In an economic downturn, two classic cost-reducing solutions come to mind in the healthcare services industry: reduce offerings (give fewer services) or control demand (limit access to healthcare or increase copayments). There are many more but these two are the most frequently used. Actually, budget cuts in the Spanish region of Catalonia fit in the first type: they will need fewer resources (both human and material) because their services offered will shrink.
It’s always controversial to cut healthcare services in Spain. Even talking about it leads to accusations of promoting total privatization, attacking the Welfare State and so on. But there is another way to cut services, drugs or technologies. It’s what Dr. Iñaki Gutierrez-Ibarluzea called ‘Evidenced-based disinvestment’ in an op-ed for Spain’s ‘Primary Care Journal’ (‘Revista de Atención Primaria’). It’s easy: just find out which services, technological means or drugs offer little or no benefit for patients’ health. In other words, stop financial support for anything inefficient.
Spanish regulation makes it possible to exclude some procedures from public system (tax funded) in the following cases:
a) If there is evidence of their lack of effectiveness or efficiency or if the risk-benefit balance is significantly disadvantageous.
b) It they lost their interest for the healthcare system due to new advances in technology or science, or if they haven’t fully proved their usefulness.
c) They no longer comply with current legislation.
Technolgy evaluation agencies play a key role in analyzing new treatments and healthcare tech and establishing which should no longer be supported in public system. But die-hard habits and widespread popularity among professionals are difficult to ignore. Nevertheless, and not matter what it takes, public healthcare systems have the obligation to get rid of anything useless or not efficient enough.
We may need to take a step forward, stop debating this issue and take action. We need to bring evidence to broad light and do something really innovative for a Government branch: remove anything that is not adding real value.
*This post was originally published in Spanish at Salud con cosas*
*This blog post was originally published at Diario Medico*