The Catalan public healthcare system, widely regarded as high-performing, faces growing financial pressure due to an ageing population, rising technology costs, and constrained government funding. With healthcare costs increasing by 5–6% annually against a 3% rise in overall Generalitat spending, experts warn that reforms are urgently needed to maintain quality without increasing strain on the public purse.

Francesc Melcion and Joaquim Coello, healthcare professionals at Germans Trias i Pujol University Hospital, argue in a commentary published by Diari ARA that while the system's excellence stems from staff professionalism and a public-private innovation model, its sustainability is at risk. They highlight that the current structure has remained largely unchanged for decades, despite evolving medical and demographic demands.

The authors propose the creation of an expert commission to identify cost-saving measures that could simultaneously improve working conditions, including higher salaries for medical staff. They stress the need to move beyond political discourse and implement evidence-based reforms.

Potential Reforms to Contain Costs

The commentary outlines several practical steps to improve efficiency:

  • Reduce primary care costs by focusing only on essential services, preventing overflow into more expensive secondary care.
  • Cut pharmaceutical spending by dispensing only strictly necessary medications and reducing patent durations from 20 to 5 years, allowing earlier generic use.
  • Introduce co-payments for non-urgent primary care visits and non-essential treatments to discourage overuse.
  • Sell high-cost medical services to international patients to generate additional revenue.
  • Streamline hospital infrastructure by expanding existing facilities rather than building new ones within 30 km of every citizen.
  • Use digital technologies and treatment segmentation to optimise service delivery.
"The system requires an update after decades without changes. We should ask ourselves some questions,"

The authors acknowledge that some proposals, such as shortening pharmaceutical patents, require action at the European level. They call on Catalan authorities to advocate for such changes in the European Parliament.

Preserving a Vital Public Asset

Melcion and Coello emphasize that universal public healthcare remains a cornerstone of social cohesion, originally inspired by Bismarck’s 19th-century Prussian model and later developed through Churchill and Attlee’s post-war UK reforms. The Catalan system, established under Convergència with broad political support, now needs modernisation to remain viable.

They argue that protecting the system’s quality and accessibility means confronting its financial realities head on. "Reform is needed, but to move from ideas to plans, work must be done. And listen to the experts," they conclude.

Reported by en.ara.cat, Diari ARA.