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Comment by antr | Hacker News Reader

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...

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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.

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.

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)

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.

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".

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