of primary care in Spain, and how the dialogue continued yesterday, 8 November, with the dialogue about the lack of doctors as claimed in the video. They also discussed the issue of head doctors and how there are not enough in the country, and they tackled the issue well. Juan Simón and Beatriz González López de Valcárcel are the presenters of the session on exceptional doctors, which will also take place this afternoon. They will be discussing the current situation of primary care, which is a topic that is still very much in the news, and which is interesting and often mishandled. They will try to address the causes of the problem and offer a good diagnosis and treatment plan. This is what they will aim to achieve this afternoon in the dialogue with the intervention of Juan Simón, a family doctor who you may know, and Beatriz González López de Valcárcel, a professor of economics at the University of Las Palmas and a specialist in health and social demographic studies. They have asked us to help them start this dialogue on the current situation of primary care, and then we will open the mic for questions later. Thank you to everyone for being here. Juan starts
00:05:00 Spain's primary health care system is in disarray, with many doctors opting to work in hospitals rather than work in primary care. This video discusses the situation and presents different perspectives. One main point is that the system is in disarray because of a lack of investment in primary care, which is caused in part by a fear of the "causal factor" – the presence of illness. This is a component of the "causal pathway," which includes the "causative component" (the presence of disease) and the "susceptible component" (the health of the patients). The third component is the "effective component" (the ability to treat patients). However, Spain's primary health care system is not only in disarray, it is also in decline. This is likely due to the lack of a causal factor (investment in primary care), as well as a consequent lack of the "effective component."
00:10:00 The video discusses the situation of primary care in Spain, focusing on the fact that the system has evolved over the past few decades. The main points are that the law on basic health structures was passed in 1984, the beginning of Spain's Reform Period; that in 1986, a real decreet on health system reform introduced the National Health System (SIS); and that from 1990 onward, the system is considered to be universal. Between 1982 and 1990, 7 million residents were added to the public health system. This period is important to keep in mind because it marks the transition from private to public health care. In the meantime, more than 7 million people entered the public health system during the period 1990-2000, making it the largest period of growth in Spain's health care system. The main problem is that Spain has a majority private system that takes on high-risk patients and acts as a collector of bad risks for the other systems. The other systems are primarily provided through private insurance, with primary care closed to the public but open to private patients when convenient. The dualization of Spain's health system is structural and not temporary. It began in the 1970s and has had a negative impact on the quality of primary care. As a result, more
00:15:00 The video discusses the situation of primary care in Spain, highlighting the decreasing budgets allocated to it and the consequent increase in specialized care. It explains that while the overall spending on primary care has increased, the percentage increase has not kept up with the growth in specialized care. This is partly due to the fact that more money has been allocated to specialized care rather than primary care, which has been decreasing in importance. The video also points out that the number of people accessing primary care has remained unchanged for the past few years, and that if primary care were to catch up to specialized care, it would require a larger investment in personnel.
00:20:00 The video discusses the Spanish health system's struggles with providing adequate care for its citizens. The main points are that Spain has a bipolar health spending pattern, with expenditures going up and down, and that primary care is very weak in comparison to hospitals and the need for inverted care. This has led to a situation where the health system cannot effectively counteract the law of inverse care or the effects of over-use of medicine. In times of pandemics, the health system is even less able to cope. The system has a problem with equity, not incapacity. The main issue is that the health system is not able to provide effective and universal care. We began to have a problem with excessive medical treatment a few decades ago, and it has only gotten worse in recent years. Today, medicine of excess is more prevalent than ever and there is a growing trend of fragmented care with units for everything. Our public health today is little more than a replica of what it was in the 1970s. The video discusses Spain's struggle with providing adequate primary care. It notes that over the past few years, due to the recession, the number of primary care clinics has decreased. The video also mentions that the number of specialist consultations has increased, as has the number of consultations
00:25:00 The video discusses the situation of primary care in Spain, and how the rotte, an old man, describes it in this cartoon. In it, the doctor tells the patient that they have caught the disease in time, or he would have been at home already. The disease is just another illness, and it is difficult to explain what is happening. This Nice director says that as close as you are to the hospital, the better the chances are of having surgery. It takes three months for a neurosurgeon who has retired to learn how to do an operation. It takes three years to learn when to do it and 30 years to know when not to do it. And this recent article by Juan, a good doctor, is even harder to understand because it is easier to learn to do than not to do something. What politicians could do to improve primary care I hope Beatriz shows up in this, but I will say four things to start. They could incentivize outpatient care by making it more available during the daytime when they say to make it more incentive is to put pasta on the table for people when they're in the office. They could make telephone accessibility more available during office hours. They could incentivize notable increase in the number of patients seen by general physicians
