Ophthalmological assistance in private health care and public health, collaboration or confrontation?

Jiménez Benito, J.; Torres Pérez, J.; Medina Sandonís, M.

doi:10.1016/j.oftale.2020.10.002

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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "61" "paginaFinal" => "62" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Jiménez Benito, J. Torres Pérez, M. Medina Sandonís" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Jiménez Benito" "email" => array:1 [ 0 => "jjimenez@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Torres Pérez" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Medina Sandonís" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Oftalmología, Hospital Universitario de Burgos, Burgos, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La asistencia oftalmológica en la sanidad pública y en la sanidad privada ¿confrontación o colaboración?" ] ] "textoCompleto" => "Until not so long ago, diseases and their treatment were a source of great concern to citizens, not only due to the physical and psychological problems involved in suffering from diseases but also because of the economic cost they could entail. The existence of public health, which guarantees universal and free coverage, is the achievement of a collective dream that we believe is not appreciated in its true magnitude, particularly by the younger generations who may take it for granted.Public health has been a very recent development in the history of mankind, with the characteristic that it is only possible in some countries with an acceptable level of socio-economic development. This model of public health has been implemented after the Second World War,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> largely because of Marxist ideas which proposed universal health care. This model of health care is based on solidarity, whereby healthy citizens bear the economic costs of the health care of the less fortunate members of society.However, the public health model has serious problems, the most important of which is the sustainability of the public health system, because spending is increasing year after year.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> It is beyond the scope of this editorial to try to analyse the various causes of the unstoppable public health spending.Private health care has been the classic model of medical care for many centuries, in which the doctor's profession was understood as a liberal profession whose basis is a contract for the provision of health services in exchange for financial remuneration. It is quite important in our speciality, as private eye care is common.These two models of care, public and private, have become considerably more complicated. In private health care, it is very common for patients to be covered by health insurance companies, a situation which jeopardises the quality of care, largely because of the low rates charged by private health insurance companies for remunerating the doctor’s professional work. In the public health sector, the outsourcing of services is becoming more frequent, especially for cataract surgery, which has important consequences such as hindering the training of residents and a certain degree of frustration among ophthalmologists working in the public health system.Health is a very complicated concept and the current demand for health care seems unstoppable and inexhaustible, even more so if it is free. We believe it is appropriate to recall the World Health Organisation's definition of health in 1948: Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> This concept of health is very disturbing: who has a complete state of physical, mental and social well-being? Our existence is tinged with dissatisfaction and ageing is a reality that we can only delay, but the physiological decline of our body is an inevitable experience. In order to increase complexity, we should bear in mind the worrisome increase in marketing of all health problems by the powerful bio-health industry. To give specific examples within our speciality: a certain degree of eye discomfort may be inevitable in advanced ages due to tear film dysfunction and some visual acuity decrease due to retinal ageing, etc. Furthermore, we must remember that medicine does not have the solution for all diseases, and even less for those related to ageing, in which it is only possible to provide relief and, on many occasions, with doubtful effectiveness.The authors of this editorial consider the existence of both healthcare models to be necessary. However, it is necessary to define very precisely the portfolio of public health services because some requirements cannot be assumed and in which the option of medical care in the private sphere is very convenient and necessary. Examples are refractive surgery, which is only possible in private ophthalmology, and the demand for care “at the pleasure and whim of the patient-user”, which public health cannot (and should not) take on either.To conclude this editorial, how can we reconcile these two models of care, public and private, if many professionals work in both fields? The authors believe that these are very complicated balances. Perhaps medical and civil ethics<a class="elsevierStyleCrossRef" href="#bib0020">4</a> can help, but this is only a suggestion. You see, we also need illusion in our lives." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Jiménez Benito J, Torres Pérez J, Medina Sandonís M. La asistencia oftalmológica en la sanidad pública y en la sanidad privada ¿confrontación o colaboración? Arch Soc Esp Oftalmol. 2021;96:61–62." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Algo va mal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Judt" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2011" "editorial" => "Santillana Ediciones Generales, S.L" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Como arqueros al blanco. Estudios de bioética" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Gracia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2011" "editorial" => "Editorial Triacastela" "editorialLocalizacion" => "San Sebastián" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bioética en ciencias de la salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M.A. Sánchez González" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2013" "editorial" => "Elsevier España" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ética médica y oftalmología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society.
All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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Vol. 96. Issue 2.