The schedule of Pablo Crespo, secretary general of Fenin, is complicated, which is why he calls us to his office to optimize time. A Law graduate with several master's degrees to his name, he was a lawyer for the Spanish Agency of Medicines and has held various positions at Fenin, where he was first director of the legal department and, subsequently, Chief Operating Officer before assuming his current role. He knows perfectly well what messages he wants to convey and, in a few minutes, intersperses them in a very reasoned discourse.
QUESTION. How to position the health technology sector as a strategic sector for healthcare and for the country?
ANSWER. All of us who work in the healthcare system, including citizens, are aware that without health technology, the healthcare system simply does not work. Entering a hospital means seeing technology from the very first moment: when you have a blood test, when you have an X-ray, and, above all, also when you are receiving care throughout your hospital stay.
But there is also increasingly more technology present in the home environment: we have continuous glucose monitors that allow us to monitor when a diabetic patient may have any fluctuations in their glucose, or a portable oxygen concentrator that allows a grandfather to go see his grandchildren after school.
Therefore, technology is present throughout the entire value chain in the healthcare field. We know that technology allows people to live and also allows people to have a good quality of life. Let's think, for example, about a wheelchair, which allows a person with a spinal cord injury to move. Or, for example, a hip prosthesis, which allows a person to walk again. Or an intraocular lens, which allows a person to see and to eat fish because they are not at risk of not seeing a bone.
Technology is decisive for the way we live and coexist with illness. But it is also very important from an economic point of view: we are a sector that invoices 12.7 billion euros, exports 5 billion euros, generates 6 billion euros in gross value added to the Spanish economy, and 6.4 billion euros in indirect and induced value added.
And that for every euro invested in the Spanish economy, we generate 1.27 euros. On the other hand, we generate 55,600 direct jobs and more than 80,000 indirect jobs, with a cost per employee in our sector that doubles the average of the Spanish economy. We have 46% female employment, 3% employment for people with disabilities… All these figures exceeding the average of the Spanish economy. In short, we are a sector that improves life, that makes people live, and, above all, we also generate a very positive impact on our country's economy.
Q. In this very complicated geopolitical context, from Fenin, you insist a lot on the need to index public contracts. What does this measure consist of?
A. It consists of guaranteeing the medium-term viability of public contracts that our sector has with the public administration: companies submit a bid for a public tender on a specific day, with a specific geopolitical and economic situation, but then we are seeing that the situation is becoming increasingly complicated, more unstable and unpredictable. We have had pandemics, we have had 'Filomenas', we have had wars in Ukraine and now in the Middle East, and all this situation generates very significant economic volatility: in the last 5 years, the accumulated CPI has been 20.8% and, in a context where contracts cannot be updated to costs, it means a decrease in the competitiveness of companies and in the capacity of companies to bring the highest quality technology to our country. These are challenges that we need to address as a system if we want to continue guaranteeing that our sector can provide the highest quality technology to patients, which is our purpose.
Q: Another area you advocate for is the need to boost national manufacturing to guarantee strategic autonomy. What lines are you working on in this regard?
R: We are in a geopolitical moment of protectionism, where we have now realized, globally, that it is important for strategic sectors to have industrial capabilities, such as ours, of course. And what we are doing is working with the Ministry of Industry to try to promote a national industry plan for our healthcare technology sector that favors investments, that favors us being able to continue investing in manufacturing plants, and that allows us to have more industrial capacity. And in our two major industrial hubs, which are the Community of Madrid and Catalonia, we are implementing two specific plans with them to try to encourage companies to invest in these territories or for current investments to be expanded.
P: In addition to this industry law, they are requesting a specific healthcare technology law. But differentiated from the pharmaceutical one. Why this differentiation?
