Observation of the situation in Spain
The Spanish constitution, the most important law, establishes the following in article 14: “All humans are equal before the law. Therefore it is not legal to penalize anybody because of his ancestry, his race, his gender,…”
That means no one may be treated harmfully because of his age, because we are all members of this society.
The White Paper for the European Constitution which finally didn’t come off, says in article II-81 that “Discrimination because of gender, race, color of the skin, handicap, AGE, …” is illegal.
The bill determines that all men and women who define this society are equal before the law.
In a natural way one reaches an age in which one doesn’t decide to retire because of just wanting to but because of reasons of life expectancy.
It is all human that strengths decrease and that vital energy degenerates.
Then has begun what a French doctor once called the “third age”.
At this age one sickens faster and the risk to infect increases.
One is in need of medical care to obtain quality of life as long as possible.
Today the “third age” starts with 65 years. This number refers to the social order and can vary permanently.
An example for this is the following statistic:
YEAR 1960 2004
Complete population 30.528.539 43.197.684
Older than 65 2.505.165(8,20%) 7.301.009(17,87%)
Besides the latest numbers of life expectancy are 75 years for men and 83 years for women.
Aging of society, decline in the birth rate and the increase of life expectancy influence the premises of well being.
At this point preferences add to the game of worries about how our way of living changes when we enter a new period of life.
According to some studies from 2002 from the Center of Socio-Scientific Research, Spanish people reach a marking of 9,8 of 10 points referring to health. But they only reach 8,1 points in economic wealth.
This change of the age of the population causes consequences for the national budget because it has to pay back to the pensioner what he had paid in during his working life.
So now we are on a way on which it will be much harder to uphold an equilibrium in the budget.
But if one adds all costs for one pensioner it strikes that the mayor part is paid for health: Doctors, pensions, medicaments, hospitals, mobile medical services.
However almost no one talks about this part just like parts not related to the health care system (hotel, communication sector, textile industry). Here pensioners assure earnings and jobs.
They cause tax receipts with pensions, social insurance contributions and sales taxes.
If we refer this demonstration to general cases of discrimination of older people we find a trend not to attend to these people.
That follows from discrimination of older people in many cases: Younger people are favored clearly.
However worse is institutional discrimination. One example for it is the fact that the Spanish health care system is adapted very slowly to the changing situation, like mentioned before: Aging of the population, proceeding integration of women into the work environment, decline of birth rate because financial coverage by the state is missing.
A first consideration facing the passivity of the Spanish health care system leads to the conclusion that there are missing professional manners of dealing with aging.
Concretely that means that there is a lack of medical specialists of geriatrics. In the group of specialists (doctors, surgeons, diagnosticians, therapists) their number is:
Cero specialist of geriatrics.
The same happens at the emergency room and at the criteria which decides how urgent a patient needs treatment. There is a lack of beds.
At the moment “even older people” are treating and visiting “old people”. The question arises: Who will take care of the “old people” tomorrow? The answer is that we have to prepare a solution to this problem now.
We also have to include the changes in society. Just like parents took care of their children those have to take care of their parents when they are aging.
Therefore we feel bound to eliminate sanitary and economic effects.
The law for encouragement of personal autonomy and attention for those who are in dependency from 14th of December 2006 shall ease sanitary incidents because this situation affects the “older people”.
In Spain this law was allotted very late. Different points were worked over and over again and written out.
One reason therefore was the fear that a huge part of public funds would be used for that. That would endanger economic stability and the sustainability of the welfare state.
That approach leads to the area of sustainability. We have to admit that this is a difficult problem if one wants to solve it in a realistic way because it combines the discrimination of the “older people” in the health care system and the sustainability of financing of pensions.
However this law also determines that the beneficiary has to participate in financing of benefits, according to the manner and the costs of the service and their personal economic possibilities.
The way (or one way) to realize this law is co-payment because this can be the justest way, too.
The first ideas of co-payment consider about 80% of the costs.
The model that is taken into consideration plans a co-payment for a stay in a day care for older people of 75% from the pension of the beneficiary.
The left over of the pension is available for the retiree as “pocket-money”.
But the manner the medical attendance is financed affiliates to the financing of protection of dependency. It must be ensured that it is sustainable and the beneficiary has to get aware of the fact that his personal participation is necessary to assure his future.
When financial resources run short the marketing has to be checked. Because the marketing is responsible for if benefits are bad or deficient of if the price has to be hiked.
The co-payment downsizes the unnecessary use of benefits, upgrades the capacity of public services, gives away benefits accordingly as the need arises and reduces financial pressure on the population in general because the one who engages benefits has to pay. Furthermore social conflicts caused by fiscal discrimination are prevented.
Ways of solving this problem are rare: direct or indirect taxes, transfer of the cost to other budgetary items, social service contributions or fees.
Because of observation and consideration of the law of dependency the Spanish Group Of Retired Staff And Pensioners defends different points of co-payment. In cases of hardship all Spanish have the right to use the funds of the law without co-payment.
In case of the following situations one has to participate in payment: medical attendance witch isn’t done by a specialist, social services by family, culture, spare time.
The next step has to be to limit the percentage of co-payment by an upper limit.
This upper limit has to be the maximum and not the average. Here a maximum participation of the beneficiary of 30% or 33% is destined. That is based upon the characteristic of the law which is universal. But if, for example, the total costs amount 100% and if there is more than one beneficiary one of them would have to pay for himself and the others who have preferential treatment and who aren’t able to pay for themselves because of economic reasons.
Considering what I reported about discrimination of “older people” in the health care system and the startup of the law for protection of dependency, the claim for sustainability raises.
A business consultant of the prime minister estimates that if we stick to the current system of sharing the payment of contributions and if we increase the costs for medical care and social services, we’ll reach a point in 2015, where it won’t be possible to increase them anymore.
Here the reserve fund is already included.
This concern isn’t new because studies to this issue have signalized such a scenario.
That raises the question for a system that incolces the capitalization of pensions, extension of warking life and the setback of the age of retirement.
It is necessary to plan pensions during the whole working life.
We personally agree with this idea, it seems to be realizable. The problem we see is a political one, because we must not forget that the group of people who are older than 65 years amounts more than 8 million voters.
CONCLUSION:
A) We pick up the commendation of the commission of doctors of the European Union. It says: ”… the rights of the elderly are identical to those of the rest of the population. Older fellow citizens have to have the same access to the health care system like anyone else, without any limitation.
B) The capable reform of the actual system for financing the pensions and national insurance has to be analyzed. There have to be better benefits which avoid discrimination of the elderly in the health care system.
Furthermore there has to be an adequate upper limit for co-payment to protect those who are dependent.
Julio Barrera Garcia
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References: Lecture about the health care system by VII parliament of the CEOMA (2005).
Concept of the bill of the lay of dependency. V parliament of the CEOMA (2003)