00:30:00 The video discusses the situation of primary care in Spain, highlighting that most educated Spaniards are not familiar with the concept of mutualism. It goes on to discuss how unions of government officials are a form of mutualism, as they are supposed to protect the interests of their members. This is no longer the norm, as government employees now seem to be more interested in following the opinions of unions like UGT (Unified General Workers' Union) and COMisiones (Committees of the Spanish Socialist Workers' Party). Even when they are against a particular union's protest banner, they will still defend public health when it comes to the sale of health services. This Manifesto was published in 2001 and was signed by the CEO of BBVA (Banco Bilbao Vizcaya Argentaria), Carlos Ríos. It states that the survival of the cooperative health services provided by santías colaboradoras (collaborative health services providers) is at risk. This document was published in 2001, long before the current health care crisis. Since that time, those who are not government employees have lost all access to public health care. The article goes on to state that the majority of Spanish parliamentarians are civil servants, and that they are not dedicated
00:35:00 The video discusses Spain's healthcare system, noting that only 5% of the population are members of mutual health care organizations, while 1% of these substitutes are mutual aid societies. The three Spanish parliaments have played a major role in the current state of Spain's healthcare system. In some cases, the 35% of mutual health care organizations in Spain, which substitute for 75% of the total number of mutual societies, have an even higher membership rate. The reason for this is that politicians use healthcare to appear relevant to those who say they represent the people. I read this when I saw the headline "Powerful military protesting cuts, not defending system, in letter to defense secretary". I said to myself, "Wow, this is someone protesting about cuts in health care while they're in power, not protesting the cuts on islands". This is what I read in the article. I'm not a military man, so I don't defend the healthcare system. I protest the cuts that are happening. But I wasn't protesting the cuts in health care when I wrote the letter. I was protesting the cuts in social services. Health care spending in Spain is 18% higher than it was before the pandemic. After the pandemic, it's still growing.
00:40:00 In Spain, the primary care situation is clearly not ideal. Here, we have a clear case of dislocation due to a symptom that concerns the patient, but which is neither urgent nor grave. It is typical symptom of primary care attention, predominantly brutal. Private health insurance is overwhelmingly predominant, with the majority of patients seeing their doctor through private health insurance. And here is a selection of risks associated with primary care: although a complex and frustrating thing, I am not going to go to the public hospital. Well, and in regard to surgery for example, hernia of the vesical bladder – which a few years ago there was no doubt that surgery should be carried out in the public sector – is now starting to be covered by private health insurance. What this means is that, behind primary care, there is a system in disarray. This is the principle of the dislocated social structure of the hospital. Health care spending as a whole has increased by 70% over the last three decades, with 30% of this coming from private health insurance. This is represented by the green bar over here. But when we look at the distribution of health care spending, the private health insurance of doctors is gradually becoming more complementary and less substitutive of the
00:45:00 The video discusses the situation of primary care in Spain, discussing the fact that 17 million euros will be spent on private medical insurance for bank employees for four years, with the contract not usually including current workers and retirees as well. There is also the possibility of insuring family members with public health insurance, but the bank is also responsible for paying for their private medical insurance. National Services workers don't realize what a system like this would be like in the United States, where many people would like to make an homage to it but don't because it would be too easy. The institutional deterioration is chronic and similar to corruption, with social convenient being attractive only for those who have individual brilliance. This quote from the video is the main point: "Situación de la atención primaria en España." The low budget doesn't reduce the amount of money that is spent on private medical insurance, but the way the budget is handled does. The deterioration of institutional structures leads to Robin Hood in reverse, with the rich taking advantage of the weak. This is what happens when the budget is mishandled- the health system deteriorates. I'll ask you again: where does the poor budget hurt? It hurts the health system.
00:50:00 The video discusses the current situation in Spain with regard to the pandemic, which has caused private health insurance to decline in recent years. Paul McCartney, who died recently in London, was a vocal opponent of private health insurance. Enrique Peñalosa, an alcalde in Spain for 8 years, said that an advanced activity is one in which the poor use public transportation, not one in which the rich use private transportation. Sociológically, the health system has always been characterized by a lack of coordination between public and private hospitals, as well as financial and political power being concentrated in the hands of those in the upper classes. The video also discusses the role of citizens in choosing the second tier of health care, and the importance of primary care in the overall health of a population. There is overwhelming evidence that a system based on primary care is more effective and cheaper than systems based on private health insurance, and it is this system that Spain should strive to return to.
00:55:00 Spain has a clear longitudinality in its healthcare system, which is its main value. This is the value of knowing your doctor for over 30 years and having access to additional information about your environment, community, family, and health history. Five minutes of consultation with a doctor provides this additional information. This is important because it helps to achieve better health outcomes at a lower cost, and provides a more responsive primary care system that prevents illness. The article mentions that the US also has a long history of longitudinality in its healthcare system. The main problem with Spain's healthcare system is that it is not able to use its strengths in a responsive way. This is due to external factors such as political power and powerful economic interests that place obstacles in the system's ability to achieve resolution. However, the most significant issue is the lack of good working relationships between doctors and their patients, which is called "cryptolity." This is a bad news story because it indicates that Spain's healthcare system will be unable to cope with the increase in the elderly population in the next 15 years.

