of the situation in Spain
Spanish constitution, the most important law, establishes the following in
“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
Then has begun what a French doctor once called the “third
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
Today the “third age” starts with 65 years. This number refers to the
social order and can vary permanently.
example for this is the following statistic:
Older than 65
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.
to some studies from 2002 from the Center
Spanish people reach a marking of 9,8 of 10 points referring to health. But they
only reach 8,1 points in economic wealth.
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
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
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
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
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”.
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
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.
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
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
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
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
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.
there has to be an adequate upper limit for co-payment to protect those who are
Julio Barrera Garcia
Lecture about the health care system by VII parliament of the CEOMA
of the bill of the lay of dependency. V parliament of the CEOMA (2003)