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It seems clear that the policy of economic cuts is affecting the Spanish healthcare system, leading to a high level of social conflict and questioning of the public health system and the welfare state.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although there are many questions and not too many answers about the consequences of some decisions, it is clear that in everyday clinical practice each one of our patients has a life, a family, a job (often interrupted) and a social context that we cannot and should not forget.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Health is very much influenced by the environment and by how people live, work, eat, move or enjoy their leisure time. Moreover, these life circumstances do not depend solely on individual decisions, as they are strongly influenced by social, cultural, economic and environmental factors.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It is necessary but not enough to understand government health policies, healthcare organisation management and clinical practice itself to forward proposals that add to system solvency.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> It is an ethical commitment to continue supporting brave policies that improve decisive and broadly beneficial social factors. This will improve the quality of life equitably, as economic growth will not improve health without explicit public intervention.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Public services’ management must aim to be efficient, even though paradoxically this is not always possible. This is because they are expected to guarantee our health, security and wellbeing, so that sometimes the system needs to dedicate resources to health matters that cannot be made more efficient. The priority therefore has to be social benefit.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The General Healthcare Law of 1986 guarantees universal and free healthcare coverage based on solidarity, fairness, quality and efficiency. The healthcare reform arising from Royal Decree Law 16/2012 of 20 April, <span class="elsevierStyleItalic">Urgent measures to guarantee the sustainability of the National Health System and improve the quality of its services</span> breaks with the universal, free and guaranteed nature of the public healthcare system that has been one of the foundations of the welfare state in Spain.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This Royal Decree affects aspects in connection with access to the system, healthcare itself, the range of services, the supply of medicines, user participation in financing through copayments, human resources and public health.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This reform has also led to a transfer of spending from society as a whole to households and from healthy individuals to the sick, who have to pay more. This has a negative impact on the principle of fairness. The strongest effects occur in the poorest households and for the chronically sick.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This reform also broke with the principle of solidarity, as it excludes immigrants without a residence permit (except for emergency treatment) due to their administrative circumstances. Irregular immigrants with chronic diseases have ceased to receive treatment, leading to major deterioration of their health. This has also forced them to use hospital emergency services, which are far less cost-effective. It may be impossible for a doctor to prescribe insulin for a patient with diabetes, even though they know that in a few weeks time they will have to visit the emergency department in an increasingly poor condition. This is a dilemma for healthcare professionals who cannot understand why short-term cost-centred policies should predominate over investment in a healthy, productive and satisfied population.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The European Union Fundamental Rights Agency (FRA) and other stakeholders such as the Platform for International Cooperation on Undocumented Migrants (PICUM) are in favour of indiscriminate access to primary and preventive healthcare. In their 2014 and 2015 reports the FRA and the PICUM make it clear that denying undocumented immigrants immediate access to diagnosis and treatment, and only treating their diseases once they have become an emergency, may not only be a risk for their personal health. This may also be hazardous for public health in general and lead to increased expense for healthcare systems, as supplying emergency care is more expensive. This theory is supported by a recent research paper on refugees and asylum seekers in Germany, which suggests that the long-term cost of excluding these groups from the healthcare system is higher than guaranteeing them full access to the same.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Another reason for supporting strong, equitable and universal healthcare policies is given by the economist Vicente Ortún.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> He states that convincing data link productivity to investments in human capital: primary education, basic health care, nutrition and family planning. Improving workers’ health and nutrition makes them more productive, reducing the number of days they feel sick and prolonging their economically active lives. Although sustained economic development is necessary to improve public health, it cannot be based on a limited and disease-ridden population.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The importance of planning based on a policy that centres on people, their needs and their situation, sets a clear and certain route. The goal is visible, and it never involves a lack of concern about financing or efficiency. It simply about putting the universal values first which will make our healthcare system one of the best in the world, as it had been.