01:00:00 - 02:00:00

In the video, "Situación de la atención primaria en España", doctors Juan Simón and Mercedes Castilla discuss the current state of primary care in Spain. They point out that the Spanish government has recently made changes to the law that include the inclusion of olgapanet, a website run by the government, within the law. However, they believe that more needs to be done in order to improve the system, including the elimination of mutual insurance and the introduction of independent professional health care. Paco, a patient's doctor, shares his thoughts on the difficulty of getting medical attention in Spain, and Mónica García, a young healthcare professional, offers her thoughts on the issue.

01:00:00 In this video, we see that primary care is the "Superman" of healthcare, but with some Kryptonite. If you're looking for a superhero who can do it all, you're out of luck. Primary care physicians have to have a lot of longitudinal knowledge in order to be effective. This is in addition to the value of the one-on-one relationship you develop with your patients. If you're forced to see another doctor because your primary care physician is out of the office, that value is lost. Secondarily, primary care physicians also have problems that can be attributed to external or internal factors. For example, primary care physicians are aging and this is affecting their productivity. In Denmark, where primary care physicians are organized into groups that work autonomously, there is greater continuity of care. Primary care physicians in Spain are also aging and this is causing a shortage of practitioners. To make matters worse, many young physicians are not choosing primary care as their career specialty. If primary care physicians were paid fairly for their services, and if the system were financially sustainable, this problem would be resolved. Doctors in primary care also have to deal with rotations, which can be a challenge when you're working with patients who are regulars
01:05:00 The video discusses Spain's system for primary care, which is revised every two years to see how the system is performing in different conditions. With what hours, with what dedication, and especially how they will pay for services with a mixture of payment for act and payment for service, this is the main difference between Spain and Denmark. Spain falls behind Denmark in terms of how often its doctors visit their family doctor in a year, with 6.17 trips compared to 6.9 in Denmark. In terms of opening hours of the primary care center, 5.69 trips are made in the doctor's regular working hours and 048 emergency visits are made in primary care, for a total of 5.69 trips per doctor per year. In terms of primary care centers, almost half of Spain's family doctors have a number of cards assigned between 1000 and 1500. Another 36% have cards assigned between 1,500 and 2000. This means that, on average, Spain's doctors are somewhere in the Danish numbers. However, Movistar, Spain's largest telecommunications company, has announced that it is introducing a new health insurance product, called "Seguro de Atención Primaria a distancia" (Primary Care Distance Insurance), which is available for purchase online. This product
01:10:00 The video discusses the situation of primary care in Spain, and points out that while there is a crisis within the profession of choosing a doctor, it is actually Medicine of Families, not Pediatrics, Nurse Practitioners, or Emergency Medicine that are at risk. The video also discusses the various specialties that are in the top 400 most valued by the median voter, and Enfermería Familiar y Comunitaria is third.
01:15:00 The situation in primary care in Spain is Professionalism and this implies autonomy, but autonomy implies shared responsibility. This means that taking on risks is not possible and can't be said to look up and say "Oh, they treat me better than they make me work less, I'll just take it." The responsibility to assume risks means accepting responsibility for one's work. This is what Danish doctors working in primary care are able to do, as they are highly respected and earn a lot of money. They also have a great work-life satisfaction and have a personal satisfaction. However, Danish doctors also have a notable labor-management relationship because they are autonomous professionals. The Netherlands, Denmark's biggest competitor in terms of satisfaction, began its primary care project with only a few teams, and now has 10,000 nurses working in this network. This success has been spread throughout the world, and new MBA programs in healthcare are starting to take note. It is essential that new professions in primary care be allocated tasks logically, as nursing has a huge impact on primary care. Primary care, in fact, has a greater impact on 2021 than any other area of healthcare. What I see as the most significant changes in numbers is that the Siae's system for information on primary care has
01:20:00 The video discusses Spain's healthcare system, focusing on the low number of consultations patients receive and the lack of value placed on patient experience. It highlights the importance of measuring the value of healthcare with the number of patients seen, rather than simply measuring activity or number of procedures performed. Spain's healthcare system is struggling with bureaucracy and outdated practices, and there is a need for reform in order to improve patient care.
