スペインでの公立病院の経営·管理の私営化は、公営病院の効率化·高率化·高利つ化·功利つ化??
De la pública a la privada y al revés
El trasvase de directivos y gestores entre la Administración y las empresas de la sanidad evidencia sus estrechas relaciones y la falta de control y transparencia
G. ABRIL / E. G. SEVILLANO / J. PRATS Madrid / Valencia 2 DIC 2012 - 00:02 CET
From public to private and back
The transfer of executives and managers between the administration and business of health evidence his close relations and the lack of control and transparency
G. APRIL / E. G. SEVILLANO / J. PRATS Madrid / Valencia 2 DIC 2012 - 00:02 CET
Manuel Marin Ferrer was between 2000 and 2007 the man of the Generalitat Valencian Health Department in the district of La Ribera, privately run. During this time he served as commissioner. His job was to oversee the Administration awarded to private health care: Health Ribera UTE. In September 2007, the same attendant health signed him for the position of greater responsibility: the direction of the Department of Health. And he went, without intermediate stages, to monitor the company from his position as public health administration to be on the payroll of the company.
The British press has echoed recently in cases than whites graphically called "revolving door (revolving door)": the transition from public to private sector managers to monitor passing companies to work for them. The Guardian published on November 23 that a government health exasesor Cameron has just been signed by a private health lobby.
THE COUNTRY
In Spain there are similar cases, as shown in the case of Marin Ferrer. Both of people who are at the service of private firms all the knowledge acquired in the public health and on the contrary, the Administration charges privatization drive initiatives that benefit the health sector companies and that some have dubbed "Horse strategy Trojan ".
This happens in a very turbulent time for public health, hit by spending cuts and privatization registered the biggest bet so far. The management of 10 hospitals in Madrid and Castilla-La Mancha is about to change hands: from public to private. The rejection of these policies has taken to the streets in Madrid block the health sector.
Valencia and Madrid highlighted by the return of health executives
The debate is not just ideological. Also due to the lack of evidence that privatization can control spending, transparency regarding the interests of the sector and control over the companies involved in public health. Governments that have chosen the model is often turned in their top defenders, as are those companies that provide the service and draw revenues from it. No wonder the movement of officials who cross from one side to other public and private areas.
For Marin Ferrer took place precisely at the cradle of private health management of public hospitals, the Valencian town of Alzira. In 1999, the PP government led by Eduardo Zaplana launched that has come to be known as Alzira model, a formula that has been consolidated in Valencia: public health coverage of 20% of its inhabitants depends on the moment of a company . Marín became the company that used to have to watch. Its functions in government was to oversee the Bank of UTE Health (majority owned by Adeslas and Ribera Salud), which deals with health care of the 250,000 residents of the region of La Ribera. His duties included checking that conformed to the terms of the contract and who met the criteria of quality of care agreed.
Marin Ferrer, in a written response to this newspaper, not considered to be committing a potential conflict of interest to be passed over. "The Administration and the concessionaire at all times act as allies (...) to ensure quality public assistance, as polls show, patients and our staff, so there will be no inconsistency".
There are no regulations regarding conflicts of interest that may fall on the figure of the commissioner private management departments. There are no rules that prevent, from one day to another, sit across the table and go to serve the public to put their knowledge at the service of the company that oversaw.
Nor is there a law guarantees able to preserve the public interest in new approaches to health management to its ongoing expansion and implementation. The consultancy PriceWaterhouseCoopers called attention to it in the report Ten hot topics of the Spanish health for 2012. "In order to solve some of the most controversial aspects of these forms of collaboration [private public in general], it would be reasonable to start the debate on whether to design a regulatory framework that settles the basis of the public interest to preserve, along with the type of relationship with the company or desirable private companies involved, "stated in the chapter titled It's time to revive the public-private partnership.
