For the past weeks, the Generalitat has been addressing a significant budget cut in healthcare, amounting to a reduction of one billion euros, which accounts for 10% of the resources allocated last year. To implement this, the Department of Health has communicated the available funds to healthcare centers, enabling them to determine and apply the most effective measures to manage the budget cut.
In fact, constraints in the healthcare sector have been a result of the economic limitations imposed by the European Union (EU) through the agreements of the Maastricht Treaty in 1992. Since then, numerous reports and studies have been conducted, focusing on the analysis of the healthcare sector. These studies aim to shed light on the considerable economic resources associated with healthcare and how they intersect with other sectors of the economy.
Among the various variables analyzed recently, we can consider, for instance: public health expenditure per capita, public health expenditure by spending agents in Catalonia, the evolution of health expenditure in millions of euros within Catalonia, public health expenditure as a percentage of GDP, proportions of public and private health expenditure relative to total health expenditure, growth in the overall healthcare workforce, comparative healthcare costs across regions, and more.
In my perspective, this approach is perhaps one that, especially in the current context, should be completed with an in-depth study. Such a study would not rely solely on external comparisons or economic macro-indicators. While these indicators are crucial for understanding the evolution of healthcare in Catalonia, they currently offer analyses at a broad level, which might not be specific enough to guide decision-making.
Considering the information above, one way to handle the healthcare budget reduction proposed by the Regional Ministry of Healthcare is by using a method called process reengineering.
The term “reengineering” was coined by Michael Hammer. He wrote a significant study in the past decade, published in the Harvard Business Review with the title “Reengineering Work: Don’t Automate, Obliterate”. Reengineering involves rethinking and redesigning how a business operates to make big improvements in important areas like cost, quality, service, and speed. This optimization of workflows and organizational productivity forms the core of reengineering.
This approach helps plan and manage change. It is a complete process for adjusting organizations to new and challenging situations in a world that is becoming harder to control. In simpler terms, it is one of the ways to make changes happen.
With this introduction in mind, the initial step involves creating an analysis framework that portrays the primary cost areas within the system under examination. This means identifying the shared elements and key metrics that will serve as the baseline for each of these areas (such as personnel, consumables, medications, infrastructure, administration, procurement, etc.). This approach ensures that when we compare outcomes across different areas, we are doing so using a common parameter. For instance, were you aware that hospital medication accounts for 20% of the budget?
Once this phase is accomplished, the next consideration is to establish a benchmark management model. This model should encompass the various socio-economic and demographic diversities present in Catalonia. Are the requirements of Barcelona, Girona, Lleida, and Tarragona identical? The answer is unequivocally no.
Once this model has been established, it is at this point that we might consider measures aimed at optimization and enhanced effectiveness and efficiency, all within the specific context of its implementation. This approach ensures the ongoing equilibrium of health services across different regions, regardless of the province in which they are situated.
Ultimately, to ensure the sustained functionality of the system, the concept of continuous measurement and improvement should be embraced. This will help preserve the established model and allow for proactive adjustments in response to societal changes. As the English mathematician Lord Kelvin once stated, “What is not defined cannot be measured. What is not measured cannot be improved. What is not improved will always degrade.”
The current state of the Catalan healthcare system should be viewed as an opportunity for enhancement by all parties involved. With a spirit of self-reflection, they can embark on a comprehensive reorganization of the healthcare model, laying the groundwork for the healthcare system of the forthcoming decades.
The optimization measures – I refuse to speak of cuts – must be, as I mentioned earlier, contextualized to the specific environment and aim to maintain the balance across regions as a symbol of solidarity within Catalonia.
