スペインの医療予算は、財政削減のために、2010年の63'775'000'000ユーロ(637億7500万ユーロ)から11%の7'179'000'000ユーロ(71億7900万ユーロ)減少して、2014年は56'596'000'000ユーロ(565億9600万ユーロ)に激減！
Diez sábanas para 30 pacientes
Los presupuestos de Sanidad retroceden a niveles de 2007
Tras los grandes recortes, llegan ajustes al detalle: personal, material, comidas u horarios
La OCDE alerta de los efectos de los recortes sanitarios
María R. Sahuquillo / Elena G. Sevillano Madrid 19 MAR 2014 - 00:03 CET
Fuentes: Ministerio de Sanidad, comunidades autónomas y Ministerio de Hacienda. / EL PAÍS
Sources: Ministry of Health, state government and Ministry of Finance. / EL PAÍS
出典：厚生労働省、州政府や財務省。 /国
Fuentes: Ministerio de Sanidad, comunidades autónomas y Ministerio de Hacienda. / EL PAÍS
Sources: Ministry of Health, state government and Ministry of Finance. / EL PAÍS
出典：厚生労働省、州政府や財務省。 /EL PAIS
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Ten sheets for 30 patients
Health budgets to 2007 levels recede
After the big cuts come retail settings: staff, equipment, meals or schedules
OECD warning of the effects of health cuts
Mary R. Sahuquillo / Elena G. Sevillano Madrid 19 MAR 2014 - 00:03 CET
After four years of large budget cuts in the Spanish public health has lost almost 7,200 million euros, the autonomies have relaxed settings . At least on paper of the annual accounts. The investment in health in 2014 was virtually stable in most autonomy. The system, which has been traditionally underfunded - is estimated to spend more than 7 % of the budget - no longer supports more snips in big games. But bills clamped. Thus, in addition to continuing cuts in human resources, which, along with pharmacy, take a large piece of the pie - budget , managers are focusing on the small adjustment . He looks down to the smallest detail: check the schedules of the centers cut - item health and non-health - in food or cleaning.
The delays in the entry into the operating room are exacerbated by the lack of staff. / Christopher Furlong ( Getty Images)
These elements could be complementary or secondary , but also shape the quality of the national health system and linked to key factors such as the impact of the pharmaceutical copayment increased waiting lists , which reached a record 100 days average for surgery - or delayed innovations threaten to impair attention. Experts warn that after the great ax in recent years , these microrrecortes if not done with care can cause much damage . "The only thing that could save the situation would be a good deal of structural changes, including clinical management, from an alliance with physicians and a change in the way of organizing the services," says José Ramón Repullo , Professor of National school of Public Health .
Bring blanket from home. In Alicante General Hospital peripheral - catering services , laundry , etc.- are being degraded . While the Minister of Health , Manuel Llombart , inaugurated a scanner generation , some patients were forced to leave their homes linens. In the center, referring to 1.9 million people , have come to miss blankets, pillows, sheets and pajamas, as denounced by the unions, because the cutbacks in the lingerie department . This service hospital has grown from ten laundresses and seamstresses in 2009 only five to four tons daily deal sheets moving in a lower center of 800 beds . Deficiency is also seen in the small details : If you enter a patient of above average size no one can adapt him the robe.
The hospital doctors also complain that there are days walking several floors to find pajamas to wear. " A few weeks ago , Pulmonology nurses who were trilled . They were given 10 sets of bed for 30 patients , they must negotiate who gets and who does not change . They say it is widespread , but no changes daily , just for the two flu patients , "says Paloma Serrano , who has been admitted a week at the plant. A center spokesman says however that there has been no problem of lack of material.
But it is not the only region where the bedding is scarce. In the dialysis service at the Clinical Hospital of Valladolid appeared last February a poster - letterhead and official seal of the servico health of the region informing patients that they should " bring home the pillows each deems appropriate " . "Just be provided ," he added , patients who are " admitted " to the hospital. After jumping to social networks , a spokeswoman said the service castellanoleonés poster was placed in the center " without the direction of the hospital ." "As knowledge he had of it , was removed immediately and the service continues to operate as usual," he said.
Sources: Ministry of Health , state government and Ministry of Finance . / COUNTRY
No diapers or pads. In the Vall d' Hebron hospital in Barcelona , newborns no longer have free diapers during your stay. Babies are placed one when born, but then it is the families that have to take care of the rest . " Please be advised in writing when they enter ," said a spokeswoman for the center , who said that those who come with some pathology and allowed themselves admitted they supplied all the diapers . This reduction , health officials explain , already widespread in most of the hospitals managed by the Catalan Health Institute (ICS ) .
The same applies to the pads used by mothers when they first give birth , that before were also in abundance. Center managers say the hospital has installed vending machines with various materials , such as newborn diapers, wipes , teats and bibs -a " discounted prices " .
