To talk about the National Health System (SNS), a pillar of the Spanish society and its way of living, is to do so about the health of its population, that is, a basic right in the pyramid of people’s needs. In short, health and SNS are stories of life and topicality. This sets up a sector that demands immediacy and is reluctant to enter a framework of reflection focused on the long term. And it is this short-term disposition that the concept of sustainability has to deal with.
In a recent interview published in the ABC newspaper, cardiologist Valentín Fuster made the following reflection: “For years we have worked in the science of disease and now we must do so in health science, with the same technology and science. Promoting health is going to be much cheaper than treating the disease.” Fuster highlights the idea of, prevention, and connects with the theory of sustainability.
How can this scenario be managed by the political sphere? There is no single solution, but the dynamic could be the overcoming of electoral logic and classical partisan “competition”. An example of this is the priorities that the new European Commission, led by Ursula von der Leyen, has set for the mandate it initiates, with health objectives as ambitious as the design and implementation of a European plan against cancer or the transformation digital transformation of simple care services.
With this, political and technical leaders face decisive challenges in the survival of the SNS. Without numbering them all, there are two that symbolize the requirement for structural changes that will entail big changes of the organizational structure of healthcare. These are the coverage of mental health, by the change of care scheme, and the incorporation into public funding of T cell therapies with CAR (CAR-T), for their degree of innovation.
The first is challenge insofart is to transition from a care focused on the limited physical ailment, resolved with a limited series of standard medical appointments and the corresponding pharmacological prescription, to one aimed at balancing a person and their environment, “I am me and my circumstances”, as José Ortega y Gasset wrote, resolved with personalized psychological attention and by an indefinite horizon. How will this paradigm shift be funded? The solution may be to promote digital tools such as telecare or the collaboration with private healthcare, be public aid in the terms of financing of private provision, for example, a fundamental part of the health system. Advantages? This change will primarily affect young patients, increasingly demanding psychological care, who are digital native.
The second challenge refers to CAR-T therapies, state-of-the-art oncological immunotherapy capable of curing hitherto deadly diseases, and their incorporation into the Basic Portfolio of SNS and Pharmacy Services. As of 2019, the Ministry of Health, Consumer and Social Welfare made it possible (after a process of accreditation of health centers with the Autonomous Communities) that certain Spanish hospitals would treat patients with these innovative therapies. The dilemma for the public health system lies in the high cost of care per patient, the low popularity of fiscally increasing measures and the consequent need to restrict access to therapies that can cure cancer, to very structured medical treatment. As in the previous case, coordination between public research (a team from Puerta de Hierro-Majadahonda University Hospital has already developed the first public CAR-T, drug NC1) and private one will be essential in managing this disjunction. In the background there is a whole open debate on the funding model and the relationship between the General Administration of the State and the Autonomous Communities, which owns much of the health rights.
In conclusion, the next decade presents for the SNS a series of challenges that will test the very survival of the model that transcend legislatures. Thus, it is necessary that the political-technical debate on sustainability start from a holistic view of the approach to health, by finding mixed formulas of action between public and private resources.