The debate includes questions about the savings privatize
The Spanish Society of Public Health and Health Administration (SESPAS), which are part of the 12 scientific societies, is more explicit. First, it highlights the lack of information on the outcome of the privatization experiences: "Contrary to advertise their defenders, in practice it has proven benefits warrant its adoption." This limited information "has allowed only credible risk warn that excessive proximity between authorities and dealers can make to reduce the effectiveness of supervision on the services provided," he adds. And even going so far as to warn of "serious risk of regulatory capture" phenomenon that occurs when corporate influence [in this case the private sector health] is such that it has the ability to submit to the Administration, void your inspection function and convert the regulator "in extreme cases in defense of the interests of the dominant" instead of interest.
"It may make sense to separate the service provider [private] payer [public], but whenever there is a strict control of the second over the first," adds John Oliva, president of the Association of Health Economics (state level , has about 900 members, doctors and economists, and is part of SESPAS). "The problem is that lack of good governance standards" on this model, he adds. Especially when few health operators monopolize the market and, as a result, acquire great power to influence the authorities who contract their services, as in Spain with the weight of Shore Health and Capio, the two main groups that manage public hospitals.
An example of alleged "Trojan horse" is Anthony Burgess, CEO of Hospitals Ministry of Health in Madrid since 2008, Madrid ideologue of the health plan for 2013 (privatization of the management of six hospitals and 27 health centers), which went over 20 years working for companies. In his time as director of care in Adeslas launched Alzira hospital. After Capio advised on the construction of the hospital-translational Valdemoro Alzira model to Madrid, opened in 2007. His son, Antonio Burgueño Jerez, works for Health Bank, which advised on the hospital project Torrejón (recently purchased by Sanitas), that the Department of Health awarded when Burgueño father was in office.
"There will be no incompatibility," says a concerned
In Madrid the transfer works in both directions. The last two directors of Health have interests in private healthcare. Manuel Lamela was in office between 2003 and 2007, when the scandal splashed case of alleged irregular sedations Severo Ochoa Hospital in Leganes. In 2010 created the corporation Madrid Medical Destination, S. L., dedicated to promote Madrid as a destination for medical tourism. Journalists still remember the launch of his new project in July 2011. Appeared flanked by two directors of the autonomous government of Esperanza Aguirre, two town councilors of Ruiz-Gallardón and the president of the employers. Presented a "nonprofit association" called Madrid Medical Center (MCM), which was born with the goal of "health tourism boost class" to private clinics in Madrid. Among his clients, Capio, MD Anderson or Light Clinic.
The Madrid City Council and the capital of MCM helped takeoff. The first, through the body Madrid Network, granted a loan of 1.3 billion euros. Money came from a batch of 80 million from the Ministry of Science and Innovation aimed at investment in innovative projects. The City Council awarded a grant of 5,900 euros in exchange for including the logo of the city on the website. Year and a half later, the site has no content. MCM's director, Mario Esteban explains that they have changed the name and the commercial Ibersalud gone. Lamela has not made the "big event of the health sector" who claimed to have signed with Ifema 2012 and that was to be called Madrid Medical Meeting. "It is suspended without date" confirmed in Ifema. This newspaper has tried unsuccessfully to contact Lamela.
Juan Jose Guemes is another example of revolving door in Madrid. He left his post as Minister of Health in 2010 and joined the IE business school, but some of their activities are related to the position he held in the public domain. The Swiss company Unilabs, clinical analysis, signed him last June as director. Unilabs manages the hospital laboratory Fundación Jiménez Díaz, owned by Capio. This newspaper tried unsuccessfully to contact this exconsejero Madrid.
Experts warn of "too close" to firms and authorities
"We must distinguish between legal inconsistency and incompatibility ethics and politics," says IESE Prof. José Ramón Pin. "The transfer of management is quite natural in the U.S., but they solve it with transparency. A secretary of state, for example, goes before a parliamentary committee. In Spain it would be nice to have more transparency, a body to judge potential conflicts of interest. " Pin considers unduly restrict that transfer is negative because "lost talent": "The important thing is not the way the private sector, but there are mechanisms to find out if someone has passed as a return of favors or just because it is good professional."
