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スペインの医療費削減で、保険料を払う人のみに無料健康保険を適用、保険料を払わない人は、病院などの緊急部門で対処
La salud para quien la cotiza
Desde los 80, España avanzó desde un modelo de seguro social a una sanidad como derecho
La reforma desanda ese camino con repercusiones en la cohesión social y la salud pública
Health for whom the listed
From the 80, Spain moved from a social insurance model to a health as a right
The reform retrace that path with implications for social cohesion and public health
ANALYSIS: 'the Past', by Joan Carles MARCH CERDÁ
Kings Corner / Elena G. Seville / Mary R. Sahuquillo 24 ABR 2012 - 21:39 CET
From the 80, Spain moved from a social insurance model to a health as a right
The reform retrace that path with implications for social cohesion and public health
ANALYSIS: 'the Past', by Joan Carles MARCH CERDÁ
Kings Corner / Elena G. Seville / Mary R. Sahuquillo 24 ABR 2012 - 21:39 CET
Public health was born in Spain as a social insurance linked to the worker's contribution. The model is transformed after the transition. From the 80, has been inching towards a different conception of health: not a consideration to what is quoted, but a universal civil right. From the Health Act 1986 to the Public Health Act 2011, all the steps have gone in this direction, even during the eight years of Aznar in the government. Separate accounts for some time healthcare from Social Security, are general taxes which support the provision. However, the reform package published Tuesday in the BOE retraces much of the way. The Government has changed the model and health again considered something to be earned. The patient is to be a citizen to "insured".
The Royal Decree on Urgent Measures to ensure sustainability of the NHS also speaks of healing "universal", but argues that this has been jeopardized by the mismanagement and inefficiency. However, the fact is that the system will eject some citizens who will lose their health umbrella. This applies, for example, illegal immigrants or students over 26 who have not yet agreed to their first job.
What has made the government back in the model is marked by the Law of Cohesion National Health System, 2003, he considered that "all Spanish and foreign country" are "entitled to the right" to health. A model underpinned by the Public Health Act 2011 which removed the regulatory limbo to people-some 300,000-who lacked health coverage to have exhausted unemployment benefits and have some sort of income. The road towards universal should have followed in June with the inclusion of those freelancers who would stop trading. The new law changes the rules. Ensure assistance to anyone who can prove "insured status". That or be almost in poverty, the other condition requiring the government to have a health card.
Experts warnthe measureleave uncoveredsome groups
For some experts this change goes back to the healthcare system to a model similar to insurance in force in the seventies and early eighties, before the approval of the General Health Act of 1986. The longer public health, universal and free for all citizens and becomes a single for insured health and welfare.
The Government denies it is left out of the system to any resident in Spain, Spanish or foreign. "It is true that there is universality," the CEO of Portfolio Services NHS and Pharmacy, Sagrario Perez. The director is hiding behind that reform has nothing to do with a change of model, but compliance with a ruling by the European Commission obliges Spain to hand over European health insurance card to all citizens entitled to assistance in Spain. It is the case exemplifies, that a German citizen with no right to health in the country comes to Spain, Registers to Vote, it is here and, in turn, continues to receive assistance, but under Spain. "That's what we want to avoid, we want to clarify who is entitled to assistance here to prevent anyone brew," he adds. The illegal immigrants and the Spanish who would remain outside the system, as it were, a side effect.
It is a change of draft, said Jose Ramon Repullo, health management expert and professor at the National School Health. "It changes the model. We went from a definition of citizenship to another typical insurance company, which takes into account the work environment, income ... "he says. In the "real health broom decree law", as defined by the new standard, "gets all the issues." Repullo critical amendments to various health laws, made without discussion or consensus, calling for an "emergency" in his opinion it is not. "If it was to exclude coverage could have been done specifically", he argues. "It is surprising and unwise. The logical thing is to discuss and process it through a bill, "he adds.
"It's a philosophical change but with real implications," says the PSOE
Ricard also Meneu, Foundation Health Economics, the royal decree is "regressive." "Gironazo be called [a reference to the Minister Falangist Girón], taking up a base in securing Social Security surpassed for many years. For almost two decades that Social Security does not provide funds to health care in an effort wrongly recentralizador "he says. Criticism also that the change will not cover some users. "The dreadful allegations of false demagogic exploitation of our generosity no secret that the only ones affected by these changes will be citizens of our country excluded from the insured status."
