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Posts Tagged ‘primary care’

And it looks like we are losing the battle. According to “Healthcare expenditure statistics” from Eurostat, “[The] highest share [of total healthcare expenditure] of current healthcare expenditure [related to preventive care] in 2014 was recorded in Italy and the United Kingdom (both 4.1 %), while at the other end of the range, shares of less than 1.0 % were recorded in Romania (0.8 %) and Cyprus (0.6 %).” At the other end “curative care and rehabilitative care services incurred more than 50.0 % of current healthcare expenditure in the vast majority of EU Member States”

It may be that this is the right balance, but allow me to doubt it. And my doubts grow as I focus on the demographic change taking place in Europe. The baby-boomers are getting older and we are not doing anything about it, despite the fact that it is probably a generation ready to embrace a healthier and more active life than previous older generations.

I have been wondering, since I started working for the healthcare and social sectors, why it is that prevention does not get the attention of our policy makers.

Many explanations come to mind. Of course, simply saying “they are stupid” is the easy one but I refuse to fall for it. I strongly feel that anybody who has attained a position of responsibility may have many faults, but being stupid cannot be one of them; they would never have reached that position of responsibility.

The urgency of solving the immediate problem may be one of the reasons; after all, if somebody has an acute illness something urgent has to be done. It is a plausible explanation but, if that were the case, policy makers would never plan for the future building new roads or housing developments since they would be too busy repairing the existing road network or the old houses in inner cities.

I am afraid that highways are built because they make the news. I am afraid that most of the things that our policy makers do are geared towards a 30 second appearance in prime time national TV news. If that assumption is right, then it is clear that the opening of a new hospital (curative and rehabilitative care) is a better news item than the establishment of a prevention scheme that does not require any new buildings, or any new expensive and photogenic equipment. It requires only brains and hands, probably the least photogenic tools of the healthcare process and, probably too, the most ignored by policy makers.

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This is a real story of a real person in a real country that, I am afraid, can be replicated across many other countries in Europe. It is a story about cuts in healthcare services and its real influences in overall expending for the Government and for the people.

Mr. XXX is a manual worker whose job implies using his arms to move thing around. After several months of feeling that his right arm was hurting, he went to visit the primary care doctor. The diagnosis was clear: a strong tendinitis that prevents him from performing  his duties until he is properly treated. So the primary care physician sent him to the traumatologist for consultation and further treatment.

And here the nightmare starts. Due to cuts in healthcare personnel, the waiting list for traumatology is such that Mr. XXX receives an appointment for 90 days from now. What are the implications? First, Mr XXX cannot work and he will be on sick leave for at least the next three months. He will be paid  by the social security a percentage of his salary, with a complement by his employer to make up for the basic 100% of his salary. Secondly, his employer will have to employ another person to fulfil Mr. XXX duties.

So the outcome is that, by cutting back on personnel disregarding the actual demand, the health service has prompted an increase on the social security budget and at the employer’sexpense, while Mr. XXX lies in bed weighing to be taken care of!

Are these the savings that we are aiming for? I certainly doubt it.

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Efficacy in the provision of care coupled with efficient use of scarce resources is the goal of any social and health care system. Or is it?

Governments feel hijacked by their constituencies. They feel the need to provide quick answers to problems that, in most cases, their constituencies are not even aware of. Politicians feel the need to do something, and that something has to be readily visible. If you were an average  politician, what would you prefer? A front page picture in the paper of the inauguration of a hospital, or a long interview in the middle pages explaining how you have bet on primary care? You can fill in the blank ________________.

And yet, we all use a lot more primary care services than those of an acute hospital, no matter if we are young or old. We rely for our well-being on proximity services: social and health primary care. Only on extreme occasions do we use an acute setting.

Furthermore, primary care is focused on prevention, as opposed to remedial actions provided by acute hospitals. To top it off, prevention is recognized as the basic pillar of efficacy in care and efficiency in the use of resources.

And then, why is it that prevention is the black swan of care? I can only think of one answer and it is not a pretty one: our politicians need quick fixes and they have neither the knowledge nor the willingness to confront complicated problems.

Can we do something about this? I would like to think that we can. The constituents, or in other words the professionals and users of the socio-health system, should make their voices heard loud and clear: we would like a system that helps us to prevent ailments, not a system that only takes care of us when it is too late.

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