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As part of a series of policies demanded by Brussels in order to reach the 5,8% of GDP deficit target in 2012, the recently elected Popular Party (PP) has announced cuts in education and health costs held by Autonomous Communities with the aim to save 10bn. Of that amount, the bulk will correspond to the health sector - approximately 6bn. Last week’s press release concentrated on changes aiming for "further rationalization and efficiency in the management of major public services that will be launched this month." The expected savings would represent nearly 10% of total health expenditures. The document also mentioned that the stability program will establish a firm commitment to "reduce the public deficit to 3% of GDP in 2013." Furthermore, it reaffirmed the commitment to reduce the deficit of the autonomous communities to 1.5% of GDP in 2012. In the coming days the Autonomous Communities, in coordination with the Treasury (Ministerio de Hacienda), will need to bring their accounts to the planned State Budget 2012 and upgrade their economic and financial plans to account for the new macroeconomic framework of the central government. In regards to health, it is yet to be defined how the money will be obtained taking into account the adjustments. For instance, in Catalonia, the formula of one euro per prescription has been approved although has not yet been implemented. To date, there has not been official communication about the measures that will be implemented but PP leaders and representatives of the government have already outlined some ideas. According to some analysts, it will be utterly difficult to reach the planned 6bn in savings if salaries are not affected, as they make up approximately 40% of the total health expenditure. Additionally, to make the plan feasible, the Minister of economy Luis de Guindos, suggested the possibility of making changes in the current co-payment system limiting the free access to public health services to those with an income of over 100,000 euros a year. However, this statement was later denied by Carlos Floriano, a high-ranking member of the PP. The incident betrayed the lack of coordination in the government. Eventually, the Minister of the Treasury, Cristóbal Montoro communicated on April 08, 2012 that within two weeks a reform “that is very likely to include payment based on income” would be concluded. The Minister of Health, Ana Mato, and the General Secretary of the PP Dolores de Cospedal, also supported a co-payment system based on income. The first discarded the possibility of expanding the Catalan option of one euro per prescription while the latter proposed that the State should stop financing the cheapest drugs. Other measures that are being studied to achieve the designated cuts are to regulate the so-called “health tourism”, i.e. to start charging domestic tourists, and the introduction of a unique health card with the intention of avoid duplicities in the realization of clinical trials. In spite of these announcements on health adjustments in the media, the vast majority of Spanish citizens are against cuts in public health. Even most of the voters of PP oppose them. Sources: El País, The Economist, La Vanguardia.
738 2011 7. only subject to the national framework prescribed by the Health Care General Act of 1986 and the Cohesion and Quality Act 2003. . respecting the floor limits agreed at national level.081 bn 9.201 bn 57. The regional funding scheme enables them to decide on the health budget for their territory. Source: Spain Health System review 2010. they have also increased their capacity for direct revenue raising through taxation”. Euro per receta “Tique moderador” Every person who has a medical card will have to pay one euro for each drug prescribed. Each regional government is responsible for. pg 59. Regional competences: Total devolution of health care “The completion of devolution in 2001 meant the complete transfer of health care responsibility from the central administration to the regional level Since then. and regulates.pd f The expenditure cut apply to the total initial budget.888 bn 59.Madrid (Community of) Catalonia Total 2010 7. purchaser and provider functions for their population. the insurer.msps.es/estadEstudios/estadisticas/inforRecopilaciones/docs/Recursos_Red_2011.408bn 2012 Source: http://www. each region has held primary jurisdiction for planning and organizing its own health system. regardless of their income.134 bn 9.