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Many economists state that we will never again be “as we were before the crisis”. Nevertheless, adapting does not mean resigning ourselves but rather being creative, innovating and applying measures that are just, equitable and impartial. Opportunistic measures involving indiscriminate cuts without taking the consequences into account very much do not seem to be the best way of guaranteeing sustainability, and the fact is that the deficit is still increasing. At the very least they will be a momentary budgetary adjustment that ignores the medium or long-term.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Nor are management fashions, which are often based on false paradigms and sometimes respond to vested interests, the best guides if the aim is to guarantee the sustainability of a fair and universal healthcare system.</p><p id="par0065" class="elsevierStylePara elsevierViewall">A significant datum is that it is estimated that in 2050 35% of our population will be over the age of 75 years old, so that chronic conditions will become increasingly common. This means that caring for people with chronic diseases will be one of the most important challenges faced by the Spanish health system in the coming years.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The health system has to be reoriented to make individuals the chief agents in their own healthcare, increasing preventive measures and resolving health needs in primary care. This is not only more efficient, as it is also better for citizens to bring services closer to them, with increasing home care and patient empowerment, so that individuals will become independent experts in their own health matters. This is our challenge for the future.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Another key point is caring for individuals with multiple morbidities who are ageing and polymedicated. These are the major consumers of the health and social care system, and they are usually seen by several different departments and specialist professionals. Supporting healthcare policies for these individuals involves developing specific plans and care routes other than the current ones for acute cases. These would include effective coordination with the social services, responding better and more efficiently to needs. This would radically affect the quality of life of chronic patients and their caregivers, as well as the sustainability of the system. Given that due to the complexity of their cases no single professional is able to resolves the social and health needs of these patients, independent professional skills have to be developed within the framework of a definitive multiprofessional team able to accompany and empower patients and carers. Suitable technology and information systems are also needed to make it possible to achieve an equitable, universal and sustainable care system in which as far as is possible individuals will be expert active patients with the best possible quality of life.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">We live in an increasingly ageing society in which multimorbidity is the rule rather than the exception, and where expectations are high in health and social care. The other key strategy therefore has to consist of decided support for the promotion of health and the prevention of disease, so that people are encouraged to age in more active, healthier way. This will not only improve older people's quality of life, as it will do the same for their caregivers. We know that caring for more dependent people affects professional life and development, most especially for women, who still form the majority of those who care for more vulnerable individuals. To this end a more health-centred attitude will be more necessary than ever in all fields of policy, to make cities friendlier and more supportive, with healthier working environments. Social resources will be needed to overcome old people's solitude and to encourage their leisure and physical activities. Environmental policies will have to centre on improving the health of all citizens, turning them into active generators of health.</p><p id="par0085" class="elsevierStylePara elsevierViewall">As Nuño-Solinís<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> states, although the ageing and increasingly chronic problems of the population are known, in general there are no solid plans for dealing with these factors in economic terms. This is why bodies such as the Organisation for Economic Cooperation and Development (OECD) are working in this field. Some available estimates state that in financing terms and if no action is taken the healthcare budget will have to increase by about 45% by 2020 (from a 2011 base) to deal with the increase in demand. However, this budget has in fact fallen appreciably (by about 10,000 million Euros) during the crisis in our country.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Healthcare managers must make use of all the available scientific resources and evidence to make brave and decided proposals to ensure the sustainability of the National Health System, as this has been called into question for a long time, even prior to the economic crisis.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Based on exemplary leadership and management professionalisation, making organisations intelligent as well as highly effective and attractive, we will be able to successfully achieve this paradigm shift in our health system.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Picard P. Responsabilidad en política y gestión: las decisiones de hoy condicionan el futuro. Enferm Clin. 2018;28:217–219.