Dessert soup spoons . The cooks and the Hospital San Pedro de Alcántara, Cáceres , in January reported to management the worrying lack of cutlery (spoons , knives ... ) suffering . The situation at point days was such that the patients had to eat dessert soup spoons disposable material. The UGT union says it is not an isolated incident, that on other occasions have missed tops breakfast cups or cleaning supplies in the kitchen.
Cuts or lack of liquidity are causing quite miserly adjustments. In some outpatient center Alicante practitioners claim that it takes to clean the paper conductive gel used in ultrasound . Small gaps that complicate the work and also represent a loss of quality of care . " The disposable material has dropped an awful lot in the last two years. Sometimes there is not to prescribe folios . Before there was always stock of drugs and drug delivery now has plummeted . If a patient comes with a kick you can not give a gelocatil , you have to prescribe it , "says the head of Primary Care Physician union CESM in Alicante , Victor Pedrera.
What if the only orderly sick ? Those responsible for a health center in the province of Sevilla were raised a few weeks ago a dilemma: either made an exception in the installed policy in recent years not supply contracts substitutions the vast majority of sick or not could open the center. The guard was low , they had not replaced , and administrative functions that had sickened . In the end it's over hiring a substitute, and the center opened , but the story , revealed by the Secretary General of Social and Health Services of UGT in Andalucia , Antonio Macias, illustrates the main problem of alerting professionals , not just Service Andaluz de Salud, but throughout Spain : the shortage of human resources. "The level of substitution is negligible , as has never been known ," said Macias.
The perception of health that are on the ground when they look around them is correct. The data from the Labour Force Survey , said the expert José Ramón Repullo show a decline in employment in the health and social sector of between 40,000 and 50,000 people.
In all regions there are complaints that the casualties are not replaced . With templates of doctors, nurses and technicians already minimal, is still cutting in other job categories , and the guards at the Hospital 12 de Octubre . The CSI -F union denounced a few weeks of the 444 workers of the official staff of the center were only 350 seats covered ago. The guards , hospital sources as explained , are those that transfer patients to diagnostic tests or surgery. They are when they need depends on the schedules are met. "There have been delays of an hour and a half regarding the entry into the operating room by a lack of workers," he said . Although the hospital initially denied shortly after announced the hiring of six new guards .
Dialysis at midnight
With waiting lists are fired and bills of clinical concerted fatter , the regional health services have been eliminating known as peons - days extraordinary evening with their own staff , and trying to be functioning operating rooms and equipment public diagnoses as long as possible without paying overtime. Madrid, for example, surgical teams start hiring only the afternoon. Some communities tested the patient care at night.
The Minister of Health castellanomanchego Jose Ignacio Echaniz said last week that the Virgen de la Salud, Toledo , hospital and makes radiographs from six in the morning until two in the morning , also on weekends. The night time is optional , added. According to their data , in February there have been nearly 400 tests more than in the same month of 2013 . A spokeswoman for the health service said yesterday that it is considering extending this measure to other hospitals.
In Andalusia, the hemodialysis service and the Regional hospital Virgen de la Victoria from Málaga is to unify in March at a new venue . The Ministry has already announced that the afternoon shift will be extended until two in the morning, which has drawn criticism from professionals who understand that this schedule prevents patients to lead a normal life and can even harm your health to break the cycle of sleep. The Department clarifies that the shift ends the two is for professionals and patients end their treatment at 2400 . Add to nocturnal dialysis has been created to occupationally active patients and students who prefer to keep their daily routine . Since it was unveiled , says the SAS , 17 patients have requested .
Patients without snack. Over a year ago that the patients of the Hospital Josep Trueta of Girona are no longer supplying them a snack to hold the hospital between dinner served around seven in the afternoon, and the breakfast , at eight in the morning . That ressopó ( as it is called in Catalan) consisted of a yogurt, a glass of hot milk with biscuits, fruit juice or a pudding , depending on the day . " Now only given to diabetics ," says Maria Angels Rodriguez, Associate of CC OO at the center. The night shift workers of the center can no longer count on the sandwich , salad or soup, fruit or cupcake, the hospital gave them dinner. Stopped providing this refreshment in June last year, and estimated that this measure will save about 90,000 euros a year. The hospital declined to comment on its decision .
And health guard without dinner . The Castilla y León and claims to have saved from six million in 2012 ceased to provide health meals that stand guard in hospitals and health centers in the region. Now, after many protests from workers who felt that saving was minimal discomfort for generating - " Cafe hospitals have reduced hours , and no one in their right mind would leave a patient to go to dinner ," said medical -has decided to replace this service. "In all hospitals ," says a spokeswoman , facing accusations that has only occurred in some . " But only in hospitals, not in primary care," he says. The savings are six million , according to the health service Sacyl , five primary and one hospital . Now these meals again hospitals " at no cost through the hospital 's own kitchen , and where not possible, at the lowest possible cost ( almost symbolic) with cafeterias managed centers ," added the spokesman .