01:25:00 This video discusses the current situation of primary care in Spain, where there are a lack of specialized care and very radical or relative policies that are signals, for example, it is very important that there be family medicine chairs in universities and that study plans in universities have family medicine, unfortunately it does not seem that we are going in that direction. According to what I know of the current plans for competitive research projects where participation in primary care is minority, there would be a positive discrimination need to make just as women do with positive discrimination, because there are also Oye para evitar que sigamos con el 9010 vamos a hacer una convocatoria en la que haya que tener un tienes puntos Plus por por tener implicados investigadores de primaria o incluso que haya que tener un que tengan que tener un componente de atención primaria o por ejemplo señales claras de Mercado simplemente el pagar más a los médicos de atención primaria esto sería una señal potentísima porque de al
01:30:00 Spain's primary healthcare system seems to be focused on primary care, but this is not the case for all patients. It seems that some are saying that the primary care system is actually doing quite well, while others are saying that it is a problem that the health care system is focused on family medicine instead of the public health aspect. The unions for the medical professionals are claiming that the problem is with the public health system, and they are forgetting about the beginning, which is family medicine. This is a reivindication of all of the public health system, and it ends up being a plea for the medical profession to be taken more seriously. I have found that the discussion on economics in the video is very limited. There are several different cycles in health care, and the temporality of these cycles could vary depending on the speed of these cycles. These changes in health health care are clearly over 20 years old, and we are in the peak of health care that could be considered good. If we were at the peak of good health care, we would have needed to take care of these people within the last 15-20 years. However, because there are still too many professionals in the health care system, we have a remaning population that is being used up
01:35:00 In Spain, there is a crisis in the primary care system, with some administratives refusing to say that it is a system that needs to be fought for. There is also a more concrete issue, with doctors in family medicine and obstetrics having to be excellent professional clinicians, and be able to solve problems and provide care that meets patients' needs. I am optimistic and always optimistic, but when we agree to protest and say that this is a mess, and that we'll leave, there's never anything that we can do. Many thanks, I don't know if you wanted to intervene Beatriz or Juan, but if not, Josep Maria might be able to speak. Luis Palomo has lost his voice. My problem is that tomorrow I have a meeting with the service in Extremadura to present their improvement plan for primary care. I would like to bring some positive and stimulating idea that would allow primary care to improve. Unless there are legal, structural, and labor reforms, primary care will never improve. I think these two issues are key, and that we need to deal with them legislatively and structurally. Josep Maria, please take the floor.
01:40:00 Juan Simón and Mercedes Castilla, both Spanish doctors, discuss the current state of primary care in Spain. Simón points out that the Spanish government has recently made changes to the law that include the inclusion of olgapanet, a website run by the government, within the law. Luis Simón, who has not made any changes to the law, is still being paid more if specialists from hospitals resolve cases within a single visit. Beatriz Martínez, a Danish doctor, is credited with proposing a reform in 1989 that was ultimately rejected. The two doctors propose a number of specific changes to the current state of primary care in Spain, including the elimination of mutual insurance and the introduction of independent professional health care.
01:45:00 Paco, a patient's doctor, discusses the difficulty of getting medical attention in Spain. He explains that the system is designed to be patient-centered, but that doctors are often overworked and underpaid. He also points out the importance of involving the public in the design of health care services to reduce overmedicalization.
01:50:00 The video discusses the situation of primary care in Spain, noting that because of the country's hurried pace, people are generally pleased with any initiative that takes away work. However, at the end, the content is gradually being drained away, leaving patients with nothing to offer. The video points out that, despite the author's efforts, there is still little quality content to be found on Spanish YouTube. To that end, the author asks the audience to consider the aportions made by Paco in particular. The author then poses a question for Juan: should incentives be implemented in relation to the law of inverse care? Juan believes that one incentive could be to locate patients who have never used health services in private clinics. The author concludes by saying that it is important to promote primary care by training doctors at the university level as well as by providing support to community-based organizations that can filter patients who are appropriate for care. In addition, the author stresses the need for medical professionals to have a sense of detachment from patients.
01:55:00 The video discusses the situation of primary healthcare in Spain, focusing on the cleaning or auxiliary nurse's job. It then asks viewers to consider how they can help improve primary healthcare themselves. It mentions that there is a need for leadership and teamwork in this field, and that institutional support is necessary in order to overcome bureaucratic obstacles. Mónica García, a young healthcare professional, shares her thoughts on the issue. Finally, Beatriz Juan, a doctor, offers his thoughts on the importance of institutional support.

02:00:00 - 02:00:00

In this video, Beatriz Domínguez, a Spanish healthcare consultant, discusses the state of primary care in Spain. She is concerned that the current hospital model of care is not effective, and that many people have addiction issues due to drug abuse. Domínguez believes that the Spanish healthcare system needs to change to an model in which patients are directly involved in their own care, and that this can be accomplished by replacing current Público funcionarial (government employee) model with a system in which healthcare professionals are self-employed and able to choose their own employers.