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Comment by JaumeGreen | Hacker News Reader

> "Primary care is essentially provided by public providers, specialized family doctors and staff nurses, who provide preventive services to children, women and elderly patients, and acute and chronic care,"

The public healthcare here in Spain has an endemic problem of ever reducing budgets, and it's so saturated (because of that) that most people that can also get private healthcare. When politicians touch that is to reduce the budget even further.

Yet people think that the main problems in Spain are other things... damn the propaganda machine.

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Indeed, the public healthcare system in Spain, while still great compared to most of the world, is a shadow of what it once was, with the rampant privatization done by the Government in the last decade. A really sad situation. That being said, decent private healthcare here is about 100€/month, so while private healthcare is still considered "a luxury" (because public one is pretty good), it's still very very far from the cost of US private healthcare.

Rampant privatization?

Spain's public healthcare expenditure[1] was:

    38.552 €bn in 2002, and
    66.678 €bn in 2016 (latest official year),

this is a 73% increase in 14 years.

On other hand while population was

    41.31 m in 2002, and
    46.48 m in 2016,

A 13% increase. This is a 53% net increase in expenditure per capita. I'm curious to know what "rampant privatization" to you means, as government/public expenditure has by no means slowed down, quite the contrary.

In my opinion, healthcare expenditure is out of control. But that is a completely different debate.

[1] http://www.mscbs.gob.es/en/estadEstudios/estadisticas/inforR...

I'm curious to know what "rampant privatization" to you means, as government/public expenditure has by no means slowed down, quite the contrary.

I don't know about Spain, but at least in Sweden there's an argument that the increase in privatization in the health care sector has resulted in higher costs (and thus higher government expenditure) without matching improvement in heath care outcomes.

Are those numbers inflation-adjusted?

Raw expenditure tells us nothing about whether or not it has been privatised, too. Often the privatised services are more expensive - after all, they have to pay dividends.

1. the numbers are government healthcare expenditure, not private healthcare expenditure

2. CPI won't change a the bottom line take-away. Feel free to run the numbers.

1. the numbers are government healthcare expenditure, not private healthcare expenditure

Sure, but what percentage of that government expenditure is going to private health care providers? And how has that number changed over time?

Please refer to the url provided, it's there for a reason

I tried, but as someone not familiar with the intricacies of the Spanish health care system (or the Spanish language for that matter) the numbers are tricky to parse out.

So, you don't take into account inflation, not GDP per capita grow, not population ageing, but the take-away should be the same.

There is an argument made towards "rampant privatisation", i.e. a transfer of a business from public to private control. However, data shows that government expenditure has increased above CPI, the driver of prices (not an output like "GDP per capita", which for some reason you refer too as an economic driver of sorts). I cannot observe, from official data the I link to, a slow down in public healthcare investment by the Spanish government, and definitely not an increase in expenses due to the Government paying private healthcare players. Feel free to dive into the data and indicate otherwise. I'm not here for armchair politics.

The data you request (if I'm reading it correctly) is in your link, in the "2002-2016 series" document, page 9, point 3.3

The transference to the private sector in 2002 (thousands of Euros): 25017

In 2010 (the highest of the serie): 81997

In 2016: 54913

I didn't say the "rampant privatization" thing, but, as you can see, the spending more than doubled. Should we take into account the inflation here or not?

GDP per capita is, I think, important as an answer to your opinion of "expenditure is out of control" by the way.

>>"I'm not here for armchair politics."

Good to know, but until where I can see, we were discussing numbers not politics.

EDIT: I keep reading and that data is not right. The number are low, but I can't make sense of the tables. It would take a while to understand it. The good news is the data is there.

Page 6.

Page 9 is central administrative costs, and then, if we put your private expenditure figure into perspective: in 2010 (highest of the series) private costs were €82m vs €69,000m total healthcare costs in 2010. That is a 0.12%

Out of interest i did a very rough calculation of what inflation-adjusted numbers might look like. I pulled 4% per year inflation out of my ear, and came up with:

    38.552 €bn * 1.04^(2016-2002)
    =>
    66.76 €bn

..which is uncannily close to your numbers. Inflation probably wasn't exactly 4% YoY, but if it is, then in real Euros, the expenditure per population has decreased.

