catalan health system

Like many major European cities, Barcelona is ageing fast. In the years ahead the city must grapple with many of the problems associated with an increasingly top heavy demographic: as the over-65 population burgeons, health and social services are stretched, the financing of pensions is challenged, and a growing number of frail and vulnerable people face competing over declining resources. Today’s elderly cohort constitutes a greater proportion of Barcelona’s population than ever before, and, perhaps most worryingly, face an increased likelihood of living alone.  But all is not doom and gloom, as the city enjoys an active, dynamic and engaged elderly population, the health and social sector rises to meet the challenges, and the labour market benefits from what are known as the ‘super-grandmothers.’

An independent Catalonia would be totally viable, according to a report conducted by the research institute from the bank, Credit Suisse. In addition it would improve its ranking on the United Nation's Human Development Index (HDI) and reach the 20^th position while Spain would drop by three places and reach the 26^th position. The report claims that small countries tend to have a higher standard of living due to a number of factors, such as more efficient services, a higher chance of benefitting from globalisation and a more homogenous population. It uses these findings to predict the HDI of territories seeking independence, such as Catalonia, Scotland, Flanders and Quebec.

On Thursday, the Catalan Finance Minister, Andreu Mas-Colell, admitted that Catalonia will not be able to meet the strict 1% deficit target imposed by the Spanish Government for 2014. In fact, the Catalan Executive had previously warned on several occasions that this deficit target was not realistic, despite the great austerity efforts undertaken over the past four years. In addition, despite Spain's economic recovery of 2014 – which is led by Catalonia – and therefore the increase of taxable activity, the Spanish Government will reduce the Catalan executive's funds by €500 million this year while the deficit target becomes stricter. On Wednesday, the Catalan President, Artur Mas, already stated that, considering the austerity measures adopted since 2011, further budget cuts cannot be undertaken in 2014 without dramatically damaging basic public services such as healthcare and education. Instead of relaxing the deficit target or transferring pending funds and debts to the Catalan Government, the Spanish Finance Ministry will reduce the interest rate that the Autonomous Communities have to pay back to 1% for the loans of the Liquifidity Fund (FLA).

On Wednesday the World Health Organisation (WHO) appointed Barcelona-based researcher Pedro Alonso as the new Director of its Global Malaria Program. Alonso is a key figure in the global fight against malaria and has lead research into a vaccine to combat the life-threatening illness. He has been involved with WHO since 2011, when the organisation appointed him as the Chair of the GTS Steering Committee on the Global Technical Strategy on Malaria. Alonso is currently the Director of the Barcelona Institute for International Health Research. He is also the Head of the Department of International Health and Tropical Medicine at Barcelona's Hospital Clínic and a lecturer at Barcelona University. The physician is due to start his new position in October and is expected to give his formal recommendation on the strategy against malaria in the first quarter of 2015.

Following an appeal from the Spanish Government, the Constitutional Court has confirmed the cautionary halt adopted in January 2013 and it has now definitively banned the Catalan Executive's drug prescription fee. The measure had been adopted to reduce pharmaceutical spending by limiting superfluous drug demand in order to reduce the overall public spending. It was one of the austerity measures adopted by the Catalan Government in 2012 to reduce public deficit, in order to meet the strict deficit targets imposed by the Spanish Executive. The measure meant that Catalans had to pay a one-euro fee for each drug prescription, with a maximum of 60 euros per year and with many exceptions for people with chronic diseases, on low incomes and pensioners. On the same day, the Constitutional Court has backed the Catalan Executive's judicial fees, also appealed by Madrid.

A total of 23,825 patients have to wait longer than the maximum 6-month-period to undergo one of the 14 surgeries with a guaranteed waiting time, according to the Catalan Minister of Health, Boi Ruiz. In 2013, a total of 151,009 patients underwent one of these surgeries, 3,834 more than the previous year, which represents a 2.6% increase. The number of patients who still require one of these 14 procedures in December 2013 has increased by 6% and 4,261 people, reaching 75,075 with an average waiting time of 5.78 months. On the other hand, the waiting lists for all surgeries, including the 14 specific procedures, have fallen by about 7,000 people in 2013 compared to 2012.

Barcelona’s Hospital Clínic has installed the ‘Micra’ 24mm pacemaker - equivalent to the size of a one euro coin -  in 4 patients as part of a clinical trial involving 10 medical centres and 60 patients troughout the world. This innovative wireless system is minimally invasive since it does not require any surgical procedure but is implanted in the heart through the femoral vein using a catheter. Such a procedure can be performed within 30 minutes and also reduces the patients’ risks of future infections. According to the Medical Director of the Hospital, Josep Brugada, if the clinical study is successful, it will involve a “paradigm shift”. Experts estimate it could reach hospitals within the next two or three years.