In Capio, the transfer from the public sector is at the very origin of the company in Spain. One of its founders is Fernando Largo (left the company in 2005). Former member of the PSOE, the cardiologist served as provincial director of the National Institute of Health in Toledo in the early nineties of the last century, and was deputy general manager of Insalud concerts between 1993 and 1996. Two years after leaving public office, doctor's jacket hung and became a partner in a clinic in Castilla-La Mancha called Recollect. That was the germ of Capio. Almost 15 years later, 67% of the revenue of this company come from concessions and concerts with government.
Among employees Teresa Capio is Echániz, sister of Jose Ignacio Echaniz, Minister of Health in Madrid when the company took control of the Fundación Jiménez Díaz (gives health coverage to over 400,000 Madrid), and current health counselor Castilla-La Mancha, where he announced the privatization of the management of four hospitals. "The hired when his brother had no health care. She is a pharmacist and knows the industry, "said Victor Wood, the group's president. Despite attempts by this newspaper, Capio will not talk to the aforementioned provided, which has a middle position.
Among the 10,000 employees of the company also appears Elena Arias, who left his post in 2007 as Director of Human Resources at Capio to assume management of the Health Service of the Principality of Asturias. He returned to the company in 2011. No stops or breaks in between.
Last year, when the company Capio was launched to find a new buyer, knocked on his door "four or five" venture capital funds, as a director of the company. They say that public health is not profitable, but it seems a business from the point of view of private. "The proof is that all global funds to invest in private healthcare," he adds. And that's because in times of public cuts, increases the demand for private care and also the ability of these companies to make money with public privatizations. Health can be a two-way business.
A growing sector
The business of private management of public hospitals in Spain is basically about two companies: Capio, controlled by private equity fund CVC Partners, and Ribera Salud, equally owned by the former Valencia savings Bancaixa (Bankia ) and CAM (Sabadell). The sector, boiling, nearly overturn earlier this year when he tried to buy Bank Capio Health.
The Valencian company had an instrumental origin. It was created to carry out the project of regional PP give the private sector the construction and management of a public hospital in Alzira materialized in 1999. Adeslas provided health knowledge. Lubasa Dragados and took care of the work. But lacking financial muscle. To do this, the Valencian Government promoted the creation of Shore Health, owned by Bancaixa and CAM.
Health Bank grew, was emancipated and became an independent health operator, to the point of leading projects. However, the collapse of its two shareholders (Bancaixa absorbed by Bankia, in turn, tapped) and CAM (operated and sold to Sabadell for one euro) put the company in a difficult position and was released. Capio was then very nearly acquire. At the end there was no economic agreement between the parties. Sabadell CAM who is now trying to negotiate with Bankia to acquire 50% of the firm has not, according to company sources.
The British fund CVC, led by financier in Spain Javier de Jaime, is the majority shareholder of Capio. This is the same group that originated and grew the company in 1998 (then Iberian Diagnostic and Surgery, IDC). The eventually sold in 2005 to the Swedish group Capio for 331 million euros. A year later, two investment funds, Apax and Nordic Capital, bought the Swedish company and entered the Board of Directors of the Spanish subsidiary. In 2011, however, the company based in Spain covenanted cleaved from the matrix. Buyer sought and after receiving various offers, ended up closing the transaction with CVC, old acquaintances, for 900 million euros.
Along with Capio and Ribera Salud, health insurers as Sanitas (BUPA Group Property, British multinational health), the newly formed companies like Chiron-USP (owned by the family fusion Cord and equity fund Doughty Hanson) and Hospitals Madrid are closely following the announcement of the imminent release of administrative concessions of public hospitals in Madrid and Castilla-La Mancha to take positions in the field increasingly open to public-private healthcare.
0 件のコメント:
コメントを投稿