Lessons from Spain: Covid-19 exposed the inefficiency of a National Health Service

07 May 2020
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Spain's handling of the current pandemic of Covid-19 has been one of the worst. Several factors led to this tragic situation and, according to the National Government sources, more than twenty thousand lives being lost. Why?

  1. Spain chose to follow the example of communist China in dealing with the coronavirus crisis instead of the free Republic of China, Taiwan. When the crisis started, instead of applying the universal access to private healthcare system for all Spaniards, the Spanish Government decided to force everyone to go to State-run healthcare services – National Healthcare System (NHS). Later, when the State healthcare system collapsed and the deaths started to pile up, they had no choice but to allow the Private Health System to intervene and help the NHS.

  2. The State reacted late. It failed to obtain the necessary provisions for the NHS through the autonomous regional governments. The State authorities hid from the population the real danger of contagion. It even encouraged people to follow their usual routine, authorizing concerts, political events, soccer competitions and 100 rallies of hundreds of thousands of participants to celebrate the communist 8 March International Day of Women. The Government did all this although they were aware of the danger’s weeks before because several regional Healthcare Authorities had taken part in a task force at European Union level to create the protocol response for COVID 19. The Government refuses to register all the deaths reported during those first weeks by the regional governments because the number of dead would swell by tens of thousands.

  3. The Spanish Government worsened the coronavirus crisis by not allowing, from the beginning, the Private Healthcare System (PHS) to fight the virus along with the NHS. Moreover, in Spain, private labs were not allowed to carry out tests and everything had to be sanctioned by the unique centralised authority. This delayed and created more bureaucracy preventing a fast and dynamic response to the crisis.

  4. Spanish authorities chose to declare a State of Emergency. With that excuse, they put all healthcare services under one command at the central level, blocking the autonomy of hospitals and clinics to react speedily to the pandemic. This resulted in a massive expropriation of medical supplies from national production and from imported stock from international suppliers. There were long delays in the distribution of masks, protection suits, alcohol, and anti-viral medicines causing many health workers to become infected. Today more than 34,000 professionals in the healthcare sector are infected.

  5. The Government chose to battle alone, separate from the private sector. In the following weeks though we witnessed how the private sector solidarity and actions saved the day when the State failed to cope, again and again. Companies like Inditex, owners of the Zara clothes chain, offered their Asia hub to the Government to help. They imported and distributed millions of high-quality masks and protection equipment free of charge. But, the socialist Pedro Sánchez and the communist Vice-Prime Minister Pablo Iglesias, refused to use their help and chose to pay tens of thousands of euros to obscure intermediaries – even those with companies which had been investigated in the past for fraud. The Government was fooled by Chinese producers. Over a hundred million Covid-19 tests and masks had to be returned by the hospitals leaving more health professionals not properly protected and open to infection by the Covid-19.
The current pandemic opens an important matter to worldwide public debate. The defenders of big government rush to push for reforms to nationalise essential services such as healthcare. In response, those of us who value freedom must be blunt and tell the people the truth. A welfare State is non-welfare for the people. Spain is a very clear example of what should not be emulated in the fight to conquer the Covid-19 pandemic, or in any other strategy to safeguard health in normal times.

Spain's NHS is not the example South Africa, or any other country, should follow. If you value your life and health, and if your government values the health of their people, do not copy Spain.

Nimi Hoffmann couldn't be more wrong when she advocates that South Africa should seize the current crisis to nationalise healthcare. This is my response to her letter and I really hope that South Africans learn from the Spaniards' mistakes and ask for an independent healthcare service, away from a politicised management and more based on what Jasson Urbach from the Free Market Foundation proposes for South Africa.

Before the Covid-19 crisis, we were repeatedly taught in schools, by mass media or in political debates that Spain had one of the best NHS' in the world. The reality tells us a different story. One doesn't have to be Einstein to realise that. By applying common sense, one realises the best healthcare is an independent service, separate from Government management.

Spain is in the top 25 countries where Government spending for State run healthcare represents 6.24% of the GDP. During the 2008 world financial crisis, out of the National Budget, spending allocated to the NHS increased to more than 15%. Despite this increase, however, the services are inflexible, very expensive in comparison with the same treatment in the Private Healthcare System, and, above all, are mediocre.

If you think of asking the State to run your health, think carefully. To ensure universal healthcare access, you don't need the State to actually run the services. The State always spends more, wasting resources without delivering better results. Spain is proof of this. The increase in Government spending year after year for the NHS should’ve resulted in better facilities and a personalized attention to patients and their families, like we enjoy in the PHS network. But it didn't.

Almost 50% of public healthcare spending goes directly to salaries for the workers of the NHS, and the rest, in many cases, subsidises pharmaceutical products that only State doctors can prescribe to patients. This leads to inflated medical and general supplies prices. This has become more obvious in the Covid-19 crisis, but it wasn't something new.

In Spain, there is a double standard. Around two million individuals among politicians, Union leaders and more than 80% of public servants choose the private healthcare service (PHS). Civil servants have the freedom to choose to pay their Social Security contributions to access the NHS or to use their own private insurance and use the PHS. Over eight million people out of the total population of 47 million use the PHS through their private insurance. However, they pay twice because they are forced by the State to pay the NHS through taxes, a service they don't use, and then pay in addition for their private health services, which they prefer to use.

Why then do those in the Government who advocate forcing everyone to support the NHS, choose to use the PHS? Because they know that private-owned healthcare services are far better than the NHS. The PHS has a professional management rather than a political, ideological management that lacks sound criteria, which ensures the best quality at the best price.

In Spain, the waiting lists in the NHS numbers 671,494 patients and a waiting time of 115 days before you receive treatment. In the PHS, the waiting period is no more than 30 days. For the NHS, every Spaniard is forced by the State to pay 1,617 euros annually, even if they don't use the service. A good private insurance plan costs no more than 1,200 euros per year.

In any society, human relations are based on the idea of exchange. We exchange goods, services, and information in order to achieve what we want as individuals to make our lives better. The same principle applies when we acquire food, for instance, and the same goes for our health. Why is the Spanish PHS superior to the NHS? Because it serves the public’s interest. Patients receiving treatment are satisfied with the services received for the price they paid. And if they are not satisfied, they know they can always go elsewhere. But if you are stuck in one single State-run system, then you can't go anywhere. Instead of forcing everyone to use a clearly deficient State-run system, why not push reforms to guarantee the universal access of people to the best healthcare services provided by society, or the market?

Roxana Nicula is Chair of Fundalib, a Spanish libertarian think tank and free market grassroots entities incubator.

This article was first published on BizNews on 04 May 2020

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