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="https://www.ces.uc.pt/publicacoes/cescontexto/ficheiros/cescontexto_debates_vii.pdf">https://www.ces.uc.pt/publicacoes/cescontexto/ficheiros/cescontexto_debates_vii.pdf</a> [acceso 12 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El impacto de la crisis en el sistema sanitario español" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Aguilar Gil" 1 => "J.M. Bleda Garía" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ces Contexto" "fecha" => "2014" "volumen" => "7" "paginaInicial" => "57" "paginaFinal" => "63" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="http://www.gacetasanitaria.org/es/la-salud-todas-las-politicas/articulo/S0213911110002633/">http://www.gacetasanitaria.org/es/la-salud-todas-las-politicas/articulo/S0213911110002633/</a> [acceso 10 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La salud en todas las políticas, un reto para la salud pública en España, Informe SESPAS 2010" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Artazcoz" 1 => "J. Oliva" 2 => "V. Escribà-Agüir" 3 => "O. Zurriaga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2010.10.006" "Revista" => array:8 [ "tituloSerie" => "Gac Sanit" "fecha" => "2010" "volumen" => "24" "numero" => "Suppl. 1" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21075491" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1808869415000981" "estado" => "S300" "issn" => "18088694" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="http://gacetasanitaria.org/es/la-privatizacion-gestion-sanitaria-efecto/articulo/S021391111400082X/">http://gacetasanitaria.org/es/la-privatizacion-gestion-sanitaria-efecto/articulo/S021391111400082X/</a> [acceso 12 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La privatización de la gestión sanitaria: efecto secundario de la crisis y síntoma de mal gobierno. Informe SESPAS 2014" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "F.I. Sánchez-Martínez" 1 => "J.M. Abellán-Perpiñán" 2 => "J. Oliva-Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2014.02.019" "Revista" => array:7 [ "tituloSerie" => "Gac Sanit" "fecha" => "2014" "volumen" => "28" "numero" => "Suppl. 1" "paginaInicial" => "75" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24863997" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Los debates se concretan: la universalidad revertida en el sistema español de salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.I. García Rodríguez" 1 => "L. Biedma Velázquez" 2 => "R. Serrano del Rosal" 3 => "J. Ranchal Romero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Index Enferm [Internet]" "fecha" => "2017" "volumen" => "26" "paginaInicial" => "195" "paginaFinal" => "199" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La reforma sanitaria en España: Especial referencia a la población inmigrante en situación administrativa irregular" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. Fernández Huerta" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eunomía Revista en Cultura de la Legalidad" "fecha" => "2013" "volumen" => "5" "paginaInicial" => "95" "paginaFinal" => "115" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en <a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573908/EPRS_BRI(2016)573908_EN.pdf">http://www.europarl.europa.eu/RegData/etudes/BRIE/2016/573908/EPRS_BRI(2016)573908_EN.pdf</a> [acceso 12 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The public health dimensión of the European migrant crisis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Scholz" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "titulo" => "European Parliamentary Research Service. PE 573.908" "fecha" => "2016" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en <a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="http://www.econ.upf.edu/~ortun/publicacions/paper28.pdf">http://www.econ.upf.edu/∼ortun/publicacions/paper28.pdf</a> [acceso 15 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sistema Sanitario y estado de bienestar ¿Todo para todos?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "V. Ortún" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Ética y Gestión Sanitaria." "paginaInicial" => "95" "paginaFinal" => "124" "serieFecha" => "2000" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en: <a class="elsevierStyleInterRef" target="_blank" id="intr0035" href="http://www.archbronconeumol.org/es-envejecimiento-cronicidad-atencion-neumologica-articulo-S0300289615000940">http://www.archbronconeumol.org/es-envejecimiento-cronicidad-atencion-neumologica-articulo-S0300289615000940</a> [acceso 15 May 2018]" "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P. De Lucas-Ramos" 1 => "J.M. Rodriguez Gonzalez-Moro" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Envejecimiento, cronicidad y atención neumológica" "fecha" => "2015" "volumen" => "51" "paginaInicial" => "369" "paginaFinal" => "426" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Disponible en <a class="elsevierStyleInterRef" target="_blank" id="intr0040" href="https://www.ibsalut.es/ibsalut/es/ciudadania/plan-de-cronicidad-2016-2021">https://www.ibsalut.es/ibsalut/es/ciudadania/plan-de-cronicidad-2016-2021</a> [acceso 20 May 2018]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plan de atención a las personas con enfermedades crónicas (2016-2021). El reto del sistema sanitario. Palma de Mallorca: Conselleria de Salut" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Miguélez Chamorro" 1 => "J. Fuster Culebras" 2 => "P. Gómez Picard" 3 => "F.M. 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Journal Information
Vol. 28. Issue 4.
Pages 217-219 (July - August 2018)
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Vol. 28. Issue 4.
Pages 217-219 (July - August 2018)
Editorial
Responsibility in policy and management: Today's decisions determine the future
Responsabilidad en política y gestión: las decisiones de hoy condicionan el futuro
Patricia Gómez Picard
Consejería de Salud, Illes Balears, Spain
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