In recent months, the government of Pedro Sánchez has negotiated a new tax framework with Catalonia to ensure its continuity in Moncloaand which resulted in an economic agreement between the Generalitat and the State. Agreement, which causes a new health gap between the autonomous communities and will allow the Catalan health system to have between 1,500 and 1,900 million more each year.
The Minister of Finance, María Jesús Montero, assured that this Catalan fiscal pact will not affect “equality” in fundamental areas such as health, one of the pillars of the Spanish welfare state, but in reality it is quite the opposite, because this will clearly increase the differences.
Moreover, if we look at the statements made by Jordi Fabrega (Junts), stressing that the problem in Catalonia is that “between 12 and 13 billion euros are budgeted for health – and not 11,000 as is claimed – and 15,000 or 16,000 are spent”, adding 1,900 million in additional offers an indecent figure, before all the autonomous communities it doesn’t happen at the end of the year because of the high costs of health care. And if in addition this obscene budget would lead to excellence in the quality of care, It would be less offensive, but it turns out that his health is deteriorating.
The health budget is one of the main items of public expenditure in any autonomous community, and Catalonia is no exception. Currently, it spends approximately 11 billion euros, which represents approximately 38% of its total budget.
If we consider that a significant part of the new funds will be allocated to health, in a proportion similar to the current budget, we could calculate that Catalonia could allocate up to 1.9 billion euros extra per year to their health system, depending on the priorities of the regional government and how they distribute the new revenues.
The health system in Spain is decentralizedwhich means that the autonomous communities are responsible for managing their health, although the State provides part of the financing through transfers from the general financing system. Despite the promise of equality made by the Sanchez GovernmentThe reality is that differences in access to and quality of health services already exist between different regions, and this new fiscal pact will further accentuate these inequalities.
Health expenditure figures in Spain
To better understand the possible implications of this agreement, it is important to analyze the current differences in health spending per capita in Spain. According to the latest report from the Ministry of Health itself, the average spending per capita varies considerably between the autonomous communities. At the national level, the average health expenditure per capita in 2023 was around 1,670 euros. However, regions like Basque Country and Navarrewho also appreciate a special tax regime, They have significantly higher figures, with 2,000 and 1,800 euros per inhabitant respectively. Cataloniain comparison, is about 1,500 euros per inhabitant, but with the new agreement it could even exceed the figures of the regional communities.
The Catalan fiscal pact has not gone unnoticed in the rest of Spain. Communities like Andalusia, Extremadura or Castile-La ManchaCountries that traditionally have less economic weight and greater dependence on the regional financing system have already expressed concern about the possible repercussions of this agreement. Juanma MorenoPresident of the Junta de Andalucía, called the pact an “unfair imbalance”, arguing that it could generate differences in the quality of public services between communities.
In this context, health is one of the most sensitive issues. Data from the Report on the national health system from 2023 show that, while Catalonia has one of the highest life expectancy rates in Spain, other regions such as Extremadura or Castilla-La Mancha face difficulties in maintaining the level of care due to lack of resources.
Areas of investment
With these additional funds, Catalonia could make significant improvements in several areas of its health system, creating more differences in care than other regions. The known zip code that many specialist doctors have an impact on different pathologies such as cancer, with this tax increase, this will increase further, since they will be able to allocate more budget for therapies, people or hospitals.
This way, they will be able to access a increase in recruitment of health personnelsince Catalonia has been facing many difficulties in retaining and recruiting enough doctors and nurses in recent years, especially in primary care. An increase in the budget could allow for a considerable reinforcement of the medical staff.
In terms of infrastructure, they will be able to stand out more from the rest of the regions by to be able to invest in the renovation and expansion of hospitals and health centers which, in some cases, have structural deficiencies or are overloaded.
Purchasing new equipment Advanced medical technology or improvements to existing ones, such as MRIs, radiation therapy machines or minimally invasive surgery technology, will be within their reach and not those in other regions with smaller budgets.
Waiting lists for consultationsDiagnostics and operations have been a recurring problem, especially in Catalonia in recent years due to its terrible health management. A larger budget could allow for longer service hours and hiring more specialists, thus reducing waiting lists.
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