Please be a bit more serious, change rate between 2002-2016 is closer to 30%. If you want to make up numbers and conclusions be my guest. I'm not here to play Trump-mathematics

The average inflation was closer to 2% according to https://www.inflation.eu/inflation-rates/spain/historic-infl...

That plus a roughly 12% growth in population over that range.

Privatisation has nothing to do with reduction in government expenditure on healthcare: it's merely about where that expenditure goes.

As far as I've seen, privatisation seems to normally lead to increases in government expenditure: the US has the highest per capita federal health budgets in the world (and Switzerland, in second place, is far behind)

The US has the highest healthcare expenditure and the most privatization. I think I’m seeing a pattern.

Feel free to share with us another official source that shows that this increase in expenditure is a result of capital going to private players. There is a big difference between "seeing a pattern" and "believing in a pattern".

Don't know about Spain, but in some countries privatization means basically that functions that used to be handled by government employees or such are now handled by private enterprises, however the money still comes from public expenditure. The idea is that private enterprises are so much more efficient than government that they can do the same job cheaper while making profit at the same time. Not many success stories for the public in those cases.

When you compute per-capita expenditure in 2016 Euros, it's a rather more modest 20% increase.

€1191.25 per capita in 2002.

€1434.55 per capita in 2016.

So what are the main problems in Spain, according to what most people think? (I'm not very familiar with Spain)

National politics (Catalonia, etc). But there's also an endemic issue with spending on unnecessary infrastructure while underfunding heavily used infrastructure (such as public transportation in large cities); our budgets never seem to be able to reduce debt, and our pension system is doomed to explode, because eventually there will be more retired than working people.

Given that the life expectancy is so high maybe it makes sense to raise the retirement age here by a few years more.

Sadly, the political landscape has been pretty much monopolized by the Catalonian independence issue, with politicians using it as a smoke screen to cover way more important issues like constant corruption scandals, rampant privatization of health care, double-digit yearly increases in utility bills, housing rent bubble, etc.

Spanish healthcare is among the best in the world despite the problems.

Also, quite bold calling propaganda a report from United Nations analyzing population health. What do other problems the country has have to do with the people health?

Maybe your comment contains some propaganda too.

I think you misundertood my comment.

Propaganda is what is done in Spain to make people look at fake problems instead of the real ones.

I don't think this report is propaganda.

I know you are not saying the report is propaganda, but I understand you mean appearing in media is.

What I am saying is that besides the intention of the article (which is Bloomberg giving UN results) these are facts.

Seeing this facts stated might help others and it does not mean stop fighting for other causes in the country.

> I know you are not saying the report is propaganda, but I understand you mean appearing in media is.

No, I do not mean what you are saying.

I was talking about what is on the newspapers these days on here:

* Catalonia

* Next general elections (on April)

* "Minor" cases of corruption (relative to others in either money amount or the person affected)

* Football (Soccer for the people from USA)

* Venezuela

* "Famous" people (only famous because they appear on media as "famous")

* Bad migrants

* Memes

What is not talked about is:

* Mayor cases of corruption

* Dismantling of the public sector (before it was in big steps, now it is in small ones)

* Housing bubble (again)

* Low salaries

* Bad support to small entreperneurs

* The reasons why there are more migrants and what to do

I'm sorry. I keep seeing much more political intention in your comments than the article per se.

I didn't want to say anything more than what healthcare we've got is good, and it is despite the budget cuts. If I had wanted to introduce more politics I would have done so explicitly at the end of my comment, instead of a general lament. So I'm sorry if that whas the impression I gave you.

On the other hand, and repeating myself: I do not attribute any political intention to the article at all. How many more times do I have to deny it? You not letting go of this act like some bad actors when doing clumsy manipulation of debates.

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