CONFUSION WITH THE NEW HEALTH ROYAL DECREE

Concern, skepticism and confusion. Those are the adjectives to the views expressed by different doctors and groups before the implementation of health reform takes effect today. The decree, approved in April, willregulated differently communitiesAs have been announced in recent days. Health has been specifying some changes have altered the standard.

In the first reviews came the first modifications. Those over 26 who have never traded health card ran out. But this measure was reversed. Then he saidimmigrantsirregular, except pregnant and under 18 years were to be without health care centers and could only go to the emergency room.

Later also included as an exception to the group of immigrants who have a communicable disease that were already in treatment, not newly diagnosed. But yesterdayHealth turned to specify a new change.

"All citizens will be served. Changes will in rights awareness. Guests who do not card, being irregular, you receive a bill from your community. Thatbillshall be paid by private insurance (if the person has), for the country (if any agreements with Spain) or by the immigrant.If no resources, just be archived. When the citizens back to work, it will pass the bill. But all will be seen in the health center or wherever, "says Manuel Cervera, Popular Party spokesman in the Health Commission of the Congress of Deputies.

No Information

But this measure, the health care to all citizens,is novel. Doctors consulted by ELMUNDO.es yesterday had the information provided by the community in which he spoke of the people who would not be treated in health centers and would be filtered by each outpatient administrative.

"We had no instructions until Thursday, when the minister [of Valencia] said it will be the administrative to filter out people who are going to be treated by the doctor and not, but what will happen in thepeople, Where people go straight to the doctor?, Would you touch him he can not decide anything, as our profession requires us to meet everyone? "Asked Jose Luis Llisterri Taro, a family physician and president of the Spanish Society of Primary Care Physicians (Semergen.) However, this specialistwas not awarethe final twist.

Although Health Ministry sources said on Thursday that illegal immigrants would only be servedon urgencies, PP spokesman Health Commission clarified a day after this newspaper that he wouldfurther attention in health centers, Yes with the bill timely.

These last minute changes have generated much criticism among doctors who feel lost and of course among immigrants. "In any process of change and modification, and more in one like this so ambitious and complicated, thereadaptations. In addition, the ongoing dialogue shaping makes us go to an attempt to make management more efficient. It is a dynamic process and filing are situations that may arise in the future, "says Cervera.

Perhaps these changes come from the pressure derivatives of the many criticisms and objections that the decree has received. One has been driven by the MDM campaign launched a week ago, 'right to cure', and with which they have collected almost14,000 signatures in support of conscientious objectiondoctors had claimed. "As physicians, our obligation and duty is to heal. I can not deny assistance to a person. If this campaign has served to make people think about the removal of a right, I feel great, "says Rafael Sotoca, president of the NGO in the Valencian Community.

Change Model

This doctor criticizes not only the exclusion of illegal immigrants but other aspects of the decree. "We found nothing positive in this reform. Had a good model, where the Public Health looked at based on citizenship, was guarantor because you can modify the range of citizens. Now yes, now theassurance model, And the policy itself will be removed. "

The statement does not concern paragraph Sotoca first chapter I of the new decree which says: "Health care in Spain, under backgrounds public through the National Health System, will ensure those persons who have the status of insured ".

What does this point? "Now refers to theirregular immigrants, But opens the door to a future other groups are excluded from health care. We suspect that this will be the beginning of the demise of the public health, "said Gabriel del Pozo, deputy secretary general of the Association of Doctors and Graduates of Madrid (AMYTS).

For Cervera, model change "is the criticism less realistic and more distorted.'s National Health Systemuniversal. Now more than ever, because there had groups that were not recognized, as could be the architects, and now they are. It is a system that covers and protects the Spanish. But we start from a forgotten fact is that the ACs had no ability to efficiently manage the Health, there was a hole16,000 million euros, And not paid to suppliers. We have given new tools to balance the ratio betwand income and expenses "he says.

For this reason, was introduced pharmaceutical copayment or wanted to regularize the ownership of health cards. To avoid having people using the health of other EU countries with a Spanish card outdated and then pass the bill to our country. "We had to bring order and regulate a situation that was not controlled," say from the Ministry.

Other savings measures

But Sotoca wonder why not more emphasis on other measures. "Think ofOther strategies perhaps more complicated but more effectivelong term. Because nobody has done anything about medical technology spending. No one has evaluated what is efficient and what is not. We are putting intelligence on the side that does not touch, and we forget, or obvious,programs to improve resource efficiency. Sure, in the short term, these programs give less visibility but eventually are most ensure the sustainability of the system. "

Tranche Salvador, secretary of the Spanish Society of Family and Community Medicine (SemFYC), believes that "there are still many health professionals who have not realized the implications of this decree. If the decree is effective as Saturday is nowthe answer will be growing protest, "He said a day before the last change in the care of immigrants." It is true that medical tourism, which is something very different from their use irregular immigrants health, had to kill it. But this decree will be applied differently in each community and that is aabsurdity".

The family doctor also considers the model of system changes with the decree. "It happens to be acoverageuniversal insurance an issue. We will see in the future what happens if you do not work. If tomorrow they decide that they are cared for elderly orother patients, what? "asks. thing that the Ministry of Health refuses flatly:" the system now is more universal than before. "