If Spain were the best healthcare in the world we would not need heroes against the Covid-19

No, Spanish healthcare not the best in the world. Nor in Europe and, even, there is a reasonable doubt that it is not even the best in the Iberian Peninsula. Sanitary, we are a country of the bunch – that is, of the top of the bunch – where they live for many years, do many transplants and, as Carlos Sánchez explained in these same pages, doctors earn considerably less than their European counterparts.

Maybe stop repeating that we have the best healthcare in the world Be the first step to understand what is wrong and how we can improve it.

It is not even a matter of parties or ideologies. Pablo Casado said this week in a telematic press conference that Spain "has the best healthcare system in Europe"while in early February the Ministry of Health misinterpreted a report from the World Economic Forum to hit the chest again with the same slogan. We have" the best healthcare in the world ", as Adriana Lastra literally replied.

Now that hospitals are saturated and a high percentage of healthcare workers are infected with Covid-19 for having to face hundreds of cases every day without adequate personal protective equipment, we begin to intuit that, perhaps, the root of the problem was to think that those kinds of reports measured which Health is better as if it were a world ranking of tennis players.

The World Economic Forum study, for example, measured 'healthy life expectancy', not the quality of health care.

Another of the reports that usually logs the cauldron of this myth is that of Bloomberg, who in its latest edition it placed us third in the world after Hong Kong and Singapore. But again, what this report measures is the efficiency of healthcare systems, nothing more. The final grade is based 70% on the Life expectancy, 20% in the GDP-related spending and 10% the absolute expenditure on healthcare.

Obviously, we tend to exaggerate those reports that leave us in a better place. The problem is that one of the most complete, the one prepared annually by the Commonwealth Fund based on 80 indicators (Bloomberg uses only three), only includes 11 countries among which Spain is not. Beyond this, if you look for studies that classify different health systems, you can find them, but whatever they measure, they do not place Spain on their podium. The latest Euro Health Consumer Index, released in February 2019, places Spain in 19th place. Not in the world, in Europe. In this list the best sanitary systems are Switzerland, the Netherlands and Norway.

Of our health system highlights: "Very regionally decentralized. The public health system seems to rely a little too heavily on private health to achieve real excellence. Performance indicators in 2018 have improved, they are now on par with Iceland and Portugal. The 2018 Patient Organization survey (again) gave a bad vision about accessibility"

Portugal, in 13th place in this 'ranking' is noted for its improvement over previous years and its efficiency: "offer more for the same price "stand out. The London Legatum Institute is somewhat more benevolent with Spain. In the health section of its Prosperity Index it places us in 13th place worldwide. The first three places are for Singapore, Japan and Switzerland.

Finally, the Healthcare Access and Quality Index, published by the medical journal 'The Lancet' is perhaps the purest indicator in terms of quality of service. It does not measure efficiency or expense, only the results obtained in each country for the 32 most common causes of death. In this index Spain appears in 19th place worldwide. Those who top the ranking are Iceland, Norway and the Netherlands.

These countries have all the right in the world to brag of the quality of their health, but Spain? Only its efficiency and the selfless service of its professionals.

Neither now nor before the crisis

Another common place heard these days is that the ICU collapse or hospital saturation are consequence of the cuts made during the economic crisis that shook the country between 2009 and 2015. Looking at the OECD list of public investment in Health it is evident that, in relative terms, now we invest a smaller percentage of our GDP than before the recession.

In 2009, 6.77% of GDP was invested in public health and in 2018, 6.24%, but in this decade the gross domestic product has grown, resulting in greater investment per capita now than before: 1,617 euros per person compared to 1,576 euros 2009. Of course, 1,617 euros are not the same now as ten years ago. Be that as it may, we are still a long way from the top of the ranking in this regard. Now and before

Madrid is the community that is currently suffering the most from the ravages of the coronavirus, which has made many point to the regional government of the PP for the cuts made in recent years. It is true that CAM has lost doctors compared to 2008, when it had 2.3 doctors for every 1,000 inhabitants, but it is also true that the rest of the autonomous communities have followed this path. Except for the Basque Country, which Very slightly improves its number of doctors.

An even bigger problem is the persistent lack of nurses that has haunted our health system for more than a decade. While politicians boasted of having the best healthcare in the world, nursing schools were tired of asking for reinforcements and even the WHO denounced the situation. The European average was around 850 nurses per 100,000 inhabitants and in Spain we barely exceeded 530. In recent years these figures they have put on a little makeup, but far from what the professionals demand.

The latest evidence that proclaiming Spanish healthcare as the best in the world is a baseless exaggeration is in the number of beds. We have a third of the UCI places that Germany, Austria or Luxembourg have, but it is also almost all the autonomous communities have reduced their number of total beds in the last decade.

Only Murcia, La Rioja and the Balearic Islands now have more places, something that citizens who have had the bad luck of being hospitalized with Covid-19 in those regions.

There is no objective indicator to rate our public health as the best or one of the best in the world. Doctors, nurses, and other health professionals are having to facing the worst epidemic crisis of the last century from an inferior position: Without adequate equipment or protection, without enough respirators or the ICU seats that would be required to at least delay the collapse for a few more days before the curve flattens.

Until no let's assume at once our true position in the 'ranking' we will not be able to start working to improve things. Why fix something that is not supposed to be broken?