The reform must be as profound as it is inevitable

Total public health spending in Spain, measured as a percentage of GDP or per capita, is slightly higher than the average for OECD countries. More or less like Italy, Australia or Finland. Galicia, somewhat below the Spanish average, is, however, at that average level shared in Europe in which deviations do not affect life expectancy or potential years of life lost.

In terms of doctors per inhabitant, Galicia is a little below the average between communities, although somewhat above the Scandinavian countries or the United Kingdom, if the total is considered, or on par if we talk about primary care. These are the data, and they do not seem worrying. But they have their limitations, and they say little or nothing about the value created -or not- for the patient, the burden of care, the working conditions, the support of families for dependency -because there is no other remedy-, about the anguish of waiting for a test or burden of disease that could have been avoided.

That is why the explosions of discontent, although apparently subjective and emotional, reflect an objective reality, a serious problem that cannot be minimized. The care overload in primary care detracts from the dignity of the medical act and gives it the character of a rushed administrative procedure. And job insecurity fully impacts the dignity of the professional.

It is impossible for the quality not to suffer. When these things happen in Spain, and they happen too many times, a patch is put on the focus of the conflict and some time is gained.

Healthcare is a complex and highly interdependent network. A problem that explodes in primary care affects the entire system and the solution can only be global. It makes sense to speak of primary and specialized as different levels, but not as watertight compartments.

There must be fluid communication and a redefinition of roles supported by new technologies. Even patients today can play an active role. A few weeks ago, a report published by the European Commission and the OECD warned that a fifth of health spending is unnecessary and can and should be put to better social use. Can this be fixed without overview? The in-depth reform of health has been postponed for decades because it is difficult and politically risky. But it is unavoidable to do it. Sooner than later, the consequences of inaction will be unbearable for everyone.