Spain's Health Care system

Last Wednesday my C1 students and me were listening in class to Cathy, a British GP talking about her job in the NHS, the largest publicly-funded health service in the world and, it is said, the fourth largest employer no less.

Then, as you all know, the Health Care reform is a controversial big issue for the Obama administration, in a country where private insurance has traditionally exerted a big influence.

How about our health system in Spain? Funnily enough, on April 25th 2011 it will be 25 years since the Spanish government presided by Felipe Gonzalez enacted the so-called "Ley General de Sanidad", which regulated the measures aimed at protecting our health as established in the 43rd article of the Spanish Constitution. The law created the "Sistema Nacional de Salud", which is the name given to the universal health assistance provided by the state and, later, its autonomous communities.

25 years later, recent surveys appear to find considerable dissatisfaction among Spaniards with the country's health care system and substantial support for reforms going beyond the government’s law in '86. To my mind, we can be relatively proud, compared to many other Western countries, of its success in achieving a more equal access to health care for its lowest-income citizens. Studies show that, although evidence of some barriers remains, low-income Spaniards are actually seeing doctors far more often than those of higher incomes, which might reflect their higher burden of illness but also their trust in medical services to provide certain other social services. Experts seem to suggest that these data are impressive, given the comparatively low level of per capita health expenditure and the percentage of gross national product which is invested in health care in our country (see video down below)

However, there's an increasing pressure on both the national and regional administrations to extend the availability of high-technology in medicine (specially in the prevention and treatment of cancer), as well as to reduce waiting lists and lengthen the time that health professionals spend with their patients. As Spain’s per capita income grows similar to that of the rest of Europe, so will the size of its middle and upper classes and, accordingly, a greater demand for better health care. The ever so ageing Spanish population is also a factor not to be sneezed at.

To cut this short, it seems evident that Spanish citizens have some expectations that are not, and will not, be easily satisfied by the efficiency of the current health system, however good it may be.

But what do you think? Are you satisfied with the medical assistance you're given by the state? If not, in what ways could our health service be improved? Perhaps you decided to go private and hire medical insurance? Does this work any better?

Hey, why not post your comments on this blog and exchange your views with your classmates?

Jeff Goldsmith is President of Health Futures, Inc. He is also Associate Professor of Public Health Sciences at the University of Virginia.

Smoking at Spanish restaurants and bars banned

Hi everyone and a happy new year!
This is the first entry of 2011. As you know, today, January 2nd, is the date Spanish smokers were dreading as a comprehensive smoking ban is put into practice. That's why I've decided to publish this short CNN feature about the news, including this short video which summarizes the situation. You will notice most of the ideas heard in the clip are presented, more or less literally, in the article's written text:

Madrid, Spain (CNN) -- A law in Spain that goes into effect Sunday bans smoking in indoor bars and restaurants, and gives the nation some of the toughest smoking restrictions in western Europe. The law will put Spain in line with Britain, France and Italy, which prohibit smoking in all enclosed public places.

Spain's hotel and restaurant federation warns of a 10 percent drop in business and tens of thousands of job losses in the midst of the nation's deep economic crisis.

But the government says similar laws elsewhere in Europe did not hurt business in the long run. Juan Carlos Sanchez says he goes to a neighborhood bar several times a day to have a cigarette with his coffee or beer. Like many smokers here, he is adamantly opposed to the new law. "If I can't smoke here in the bar, maybe I'll come just once a day, or not at all. When I ask for a coffee or beer, but then have to smoke in the street, I don't understand," said Sanchez, who manufactures filters for air conditioners.

Fernando Vazquez, owner of a bar and restaurant in Madrid where Sanchez was smoking late last week, said the smoke-free air starting on Sunday might be nice. But it will come at a price for his business. "Spaniards spend a lot of time in bars and will probably spend less time now," Vazquez said. "Instead of drinking three or four beers, they'll have one."

Spaniards have had a relationship with tobacco for 500 years. Explorer Christopher Columbus saw tobacco on his voyages to the New World and Spanish sailors brought it to Europe. So undoing old habits is not easy here.

A law four years ago banned smoking at work. But it essentially allowed Spain's 300,000 bars and restaurants to choose whether they would prohibit smoking. Most did not. This time, there are supposed to be no exceptions, as the government tries to reduce the 50,000 tobacco-related deaths each year.

Nearly a third of Spaniards puff away and smoke-filled bars have been the norm.

Business owner Florentino Matamala is a former smoker who supports the legislation. "People can't quit overnight and those who are used to smoking while having a coffee are going to have it rough. But I think it's positive, for the general good."


So what do you think? Is it OK to toughen the existing law by banning smoking in all enclosed public places, including bars, discos and restaurants? Or is the measure too prohibitionary? Perhaps should some outside areas be added to these premises?
On the other hand, do you agree with the exception made in prisons, psychiatric wards and old people's homes? Is it fair or just absurd?
Why not post your comments here?

Bull-fighting: Does tradition justify cruelty?

Miguel (C1):

Nowadays, a considerable number of people enjoy bullfights, which to them mean from a leisure activity to a high form of art. This tradition, which has spread worldwide and gained diehard followers ever since it emerged in the eighteenth century, does not only bring enjoyment but also the suffering - and death - of animals and sometimes, unfortunately, people. Since bullfights have just been banned in Catalonia, we need to ask the question: is bullfighting necessary in the 21st century?
On the one hand, the festival often goes beyond entertainment because its supporters conceive it as a true art form, even as kind of a man-against-nature fight. Therefore, it is considered a way for the bullfighter to demonstrate his strength and courage in a breathtaking exhibition. Moreover, it means a steady flow of money, and, what is more, a cultural tradition in Spain. In this sense, the bull might be considered as one of the most representative emblems of our country.
On the other hand, as I said above, bullfighting involves the suffering and death of innocent animals. Many tend to say that it is a fair fight between the man and the bull, but is it? Before the corrida, not only is the animal locked in complete darkness for 48 hours, but also badly fed and sometimes even pinched and hurt so, when “released”, the bull is disoriented because of its induced blindness. Furthermore, every time the bull is stabbed it becomes weaker and weaker until the agonizing animal succumbs to a painful death.
While bullfight may seem simply another human “ritual” where animals are killed, like hunting or slaughter, there is one thing that worsens it: the eager public is glaring at the whole process while encouraging the bullfighter to spread more blood. Can anything - including tradition - justify this slaughter-like ritual anyhow? If tradition is the only reason to allow this “entertainment” to continue, people should think about past traditions such as the wrestling between gladiators.
To conclude, I believe bullfighting has become a harmful, unnecessarily cruel spectacle, given that there are many enjoyable, more civilized pastimes like live sport, theatre or cinema, which do not involve killing any animals. There don’t seem to be any good reasons not to follow the example of Catalonia, except for the clichéd argument that it is a long-standing, yet to my mind old-fashioned, tradition.

Thanks so much, Miguel. Great job! Now, to illustrate this heated debate for and against bullfights, I've found this YouTube report on the issue. Would you like to post your own comments?