The level of health provision and public health care achieved in the Basque Country in recent decades is high and this has produced a significant increase in life expectancy, free of disability. Public health is the social good most valued by citizens. However, the sustainability of the system is being questioned by the disproportionate increase in economic needs to guarantee the demands of the sector. In the social and health sector, the debate is similar, even though its structure and organization are even less developed.
The increase in economic needs derived from demographic change, but more especially that caused by the constant technological development (including pharmacy) are the two most important factors that determine the problem of the sustainability of the system.
The Basque public health system has focused especially on the value of accessibility for the citizen (health centers, nearby hospitals, and management of waiting lists to guarantee care without delay); It can be affirmed that important successes have been achieved in this section, a good network of general and regional hospitals by territory and health centers in each municipality. In any case, the problem of accessibility for specialized care continues to be an unresolved problem, and the management of the pandemic has also disrupted this system.
The development of Primary Care has been insufficient and has not adapted to sociological changes and their needs. Currently the model is not very effective, it stimulates consumerism, it is not decisive and it also does not meet the expectations of citizens and professionals.
In the 1980s, it was impossible for us to overcome the private doctor-patient relationship model to make professionals adapt to the public health system, identifying with it, but four decades later I am afraid that we have technologized the system to dangerous extremes .
The doctor-patient relationship is essential in healthcare, the placebo effect of this relationship is scientifically proven to affect more than 50% of recovery, even in such physiological issues as trauma to the bone structure. There is scientific research that shows that the mirror neurons of the brain have a fundamental role in the face-to-face relationship for the recovery of any disease. Mirror neurons are motor cells found in the premotor cortex and inferior parietal lobe of our brain. Mirror neurons make it possible for the brain to imitate not only the actions of others, but also their emotions. This is what makes human beings social creatures. Scientists believe that there are approximately 1,000 mirror neurons in every cubic millimeter of our brain.
The World Health Organization mentions four key aspects that are like the four walls of the building of personal health. Thus, in addition to the purely physical-biological aspects, there are questions of mentality, psychosocial environment and spirituality, which also influence people’s state of health.
The fact that a computer diagnoses and prescribes treatment for people could be effective, as it was with astronauts in the 1970s, but not for citizens served by public health. It would be the object not of a newspaper article, but of a conference to explain the reasons for these differences. We have to achieve a balanced situation in the use of new technologies, which can contribute a lot to the doctor-patient relationship. But we cannot admit that impersonal and irresponsible care is given to patients in our public health system. Thus, the fact that the patient in a hospital cannot identify the doctor responsible for his treatment, I think it is a bad practice, as is the fact that the doctor hardly even looks at the patient because he is looking at the computer during the entire consultation. The telephone consultation can be of great help, but it can never replace the face-to-face relationship between doctor and patient.
A person’s clinical history is the most intimate thing that can be, and it seems to me that we are too happily opening these clinical histories to the consultation of professionals and institutions of various kinds.
A decade ago we proposed questions such as the following, which are still valid to optimize the Basque health system:
1. Primary Care has developed a situation of accessibility to essential services. However, there is a clear need to provide it with resources and management autonomy. It must necessarily be more decisive and less bureaucratized. It requires the commitment of nursing and medical teams who take responsibility for the health of citizens in a broader way. It would be necessary to develop management systems with remuneration for results according to models already tested, for example, in the British system. Cooperative management systems and labor companies between professionals may have a place in this section.
2. The treatment policy for chronic patients is nothing more than a derivative of the need to organize Primary Care in the developed world. But none of this will be possible without the incentives and the payment for results at this level of care.
3. Health professionals tend to have a different acceptance of new technologies. Acceptance is usually positive to the extent that it means working better and more efficiently, but it is not to the extent that it means control, evaluation of results and demands for greater efficiency, as well as greater demands for discipline in the administration of resources. , in data collection, in communication lines. It is also a requirement for stability to have a system of citizen participation and good communication with citizens. It is essential to structure the system of citizen participation and that of the social agents in the Health Policy.
4. It is necessary to visualize the potential dividend of investment in health infrastructure, the link between the health sector and policies on social cohesion, space planning, and economic competitiveness. The challenge of guiding and directing this work must be the responsibility of the health system, given the high budget managed by it. For this, it would be interesting to study the Finnish strategy of maintaining two socio-health departments or Ministries, one financial-economic and the other logistical-organizational.