Dr BALCELLS: The strategy for exiting the crisis of the catalan health system

7 11 2011

Manel Balcells i Díaz

Director of the area of the knowledge of the Consorci Sanitari of Terrassa

Introduction
The health system is in crisis. Across Europe in general and in Catalonia particularly. The global economic crisis affects directly the cuts all countries apply to their health systems. The impact is, but, very different according to the starting point. In the United States, the debate has been very different. There has been a discussion of model that has become an instrument of political struggle between Democrats and Republicans. In emerging countries, Naturally, the problem is very different, and they are far from reaching what is known as our European welfare State.

In our case, fully immersed in the European reality, the crisis lies, especially, the sustainability of a system that shows ever more sophisticated and technological, You must attend an older population, with chronic pluripatologias, and that it had greater expectations of life, and above all, higher life quality.In Catalonia, the general infrafinanciacion and above all the health (1/3 of the total budget of the Generalitat), entails that in times of crisis and economic recession, general budget cuts do not affect more crude and obvious to the health system.

Our system is internationally recognized for its quality of care and the high level of its researchers and biomedical research that is generally practiced. The current lack of resources and the presumable continuity of the economic situation, It makes it necessary to pose rather than conjunctural character changes, but real structural changes.

We are talking about, because, make a change of paradigm, consider the health system, not only as a cost center, but, and above all, as a generator of wealth, so direct and indirect jobs, and also, as a dynamic instrument of the new economy based on medical technologies, in the spin-off from hospitals and research centers, and as a system capable of generating economic return to base to exploit knowledge in the form of patents and licences.

Some data
I system + (D) + catalan i is at the international level in terms of the volume of scientific publications. In fact, el 50% all of them refer to the biomedical research. According to the Citation Index Sience (SCI), in 2006, las 1.793 Catalan publications represented the 25% all of the State Spanish, el 2,5% the European votheme and the 0,9% of the world. And in terms of quality as measured by the so-called impact Factor, the global era of 6.189, with an average per item of 3.4. Therefore, Catalonia is an advantageous position on the international scene.

On the other hand, the number of patents generated by this knowledge is much lower in comparison with other European countries, and of course the U.S.. Spain represents the 1.4% of the total number of patent applications in the European Union, faced with the 44.1% of Germany and the 15.4% of France. In 2008, for example, in Catalonia they processed 75 patent applications, they counted 22 licences to companies, representing this the 38% patent and the 30% the set of the Spanish State license. Similar is the creation of enterprises Statistics.

We find ourselves, Therefore, to a considerable disproportion between the scientific production and the generation of economic activity. The weak point in our House, of the entire value chain is, because, the appraisal and transfer of knowledge.

Potential of innovation in hospitals
In Catalonia we have an excellent hospital network. Not only to the level of care, but also in scientific production. In fact, of the 10 hospitals statewide leaders in scientific production 6 they are Catalan and, In addition, located at the top. This great production and at the same time high level, it pivots in a binomial hospital-universidad by the research institutes located in large hospitals, where is performed as basic research and translational.

However, innovation, everything in medical technologies, in diagnostic imaging, health care processes and clinical management, It also pivots in the whole of the hospital network of Catalonia, where work more than 232.000 Professional, most of them, with a high academic qualification and long tradition of presence in international networks.

Multiple studies led by prestigious business schools, and recently the OECD report “Rewiews of Regional Innovation: Catalonia, Spain (2010)”, I pointed out that the catalan cluster is among five to ten first clusters in the world in terms of the dynamism of your network. Within the report, It also remarked the great potential of innovation in hospitals, with all that represents of immediacy in their applicability and subsequent marketing in the case, for example, new diagnostic and therapeutic techniques.

This environment represents a moment of opportunity, precisely, to try to convert our potential in biomedical knowledge in economic return direct to the system in general, as they are known and various countries. It is here where is the key to the involvement of the sector in the output of the current crisis.

Structural changes
Paradoxically, at a time of budget cuts, We must promote the creation of technology transfer instruments. If only to reduce spending, without above all based on the binomial cost-effective changes, everything will be useless. In order to make these changes, There are to innovate. And not only to innovate, but the technological improvements that mean savings, After a process of validation, and subsequent recovery and marketing.

We must introduce elements of competitive dialogue among technology buyers (hospitals) and innovative companies (Catalan or other parts implanted here), allow increase the productive fabric. With elements such as the innovative public procurement, This is possible.

I speak, because, changes in depth. Medium-term structural changes that allow us to have, as other countries do, centralized units of valorisation of innovation, and marketing their patents. I speak also of bringing venture capital to projects and leverage, If necessary, to them with public money, especially in the more early stages of development. However, We will always be dependent on joints and multinationals, and above all always restrictive budgets.

Proposals for the future
This is a future that should be present. The enormous economic potential of our health system (even trimmed) allows you to meet these challenges. Immediately would have to raise recovery instruments, After progressively introduce the methodology of innovation opened in our hospitals.

We must encourage entrepreneurship from the faculties of medicine and nursing, develop specific training programmes for accompaniment by professionals with innovative concern, with ideas that can become projects. A programme for hospital innovation must be urgently and must be developed in a way had the charge of all health centres.

Must be articulate immediately a (or more) capital funds willing to finance projects at early stage. Must be articulate public-private participation in all the projects with possibilities of reaching the market in an organized manner. All of this, in a participatory way, funded and urgent, with the complicity of all economic and social agents, and with international vision.

Conclusions
Underfunded economically, and with a sector and health system which is undergoing significant cuts, and at the same time presents great strengths in knowledge, It is time to make this sector an emerging economic sector.

Missing all these instruments that enable it to reverse a situation sufficiently analysed by all experts. There are, In short, that have the vision to invest in everything that represents the transfer of technology in this sector, If I want to get out, in a determined manner and medium-term, economic dependence on others, create jobs, attracting capital and help at the exit of the general crisis.

We have an opportunity. Who is capable of working in this line, to do so. For the sake of the country.


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