"Making work in public healthcare and private healthcare compatible is a goldmine"

Palma"Combining work in public and private healthcare is a goldmine." This is stated by José Manuel Aranda, a retired Primary Care physician from the Balearic Islands and coordinator of the report on healthcare privatization in the autonomous communities. Aranda believes that juggling both activities can be advantageous for professionals, but warns that there are doctors who go further and work in the private sector during their working hours in public healthcare. A practice that brings to the table the debate about incompatibilities and conflicts of interest in the healthcare system, at a time when healthcare privatization is advancing while waiting lists for the public system are skyrocketing. The retired doctor clarifies, however, that working in private healthcare is not always a profitable business. "Many times people think that working in private healthcare is a goldmine, but that is not the case," he maintains. As an example, he points to the problems that workers may suffer in certain private management models. "Privatization processes, such as in Madrid, do not even bring in enough money to pay salaries," he states.

Exclusive dedication for heads of service

Aranda argues that those responsible for public health services should have exclusive dedication and adequate working conditions. "It would never be understood for an executive of a company to be an executive of the competition," he states to explain why he considers it necessary to separate public responsibilities from private interests. His proposal is that heads of service be well remunerated, but that they do not combine this responsibility with a private activity that could generate conflicts of interest. "A head of service must be correctly remunerated, but exclusive dedication is necessary," he maintains.

The reason is the decision-making power that these profiles have over purchases and the management of waiting lists. According to Aranda, these responsibilities can have a direct impact on the activity of private centers, which can benefit from the referrals of patients who do not receive the care they need in the public system. For this reason, he believes it is necessary to prevent professionals who make decisions in public healthcare from having interests in private companies where they could benefit. The debate about incompatibilities is not new. Law 53/1984, which came into force in January 1985, established the general principle of a single job in the service of public administrations and regulated the conditions under which certain compatible private activities can be authorized. The deployment of the rule included specific transitional provisions for health personnel: they are civil servants who can work in the private sector.

"Privatization leads to the disappearance of Primary Care"

Aranda also warns of the effects that, in his opinion, the expansion of the private sector may have on the structure of the healthcare system. "The development of privatization leads to the disappearance of Primary Care and also of the corresponding specialties," he states. The retired doctor recalls that Primary Care is not a profitable activity for private providers and warns that this may put the continuity of this service at risk if the system is increasingly oriented towards economic criteria. "Primary Care professionals must be clear that, if they do not defend public healthcare, they are doomed to disappear," he maintains.

Aranda also questions the suspension of the indefinite doctors' strike scheduled for November and recalls that previous work stoppages have had significant consequences on healthcare activity, even in centers and specialties where participation was low. "Most services were suspended even though the percentage of doctors on strike was low. There are centers and specialties where only 20% of doctors supported it and, even so, all services were suspended," he states. The retired doctor wonders if there have been any advances that justify stopping the mobilization. "I find it curious that the indefinite doctors' strike scheduled for November has been suspended now that there are elections. Have the demands already been met?" he asks. "There are political motivations," he concludes.