Defending Public Healthcare in Madrid


Madrid’s physicians, nurses and other health professionals have been marching in the streets with their patients for over a month, protesting the government’s plan to privatize and sharply reduce public health services.

Spain’s National Health System (SNS), established in 1986, fulfills a mandate included in Spain’s national constitution. Article 43 guarantees healthcare to all Spaniards, including the right to adequate public health services.(1,2)

The attack on the SNS is being led by the government in Madrid. (Administration of the SNS is decentralized; each of Spain’s 17 semi-autonomous regions sets health budgets and priorities.)(3) At the beginning of November Madrid moved to privatize ten percent of public health centers as well as the administration of six hospitals – half of the hospitals in the region. Of the hospitals to be privatized, all were recently built.

The response: an unprecedented and massive mobilization of people in Madrid, now making mainstream news across the world.(4,5) Caregivers and patients together have joined protests at every public health clinic and hospital in Madrid. Marches have involved hundreds of thousands.(6) Caregivers have gone on strike and stopped traffic outside their workplaces.(7)

The Partido Popular, in power nationally as well as in Madrid, also proposed to convert La Princesa Hospital, a tertiary care center serving about 300,000 patients annually, into a specialty care center for patients over the age of 75. In addition to mass meetings and sit-ins at La Princesa Hospital, a petition in protest gained over 200,000 signatures.(8) The Mayor of Madrid, herself a member of the Partido Popular, signed on. The government has retreated yet the struggle continues.(9)

Last week a group of patients, nurses and physicians disrupted a speech at the Madrid regional Assembly, where the government’s economic counselor was explaining the hospital privatization plans. In this short news video (11), Dr. Marciano Sanchez Bayle chants for public healthcare beside a woman who unfurls a banner, the first to be led out by police. Note the Assembly members who stood to applaud the protesters.

Here is a short interview I conducted with Dr. Sanchez Bayle of the Federation of Associations for the Defense of Public Health (FADSP) this week.  He is a pediatrician who practices in Madrid.  (Any error in translation is my own.)


Dr. Andrew D. Coats: Many of us in the United States have difficultly imagining health care delivered by a public system. Would you please describe how patients in Madrid get their medical cares?

Dr. Marciano Sanchez Bayle: In Spain the health system is public and coverage is universal. This means that when a person thinks he or she has a health problem, they go their public health center. There they are attended by a doctor and/or a nurse who will make the appropriate decision whether to diagnose and treat, ask for diagnostic tests, refer the patient to a specialist or admit them to a hospital.

Of course, if the situation is serious or occurs outside regular treatment hours, patients can go to a hospital emergency room. Hospitals are also mostly public. Thus far all of these services are free, including the tests. A patient does have to pay a share of the cost of their prescriptions, however.

On a per capita basis, the Spanish system is four times less costly than in the U.S. Yet we achieve much better outcomes, according to basic health indicators.

Dr. Coates: How has the government proposed to change this in Madrid?

Dr. Sanchez Bayle: The proposal in Madrid is to privatize some of the hospitals and health centers, turning them over to private businesses.

Dr. Coates: How will this affect patients?

Dr. Sanchez Bayle: There will be an immediate and significant downsizing of personnel, resulting in diminished access to care. It will undermine the quality of care. It will substantially lengthen waiting lists.

In addition, these changes will result in what we call risk selection, whereby private entities will seek out the most profitable pathologies, i.e. those persons who are less sick. As a result, people will face more obstacles to getting the care they need, following the Tudor Hart law of inverse care (11) – medical attention will be dispensed in inverse proportion to the needs of the population.

These will be the short-term results, because it is clear to us that the Partido Popular, the conservative party, hopes to install a health care model based on private insurance. The disastrous results of such a model as the United States, are well known.

Dr. Coates: What will it mean to doctors and nurses?

Dr. Sanchez Bayle: First of all, there will be fewer of them employed, with layoffs and fewer facilities to practice in. For those remaining, it will result in overwork and a worsening of professional working conditions.

Dr. Coates: Please describe the protests that have emerged in response.

Dr. Sanchez Bayle: It would take a very long time to fully answer your question because there have been such a multitude of actions. Briefly, it has produced a strike by the staff of the centers — doctors, nurses, administrators, auxiliaries, etc. — which has been organized according to a rotating schedule, e.g. specific days a week. Health worker sit-ins, sometimes joined by patients, have also occurred. These started first in the hospitals, then in the health care centers. These protests have been going on for 30 days.