A surgical team of the Hospital de Bellvitge in L’Hospitalet de Llobregat, Greater Barcelona, has successfully reconstructed the breasts of 22 women suffering from cancer in one single surgery. This world pioneer medical procedure, consisting in transplanting dorsal muscle on to the removed breast, allows patients to “turn the page” on the disease much more quickly, according to Joan Maria Vinyals, the Head of plastic surgery. Indeed, this “complete and radical reconstruction”, which includes the nipple and areola, avoids having to proceed to a second surgery and erases the usual trauma regarding aesthetic concerns. Leonor Garrido, one of the patients, stated that the technique “had improved a lot” her quality of life since she had her tumour removed and the breast entirely reconstructed immediatly after.

The Catalan Institute of Oncology (ICO) and Roche pharmaceutical company have signed an agreement stating that the Catalan public institute will pay for treatments against cancer depending on clinical results adapted to each specific patient. For now, the agreement provides that Roche will supply two drugs against the most common cancers, mostly breast and colon. According to the agreement, the probabilities of success will be thoroughly examined and if they meet the requirements, the Catalan Government will fully pay for the treatment. If not, Roche will assume the costs progressively according to the degree of success.

Thousands of people – 12,000 according to Barcelona’s local police and 200,000 according to the organisers – demonstrated on Sunday in the streets of Barcelona to protest against the Spanish and Catalan Governments’ austerity measures and “antisocial” budgets. Led by the platform ‘Prou Retallades’ (“Stop Budget Cuts”) , the UGT and CCOO trade-unions, as well as political parties and associations, citizens voiced their disapproval of the new pension reform, working fragility and the latest austerity measures. They also specifically protested against the Catalan and Spanish Governments’ budgets for 2014, which they consider “antisocial”. The demonstration organisers criticised the “blind obedience” of the Catalan and Spanish Executives to the European Commission and the Troika.

Researchers from Barcelona’s Centre for Regenerative Medicine (CMRB), the Catalan capital’s Hospital Clínic and the Salk Institute of California have successfully created three-dimensional renal structures which are virtually indistinguishable from embryonic kidneys. They have started creating kidney cells from human stem cells, and ultimately proven that these newly created cells could aggregate in vitro to form a “micro-kidney”. The team led by Juan Carlos Izpisúa, from the CMRB, said that this scientific breakthrough would facilitate the study of kidney diseases and enable scientists to work on new treatments. He added that this achievement was a great step towards developing therapies based on the use of stem cells.

Researchers of Barcelona-based Vall d’Hebron Hospital and Research Institute discovered some of the main causes of the Idiopathic Pulmonary Fibrosis, which were unknown before today. Vall d’Hebron’s study showed that a continuous exposure to feather pillows and duvets was one of the main causes of this illness as it favours the scarring of lung tissue. This disease provokes a progressive decline of lung function and leads to asphyxia because of the deterioration of the organ’s tissue. The study has been able to trace the diseases’ causes in half of the studied cases. Besides feather pillows and duvets, the persistent exposure to fungus and close contact with birds can also trigger the illness. The Catalan research allows for a new approach to the illness’ prevention and its diagnosis in the early stages. It also represents a completely new approach to this pathology in terms of treatment.

The ambulance service has gone on strike from Monday to Thursday because of a 9.2% drop in staff wages. However, the provision of basic services is guaranteed, such as emergencies – including accidents and intra-hospital journeys – and the transportation of oncology and haemodialysis patients with scheduled treatments. The Catalan Health Ministry and the trade union CCOO showed a disagreement on the strike’s success. According to the Catalan Government, the demonstration was only followed by 8% of the workers on its first day, while the CCOO stated that 90% of the non-essential services have not been provided. The owners of the ambulance providers announced significant salary reductions in July. After talks with unions and the mediation of the Catalan Labour Court, an agreement has not been reached to avoid the strike.

Christian Brander is a researcher at the IrsiCaixa AIDS Research Institute and Scientific Director of HIVACAT, the programme for the development of a HIV vaccine. He graduated from the University of Bern in 1994 with a PhD in Immunology and has spent 13 years at Harvard University focusing on cellular immunity to viral infections.

The healthcare tourism sector is growing. Russian, British and German visitors make the most of their holiday trip by visiting specialists, passing medical tests or undergoing a surgical operation. As a response to this, a private medical center in Girona has announced that it will invest more than €1 million to profit from healthcare tourism.