Prohibit, the buzzword

Prohibit, the Buzzword

In recent weeks, we have been getting to know the true mindset of the Minister of Health, Mónica García, and her controversial proposals on how to organize the medical community in the future of the national health system, as well as her vision of public-private collaboration, based on the situation of Muface. It doesn't surprise me, neither her stance nor her statements, but I do believe that we in the sector must present our position in the same way.

On one hand, we were already aware, from her political career, of the minister's position against public-private collaboration in general and the Muface model in particular. What has surprised me, and I think it is concerning in a political leader, is that she blames insurance companies for the crisis in the Muface model, when the only responsible party is her government, which is not interested in dialoguing and agreeing on a model with solid and future-oriented foundations. I have already mentioned it in this blog on other occasions: a responsible government must continuously audit the proper management of public funds in public-private collaboration models, and do so transparently, to maintain what works and undertake consensual reforms when necessary. Always with responsibility and thinking about the citizens and the guarantees of the quality healthcare they deserve.

What the minister can't do, nor any other political leader, is force companies to operate at a loss. Quality and excellence have a cost, and the lack of agreement can only be solved with more negotiation between the parties, understanding all points of view and putting the citizen at the center, not through interventionism or incendiary statements.

However, what has truly caught my attention and on which I would like to reflect more deeply in this blog entry, relates to the two most recent announcements by the minister regarding the professional career of doctors. On one hand, with the initiative, which is not new, that heads of service in public hospitals can only work for public healthcare and thus prevent any collaboration with private healthcare. On the other hand, the proposal included in the draft of the new Framework Statute to require MIRs to work 5 years in the public system. An absurdity and nonsense. I will now explain my point of view.

It is surprising that in a government that calls itself progressive, the verb prohibit is used for everything, instead of facilitating greater freedom and choice for citizens in general and healthcare professionals in particular. This government uses prohibitions to try to make citizens do what they consider appropriate based on their ideology and not the general interest or the opinion of the citizens. They improvise proposals and launch trial balloons, from what I see and hear, to generate conflict and divert attention from other controversial issues instead of focusing on solving the real problems we have been dragging for some time.

I must say that my stance is at the antipodes of what the minister suggests. In my opinion, the formula to strengthen the public sector is not to prohibit or prevent doctors from developing professionally, but quite the opposite. More flexibility should be introduced in resource management, including people management, which is key in healthcare, and also to bet on giving them the necessary leadership and prominence in decision-making in the system, since they are the ones who truly know the day-to-day care of patients. If the administrations provided them with the means to create value in the public system and introduced people management tools updated to what 21st-century professionals demand, it would be easier to attract and retain talent.

The system should evolve toward a more flexible, open model that adapts to change and what patients and professionals demand. Instead of prohibition, we must bet on the professionalization of the system, the delegation of responsibilities to professionals, and consensus on the model.

What this minister does is resort to formulas that have already proven ineffective in the past. If an excellent and capable professional wants to take on responsibilities in the public system but also develop in private healthcare, prohibiting the latter can lead them to discard their work in public healthcare, and it can lead to the decapitalization of the best professionals in the public system.

Meanwhile, regarding the MIRs, it is inconceivable that professionals who have studied at least six years of a degree, plus another year of MIR exam preparation, plus four years of work and training as a resident medical intern, can be forced to work five more years in the public system, in a sort of mandatory and captive contract. After at least 11 years of training and learning, and in such a vocational profession, where passion and effort are so important, their personal judgment should be enough to make the decisions they deem appropriate. Making "prisoners" of those you want to attract as professionals seems to me a terrible proposal.

I also don't understand why the minister wants to generate this type of debate when we have so many other unsolved problems on the table for years. Let's prioritize and be serious, please. While absurd proposals are being debated, waiting lists continue to grow, Primary Care is overwhelmed, technology is not being introduced at the necessary pace, and the system is beginning to show clear signs pointing to its exhaustion in effectively responding to citizens' needs.