In addition, massive demonstrations have been held in Madrid, some with more than 100,000 people, professionals and patients. Every day there are demonstrations blocking traffic in front of the health centers. Last week an action was carried out under the slogan “Hug your Hospital,” in which human chains circled all the public hospitals of Madrid.

The most interesting thing is the supportive reaction of the citizenry. People are very committed to the defense of the public health care system. Of course, we Spanish continue to have a bit of the guerillero and anarchist spirit in us, so to speak, and many initiatives have been sprouting up like mushrooms.

Dr. Coates: What is the significance of the La Princesa Hospital in this struggle?

Dr. Sanchez Bayle: La Princesa Hospital is located in the center of Madrid. It has 600 beds and a high level of specialization. It is the referral center for many of the peripheral centers of Madrid and beyond.

The attempt to convert La Princesa into a geriatric center was the spark that lit the movement: the unions of the center started a sit-in which still continues. The sit-in has mobilized more that 90 percent of the facility’s workers. Citizens in the zone it serves have also joined in. The hospital’s governing council negotiated with some of the doctors, i.e. department heads, and the two sides arrived at an agreement which doesn’t seem bad. Yet the struggle to withdraw all the measures that affect health care in Madrid, including this issue, continues.

Dr. Coates: We have been hearing about many protests against austerity in Europe, in Spain, in Madrid. What is the justification used by the government to move to privatize the public system?

Dr. Sanchez Bayle: The government says that it’s the crisis and that there is no money, but it’s a lie. They have allocated 215,695 million pesetas to bail out the banks, and with these measures they say that they will save 7,000 million pesetas in health care. What they want to do is to use the excuse of the crisis to privatize health care, to put it in private hands in order to make a profit on the health of the people.

Dr. Coates: What is your view of this demand for austerity?

Dr. Sanchez Bayle: I have already said that they want to take away peoples’ rights in favor of the banks and private businesses.

Dr. Coates: Why did you disrupt the Madrid Assembly? Who was with you?

Dr. Sanchez Bayle: What we did was to try to demonstrate within the Assembly professionals’ and citizens’ rejection of this blatant act of aggression against health care. The elected representatives should not have deaf ears to the opinion of the immense majority. Keep in mind that the Partido Popular, now in government, didn’t include these measures in its election program. They gained their votes through trickery and are now attacking our public health care system.

Dr. Coates: What else would you like to share with people in North America about this struggle? What can we do to help?

Dr. Sanchez Bayle: The right to health care is a peoples’ right and should be defended as such. What is happening in Spain today may seem far-off to the people of the United States, but the world is globalized and interconnected. Every advance or retreat which happens in one part of the world has a repercussion for us all. Help can come in spreading word of the struggle so the problem is known, and also demonstrating solidarity through demonstrations in front of Spanish embassies and sending signed protest letters to entities and people in the government of Madrid.

Solidarity is very important, not only for those who receive it but also for those who practice it, because it makes us better people and benefits our common, concrete struggles.

Andrew D. Coates, MD will be president of Physicians for a National Health Program in 2013.


(1) http://www.servat.unibe.ch/icl/sp00000_.html
(2) http://en.wikipedia.org/wiki/Spanish_National_Health_System
(3) http://www.spainthenandnow.com/spanish-travel/general-map-of-spain/default_92.aspx
(4) http://www.timesunion.com/news/article/Thousands-protest-Spain-s-health-care-austerity-4103126.php
(5) http://www.adelaidenow.com.au/news/breaking-news/thousands-protest-spains-health-care-cuts/story-e6frea7u-1226533310603?from=public_rss
(6) http://www.reuters.com/article/2012/12/09/us-spain-health-march-idUSBRE8B809H20121209
(7) http://www.thenation.com/blog/171670/how-strike-back-14n-dispatch-madrid
(8) http://www.larioja.com/videos/actualidad/espana/1951507741001-madrileno-hospital-princesa-lucha.html
(9) http://elpais.com/elpais/2012/11/13/inenglish/1352818341_939984.html
(10) http://www.telecinco.es/informativos/sociedad/Protestas-recortes_en_Sanidad-Sanidad-Asamblea_de_Madrid_2_1519905142.html
(11) http://en.wikipedia.org/wiki/Inverse_care_law

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