Marciano Sanchez Bayle, MD, secretary of the Federation of Associations for the Defense of Public Health (FADSP) considers the change "worrying". "It means that health care remains a basic and fundamental right," he says. And although in the short term the impact of reform may seem "minor" to "medium term", he says, there will be many people who stay outside the system. "In principle they are people with many resources to access private healthcare, but will also be affected groups closer to the margins." warns.
"It's a philosophical change in the system, but very real," Jose Martinez Olmos analyzes, health spokesman of the PSOE. The former general secretary of Health from 2005 to 2011 states, like other experts, that the measures published yesterday brings the system to people who now had the right to health card. And gives several examples: "There are nuns, for example, that have never worked and have not quoted it should make a special agreement, or annuitants who have never contributed, together with the self-employed without benefit should be the next to go in the system, according to the forecast of the Public Health Act. "
more informationIllegal immigrants have health insurance card to the August 31Health card will leave immigrants to 150,000 within two yearsThe PP raises the pitch against the "abuses" of immigrants
Gaspar Llamazares, spokesman for Health of the United Left in Congress, believe the government has used the crisis to change the model of national health system. "And replace the model of universal health care of the welfare state to a model of Social Security has the implication that leaves people out. What about those over 26 who are not in poverty? "He asks. "It is a philosophy, when the road was walking was the opposite: to incorporate all the groups that were out of universal coverage for assistance," he says.
The same fear expressed by Sergio Minuet, professor of Health Management area of the Andalusian School of Public Health (EASP), for whom the change of articles of Law Health System Cohesion involves altering "the fundamentals" of the national health system . "It's a substantial change from what has been the system in the last 30 years," says the professor EASP, calling attention to that in none of progress on health reform offered by different members of the Government has alluded to this change.
The next and predictable way, according to several experts, is the promotion of private insurance
But for experts, the royal decree involves much more than the transformation of a system intended to have a universal vocation. Minuet Sanchez Bayle and agree that the royal decree may "open the door" is also a formula established in the different types of insurance, according to the condition of the citizen. And there may come into play the reorganization of the portfolio of services has also been included in the new standard and provides a portfolio of "basic", another "supplemental" and other "ancillary". "The union of all these changes may open the market to insurers not only to participate in public service delivery," says Minuet. "According to the royal decree only entitled to benefits with your insurance company who trades but does not say that these insurers have to be public, but is the Social Security determines who is entitled to health care. Right now it's only a hypothesis, but has left open the option in the future Social Security does not take care of everything and let some benefits in the hands of private insurers, "said the professor EASP.
The next and predictable way, consistent Olmos, Llamazares and Sanchez Bayle is the promotion of private insurance. "To complete a social insurance model neocentralizador system and take the middle classes would lack only create a single tax deductibility of private health insurance," said the spokesman of the United Left. One thing that abounds Sanchez Bayle: "The PP aims to change the system to create different types of insurance: that people with high incomes are served by private insurance and the rest by a public insurance model similar to charity." Thus, warns, the healthcare model would not be a national health system and would become a model of seizures in each group access to services.
But the truth is that Royal Decree law, for now, not talking about private insurance (other than mutual officials or the military), but some experts believe that the amendment passed now beginning to bring Spain closer to the medical model countries like Germany with Holland, where traditionally there are different portfolio of services: basic funds the state and the citizens pay for additional access.
The reform puts Spain on medical models of countries like Germany and Holland
The Andalusian Regional Ministry of Health, which is in the expected functions of forming the new regional government, yesterday issued a statement branding the changes in Health "counter". "It becomes a situation similar to unsupportive system that existed in Spain in the 70's," the department heads María Jesús Montero, who has already announced that their legal services are studying the regulation published yesterday to see how it affects the Constitution , to regional powers such as organic laws and Aliens. Andalusian Government sources caution that there are several "legal questions" about the validity of the reform.
