The Gaspar Casal Foundation has raised this Tuesday the need to promote a State Pact for Health with a horizon of 2050, which will allow us to leave behind the current "reactive" model and move towards a "proactive, equitable, and transparent" system. The objective is to ensure the sustainability of the National Health System through strategic planning that guarantees the continuity of health projects beyond changes in government.
These conclusions come from the Evaluation Report of the National Health System presented by the entity, which examines the evolution of the system in the last decade around three main axes: institutional framework, health management, and budgetary execution.
The evaluation aims to guide long-term decisions in the face of challenges such as population aging, increased chronicity, lack of professionals, pressure on funding, the incorporation of new technologies, and health inequalities. The foundation's Project Director, Alicia del Llano, has stressed that these challenges "will not be resolved in one legislature," but rather require a "long-term vision."
For her part, the Head of Projects and Communication, Isabel Rodríguez, has explained that the report depicts a National Health System with "brutal human resilience and high technical capacity," but also with "structural cracks that demand immediate action."
In the institutional sphere, the study confirms that, in the last ten years, normative production has responded above all to the urgency of crises and the social demands of the moment, frequently resorting to Royal Decree-law instead of the ordinary legislative procedure. "We have used the law as a fire extinguisher, instead of as a long-term roadmap to address the structural challenges of society," Rodríguez pointed out.
Regarding health management, Rodríguez has insisted that human capital constitutes the "greatest asset" of the system. However, the report warns that hospital managements do not have the necessary stability to develop lasting strategic plans. "There are reference hospitals in Spain that have had up to four different managements in a single decade," she pointed out.
The territorial analysis also detects a persistent gender gap: only 29 percent of the management positions in the studied hospitals are occupied by women, despite the fact that they are the majority in Medicine, Nursing, and Pharmacy studies.
On the budgetary front, the document concludes that the SNS demonstrates a "remarkable capacity" to mobilize resources in crisis situations, but it carries "structural difficulties" in translating that spending into an effective modernization of the system. Among the "worrying" aspects, Rodríguez highlighted that barely 14 percent of healthcare spending is allocated to Primary Care (AP), considered a "pillar" of the system, and that the effort in research has remained below 25 percent in recent years.
Ten-point plan towards a State Pact on Health
"All this evidence concludes that the current model, based on reaction and short-term thinking, has exhausted its capacity to generate efficiency. Spain is facing a unique window of opportunity that we cannot let pass," Isabel Rodríguez emphasized.
In this framework, the Gaspar Casal Foundation argues that the sustainability of public healthcare in the coming decades "will not depend on inertially injecting more money into a rigid structure," but on "political courage" and "commitment" to "reform the rules of the game." With this premise, it proposes a ten-point plan of actions to move towards a State Pact for Health with a 2050 horizon.
The first line of action aims to ensure strategic stability and shield governance from the political cycle. To this end, it suggests institutionalizing ten-year planning frameworks that preserve the continuity of projects and strengthening the role of the Interterritorial Council of the National Health System (CISNS) as a stable coordination and governance body.
Likewise, the foundation calls for overcoming administrative fragmentation and articulating coordinated action that transforms the SNS from a model focused on repairing diseases towards a preventive system that guarantees the well-being of the population. In parallel, it advocates for the professionalization of healthcare management through a Manager's Statute that establishes mandatory technical accreditation, limits discretion in appointments, reduces high turnover in management positions, and contributes to closing the gender gap.
In relation to management, the decalogue calls for more transparency and accountability, mandating the publication of the curricula and competencies of the management teams of healthcare centers.
Another of the document's focal points is the evaluation of results. The foundation proposes that evaluation cease to be exceptional and become the norm that guides resource allocation. To this end, it suggests creating a national ecosystem of interoperable health data that allows for real-time analysis of the system's functioning.
To avoid purely reactive legislation, the report advocates for a regulatory framework that systematically accompanies scientific advancement and new social demands, so that laws are designed with criteria of rigor and sustained social benefit. Likewise, it calls for providing managers with tools that alleviate administrative rigidity, linking funding to the achievement of operational objectives.
The document also emphasizes the need to strengthen Primary Care and guarantee dedicated funding for this care level, with the aim of making it a "strategic, leading, and decisive axis." Finally, it urges the promotion of research, development, and innovation (R&D&I) through an increase in resources allocated to this field.
Pending Challenges for the Healthcare System
In a subsequent panel discussion, the director of the Gaspar Casal Foundation, Juan E. del Llano; the Doctor of Economics and Professor of Quantitative Methods in Economics and Management at the University of Las Palmas de Gran Canaria, Beatriz González; and the Emeritus Professor of the Department of Economics and Business at Pompeu Fabra University, Vicente Ortún, all members of the report's Advisory Council, delved into some of the system's main challenges.
González, who focused her presentation on the opinion of the Commission for Social and Economic Reconstruction, described the situation of Primary Care as being immersed in "turbulent seas," subjected to forces that "push upwards" and others that "hold it back." Among the latter, she mentioned the role of certain private universities that do not prioritize training in PC and the degree validation processes that allow professionals who are not family doctors to practice as such.
"What needs to be looked at is what catalyst Primary Care needs to emerge," he stated. At the same time, he pointed out that public health is experiencing a "great paradox": despite its relevance, the choice of this specialty has fallen in the MIR after the pandemic, while the Public Health Agency remains inoperative.
Del Llano, for his part, emphasized the role of public managers, demanding that they have adequate training, that their appointment does not respond to arbitrary criteria, and that they are obliged to be accountable, in coherence with the report's decalogue. In addition, he vindicated the role of health evaluation to "usefully inform" and "move to action."