R: Historically, our regulation has been heavily influenced by pharmaceutical legislation. And our sector is very different from the pharmaceutical sector, so they require different legislative approaches. We are not asking for a specific healthcare technology law; it is not necessary. What is needed is that there be a differentiation within a regulation between both sectors. And it seems that the Preliminary Draft Law on Medicines and Health Products that is being processed, according to what we are told by the Ministry of Health, will perfectly capture in its wording that differentiation between the sector of medicines - which must have its regulation - and that of our sector, which must be different. Because our sector is different, there are no generics, and it is a sector where the innovation cycle is much shorter than that of the pharmaceutical sector. And in our sector, there is a lot of service, such as equipment maintenance or technical assistance to operating rooms. That is to say, there are a series of intrinsic peculiarities to healthcare technology that make it very different from the pharmaceutical sector. And we need different legislative approaches.
P: Another of your demands is value-based procurement. What has been done well in this area and what needs to continue to be promoted to develop it?
R: We went through very complicated years after the financial crisis. The budgetary tensions that existed and the Government's inability to continue incurring the deficit put a lot of pressure on the purchasing policies of the autonomous communities. There was a very short-sighted vision, where price was the only determining factor in many cases for the acquisition of technology.
We know that this was not the most appropriate from the point of view of promoting the quality of the healthcare system, of obtaining the best health outcomes. And, therefore, neither was the generation of efficiencies. Because there is nothing more efficient than early diagnosis, accurate diagnosis, and effective treatment. And that is done with the best technology, which does not necessarily have to be the cheapest. Therefore, what we advocate and promote is that quality criteria should guide the decision-making process of what technology is incorporated into the system.
In this regard, what things have been done well? We have done our bit: we have launched a guide for efficient public procurement of health technology with the purchasing leaders of all the autonomous communities, which has allowed us to see how we can move towards more value-oriented purchasing. A much more strategic purchase, a purchase where the incorporation of innovation allows the healthcare system to be transformed and allows the way patients are treated, cared for, and their quality of life to be improved.
And I would like to recognize an initiative that the Government has also launched, in the Preliminary Draft Law on Medicines and Health Products, where a limitation of the price criterion to 20% of health technology is established. That is to say, that health technology will not be able to be acquired - if this law is approved - using more than 20% of the price criterion, which means that 80% will be quality criteria. And this is very important, because it is the greatest guarantee that we will continue to promote a quality public healthcare system.
Q: We end up talking about another of Fenin's main lines of work, which is to reduce the obsolescence of the technological park with a medium and long-term plan to incorporate and renew equipment. What is the status of this plan?
A: Obsolescence was an endemic and systemic problem in our hospitals, which coexisted with unsustainable levels of technological obsolescence; we were at the bottom of Europe. The truth is that, in recent years, we have seen, after the INVEAT plan – which involved an investment of 796 million euros from European funds, with 851 pieces of equipment – it has had some continuity with AMAT-I plans, which Ingesa is carrying out with great success and in which the autonomous communities participate.
We are also seeing how the autonomous communities are already taking into account that technology is something strategic and structural for the system and it is what truly allows them to improve productivity, improve health outcomes, and improve the efficiency with which they provide healthcare services to patients.
Therefore, I believe we are in a better moment. It is true that today a culture of investment is beginning to emerge that does not consider obsolescence as a possibility, but there is still much to be done. We have a healthcare technology system that is clearly underfunded. We need more investment to avoid obsolescence. Because obsolescence is inefficient.
Q: Any final message?
A: Thank you journalists for the work you do, for disseminating the value that our sector brings, for disseminating the value that healthcare technology brings. And I encourage all healthcare managers to work together to improve people's health and quality of life.
From the sector, we will continue to invest to improve our technologies, to improve how the management of health data – through our devices – can help professionals make decisions. And most importantly, that we have the best care for our citizens.
IN DETAIL
Crespo's office is on the corner, with natural light flooding everything, softened by the treetops of Madrid's Salamanca neighborhood, a few days before the heat floods everything. Few decorative details: a porcelain Tower of Hercules from Sargadelos, a souvenir from a conference held in La Coruña; some figures from Ecuador brought to him by his namesake from the American country, or a replica of one of the first Spanish industrial valves manufactured by Dräger. Summer holidays are near and he has set himself the task of choosing what readings will accompany him then. Now it is impossible, between meetings and work lunches and dinners.