"The actual wording of the decree, in particular the point that regulates the right to benefit, was sloppy," said Javier Rey, an expert on health issues Alternatives Foundation and author of a paper on the reorganization of the national health system. "The preamble highlights the problems of the communities to bill, but then introduces the concept development of secured and extends not only to foreigners but also to the Spanish." And this "entails a change in the relationship between citizenship and the right to health care as the law was established in 1986, Surgeon General."
For King it is clear that one can not invoke the grounds of efficiency, because the coverage of illegal immigrants, about 150,000 is not a problem because they are few and spend less. " "You do a whole system change in approach to further complicate the legal landscape."
Also for this change expert "points surreptitiously" in an attempt to cast the idea that you can substitute public insurance for private one. "And it is contradictory to defend the tax-financing system with one of assurance. If you want to go out there, you change and say "claims.
The Royal Decree on Urgent Measures to ensure sustainability of the NHS also speaks of healing "universal", but argues that this has been jeopardized by the mismanagement and inefficiency. However, the fact is that the system will eject some citizens who will lose their health umbrella. This applies, for example, illegal immigrants or students over 26 who have not yet agreed to their first job.
What has made the government back in the model is marked by the Law of Cohesion National Health System, 2003, he considered that "all Spanish and foreign country" are "entitled to the right" to health. A model underpinned by the Public Health Act 2011 which removed the regulatory limbo to people-some 300,000-who lacked health coverage to have exhausted unemployment benefits and have some sort of income. The road towards universal should have followed in June with the inclusion of those freelancers who would stop trading. The new law changes the rules. Ensure assistance to anyone who can prove "insured status". That or be almost in poverty, the other condition requiring the government to have a health card.
Experts warnthe measureleave uncoveredsome groups
For some experts this change goes back to the healthcare system to a model similar to insurance in force in the seventies and early eighties, before the approval of the General Health Act of 1986. The longer public health, universal and free for all citizens and becomes a single for insured health and welfare.
The Government denies it is left out of the system to any resident in Spain, Spanish or foreign. "It is true that there is universality," the CEO of Portfolio Services NHS and Pharmacy, Sagrario Perez. The director is hiding behind that reform has nothing to do with a change of model, but compliance with a ruling by the European Commission obliges Spain to hand over European health insurance card to all citizens entitled to assistance in Spain. It is the case exemplifies, that a German citizen with no right to health in the country comes to Spain, Registers to Vote, it is here and, in turn, continues to receive assistance, but under Spain. "That's what we want to avoid, we want to clarify who is entitled to assistance here to prevent anyone brew," he adds. The illegal immigrants and the Spanish who would remain outside the system, as it were, a side effect.
It is a change of draft, said Jose Ramon Repullo, health management expert and professor at the National School Health. "It changes the model. We went from a definition of citizenship to another typical insurance company, which takes into account the work environment, income ... "he says. In the "real health broom decree law", as defined by the new standard, "gets all the issues." Repullo critical amendments to various health laws, made without discussion or consensus, calling for an "emergency" in his opinion it is not. "If it was to exclude coverage could have been done specifically", he argues. "It is surprising and unwise. The logical thing is to discuss and process it through a bill, "he adds.
"It's a philosophical change but with real implications," says the PSOE
Ricard also Meneu, Foundation Health Economics, the royal decree is "regressive." "Gironazo be called [a reference to the Minister Falangist Girón], taking up a base in securing Social Security surpassed for many years. For almost two decades that Social Security does not provide funds to health care in an effort wrongly recentralizador "he says. Criticism also that the change will not cover some users. "The dreadful allegations of false demagogic exploitation of our generosity no secret that the only ones affected by these changes will be citizens of our country excluded from the insured status."
Marciano Sanchez Bayle, MD, secretary of the Federation of Associations for the Defense of Public Health (FADSP) considers the change "worrying". "It means that health care remains a basic and fundamental right," he says. And although in the short term the impact of reform may seem "minor" to "medium term", he says, there will be many people who stay outside the system. "In principle they are people with many resources to access private healthcare, but will also be affected groups closer to the margins." warns.