In the Hospital Josep Trueta of Girona have been left without dinner and there are no views to recover . The night shift workers of the center can no longer count on the sandwich , salad or soup, fruit or cupcake, the hospital gave them dinner. Stopped providing this refreshment in June last year, and estimated that this measure will save about 90,000 euros a year. "We ask that give us some tickets for coffee and pastries, but nothing ," says Maria Angels Rodriguez, Associate of CC OO at the center.
Charge for the health card . Patients Balearic Islands, Galicia , Madrid and Catalonia are already paying for duplicate their health cards. In these last two autonomies also well - paying 10 euros is required Madrid and Catalonia seven, even for theft.
A third less for cleaning. Managers tend to consider it a complementary to secondary health care services , but the cleanliness of health centers and hospitals is vital. A few months ago , Madrid issued a tender cleaning nearly 300 health centers in the region. Cut the price of the award 30 % of what it cost before. The result : a few weeks the professionals were denouncing poor hygiene , waste accumulation , days without cleaning staff ...
The Ministry of Health itself up penalty minutes of over 70,000 euros against the company for partial breach of contract. The company has paid Health says, but has filed a motion for reconsideration . Labour Inspectors determined that the dedication of cleaning staff was "insufficient" and inspections found " widespread dirt on floors, walls and stretchers " and "biological risk by poor hygiene in queries where you should do cures " among many other shortcomings.
In Castilla -La Mancha has also wanted to save cleaning. The new contracts that have come to contest offered to bidders 15% less on average. Something that, according to the complaint Symphorian Madroñal, UGT , means loss of jobs. One company , Clece, among other centers would clean the Hospital for Paraplegics in Toledo, renouncing the contract ended . According CC OO, the " reckless cuts " in the budget, threatening the quality of service . From the health service ( Sescam ) ensure that cleaning is being provided without problems.
Also in Catalonia managers have set the cleaning and cut- match. In the primary care center Cirera Molins, Mataro , has dispensed with the person covering the morning shift . Some workers have complained to the council of the Maresme Health Consortium , managed by this device, the ambulance is dirtier and that , if a patient vomits or suffers blood loss , no staff who can clean .
Material of lower quality. At the Hospital 12 de Octubre, Madrid , nursing staff noticed that the dressings are no longer what they were. "Until now it was one hundred percent cotton , now there are synthetic and not soak or absorb as before ," said a union source that has collected complaints from workers. " The staff begins to refuse to use them because they do not work as they should ," he adds . A hospital spokeswoman acknowledged that yes there was a problem with the previous provider ( was reached to terminate the contract ), but says it is resolved and now "article called nonwoven [ sic ]" has just received a complaint from a doctor .
Some Andalusian professionals also note that in the last two years has dropped the quality of the material , such as gloves, syringes and tape or abounds made in china. " We complained and when it is very obvious sometimes changed . But other times have made a large purchase and you have to finish " account Satse Secretary of Andalusia.
The laundry , cheaper . Health services expect to conclude contracts in force for new contests draw down , or take a more direct way and privatize the management of the service. That's what happened in Madrid , the government decided in October to award the laundry clothes - hospital serves 19 public hospitals in the region of 46 million euros. According assumed the regional government itself , would save 36 million euros compared to the previous cost . What did the winner - FLISA UTE and Industrial Laundry Laundry Center, both of the ONCE Foundation - Providing workers spend an average salary of 1,100 euros to 660 . Employees did 42 days of strike - and managed to improve 25% - his salary . The Labour Inspectorate found that the companies had engaged in a "very grave " for hiring employees to replace those who did strike offense. They have resorted .
Center closed in the afternoon . In addition to downsizing , some autonomy managers have also decided to reduce the hours of some health centers , and even close some rural emergency points . This is the case of Extremadura, where health centers no longer have the afternoon or Murcia, where the few centers that offered longer do . The latter , according to a spokesman for the Ministry, opened in evening hours to serve patients of other outpatient area , which was under construction, closed the next day . A cutout for the Association of Users of Murcia Health helps to cut the quality of care . This organization of healthcare and patient explains that in the evenings health centers that opened attending emergencies, vaccines, cures ...
In the region of Murcia also have closed five centers on call. Neighbors Portman , Librilla , La Parroquia, Campos del Río and Moratalla have to travel to another town when they have some urgency . A spokesman of the Ministry of Murcia says the decision to shorten the time is taken by efficiency . " All these centers are within 15 minutes of opening another 24 hours, so seeing all the activity was residual decision was made to change the schedule ," he says .
With information Antía Castedo, Esquitino Ruben Reyes Rincon.
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