"It's a philosophical change in the system, but very real," Jose Martinez Olmos analyzes, health spokesman of the PSOE. The former general secretary of Health from 2005 to 2011 states, like other experts, that the measures published yesterday brings the system to people who now had the right to health card. And gives several examples: "There are nuns, for example, that have never worked and have not quoted it should make a special agreement, or annuitants who have never contributed, together with the self-employed without benefit should be the next to go in the system, according to the forecast of the Public Health Act. "
more informationIllegal immigrants have health insurance card to the August 31Health card will leave immigrants to 150,000 within two yearsThe PP raises the pitch against the "abuses" of immigrants
Gaspar Llamazares, spokesman for Health of the United Left in Congress, believe the government has used the crisis to change the model of national health system. "And replace the model of universal health care of the welfare state to a model of Social Security has the implication that leaves people out. What about those over 26 who are not in poverty? "He asks. "It is a philosophy, when the road was walking was the opposite: to incorporate all the groups that were out of universal coverage for assistance," he says.
The same fear expressed by Sergio Minuet, professor of Health Management area of the Andalusian School of Public Health (EASP), for whom the change of articles of Law Health System Cohesion involves altering "the fundamentals" of the national health system . "It's a substantial change from what has been the system in the last 30 years," says the professor EASP, calling attention to that in none of progress on health reform offered by different members of the Government has alluded to this change.
The next and predictable way, according to several experts, is the promotion of private insurance
But for experts, the royal decree involves much more than the transformation of a system intended to have a universal vocation. Minuet Sanchez Bayle and agree that the royal decree may "open the door" is also a formula established in the different types of insurance, according to the condition of the citizen. And there may come into play the reorganization of the portfolio of services has also been included in the new standard and provides a portfolio of "basic", another "supplemental" and other "ancillary". "The union of all these changes may open the market to insurers not only to participate in public service delivery," says Minuet. "According to the royal decree only entitled to benefits with your insurance company who trades but does not say that these insurers have to be public, but is the Social Security determines who is entitled to health care. Right now it's only a hypothesis, but has left open the option in the future Social Security does not take care of everything and let some benefits in the hands of private insurers, "said the professor EASP.
The next and predictable way, consistent Olmos, Llamazares and Sanchez Bayle is the promotion of private insurance. "To complete a social insurance model neocentralizador system and take the middle classes would lack only create a single tax deductibility of private health insurance," said the spokesman of the United Left. One thing that abounds Sanchez Bayle: "The PP aims to change the system to create different types of insurance: that people with high incomes are served by private insurance and the rest by a public insurance model similar to charity." Thus, warns, the healthcare model would not be a national health system and would become a model of seizures in each group access to services.
But the truth is that Royal Decree law, for now, not talking about private insurance (other than mutual officials or the military), but some experts believe that the amendment passed now beginning to bring Spain closer to the medical model countries like Germany with Holland, where traditionally there are different portfolio of services: basic funds the state and the citizens pay for additional access.
The reform puts Spain on medical models of countries like Germany and Holland
The Andalusian Regional Ministry of Health, which is in the expected functions of forming the new regional government, yesterday issued a statement branding the changes in Health "counter". "It becomes a situation similar to unsupportive system that existed in Spain in the 70's," the department heads María Jesús Montero, who has already announced that their legal services are studying the regulation published yesterday to see how it affects the Constitution , to regional powers such as organic laws and Aliens. Andalusian Government sources caution that there are several "legal questions" about the validity of the reform.
"The actual wording of the decree, in particular the point that regulates the right to benefit, was sloppy," said Javier Rey, an expert on health issues Alternatives Foundation and author of a paper on the reorganization of the national health system. "The preamble highlights the problems of the communities to bill, but then introduces the concept development of secured and extends not only to foreigners but also to the Spanish." And this "entails a change in the relationship between citizenship and the right to health care as the law was established in 1986, Surgeon General."
For King it is clear that one can not invoke the grounds of efficiency, because the coverage of illegal immigrants, about 150,000 is not a problem because they are few and spend less. " "You do a whole system change in approach to further complicate the legal landscape."
Also for this change expert "points surreptitiously" in an attempt to cast the idea that you can substitute public insurance for private one. "And it is contradictory to defend the tax-financing system with one of assurance. If you want to go out there, you change and say "claims.
スペインの医療費削減で、保険料を払う人のみに無料健康保険を適用、保険料を払わない人は、病院などの緊急部門で対処
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