The citizen working group on a healthcare debt audit “Audit Healthcare”, launched in April 2013 and based in Madrid, comprises of a group of citizens who hope to offer their fellow citizens and social movements a rigorous instrument to help estimate debt in public healthcare and identify what part is illegitimate in order to be able to declare non-payment of it. In addition, we seek to help understand and transform health services towards a genuine public health service regarding its ownership, in its provision and the management of its services; free, funded by our taxes and without “re-payments”; universal and without exclusions or inequalities and with a much higher level of quality, equality and humanity.
Our objective is to build a tool; one that promotes information, awareness, training and participation for citizens, with regard to controlling the management of public resources and the impact that debt has on the Community of Madrid’s Ministry of Health. A tool which helps to bring transparency to the management of public resources, promote accountability processes and increase the efficiency and efficacy of the management of the Community of Madrid’s Ministry of Health.
We aim at providing tools and arguments for the Community of Madrid’s government for the suspension or annulation of debt identified as illegal and/or illegitimate (debt that strangles and cuts down our rights), in an eventual negotiation with creditors. We also seek to demand administrative, civil and penal responsibilities from those who participate in debt generation, and build the necessary mechanisms to avoid new harmful debt processes.
We are organised into three commissions; the first focusses on analysing the link between political powers and the economic elite, the second on evaluating debt in the health system and identifying illegitimate debt and the third specialises in communication of information relating to the activity of the working group, especially regarding public healthcare debt.
Regarding the work done in the last year, in addition to the talks done with Neighbourhood Associations |1|, Health Centres, social movements, etc., we have incorporated into the Citizen Group against Corruption at a state level. Audita Sanidad has established its presence on social networks, and continues to self-educate itself through Radical Community Manager courses. We have also monitored public procurement in the Community of Madrid’s Ministry of Health and have been examining their budgets as well as permanently gathering information on public service positions and heads of businesses |2|. Most importantly, we produced a report about public procurement of the Community of Madrid’s Ministry of Health in 2014 which was presented to the press. We also set up our group’s website.
In the coming year, as well as continuing to inform and empower citizens (with our next workshop on the Public Sector Contracts Law and budget management), we are in talks with publishers about the possible publication of a book about the role of lobbyists in the public healthcare sector, and we intend on producing new reports. We also hope to produce a viral video that will also help us achieve our goals.
As we are aware, political policies that dismantle public services and the welfare state are not the result of the last economic crisis, but of the neoliberal offensive in action since the 1980s. In the health sector, the document Working for Patients (1989), which gave the keys for the privatisation of the British National Health Service thanks to Margaret Thatcher’s government, as well as the recommendations of the April Report (1991), published in Felipe González’s Spain, and the World Bank
WB The World Bank was founded as part of the new international monetary system set up at Bretton Woods in 1944. Its capital is provided by member states’ contributions and loans on the international money markets. It financed public and private projects in Third World and East European countries.
It consists of several closely associated institutions, among which :
1. The International Bank for Reconstruction and Development (IBRD, 180 members in 1997), which provides loans in productive sectors such as farming or energy ;
2. The International Development Association (IDA, 159 members in 1997), which provides less advanced countries with long-term loans (35-40 years) at very low interest (1%) ;
3. The International Finance Corporation (IFC), which provides both loan and equity finance for business ventures in developing countries.
As Third World Debt gets worse, the World Bank (along with the IMF) tends to adopt a macro-economic perspective. For instance, it enforces adjustment policies that are intended to balance heavily indebted countries’ payments. The World Bank advises those countries that have to undergo the IMF’s therapy on such matters as how to reduce budget deficits, round up savings, enduce foreign investors to settle within their borders, or free prices and exchange rates.
http://worldbank.org reports on Investing in Health (1993, 2003) are all good examples of how public health systems have long been the target of large corporations. More recently, a sign of the lack of transparency and corrupt practices that accompany these policies, is the report Study on Corruption in the Healthcare Sector (2013) |3|, which notes the particular vulnerability that the healthcare sector has to corruption; in 2013, between 10% and 25% of public procurement spending on the provision of health technology and pharmaceutical products were lost in corrupt practices. |4|
We strongly believe that it is crucial to give a global response to the global agenda that we are witnessing; one that constitutes a corrupt, opaque process of privatisation; this is not simply a new idea motivated by the need to save money imposed by the current economic situation – rather, it is a point of arrival of an entire political and ideological programme characterised by the supranational bodies of capitalism that are pressing for implementation by the most fragile of states.
The reason behind this introduction of Audita Sanidad to ICAN is the hope of promoting the creation of citizen groups dealing with similar tasks relating to the public healthcare sector – not only for the Spanish State, but on a European and international scale. We believe that only the emergence and strengthening of these groups, and the sharing of knowledge and experience, can lead us to successfully achieve our goals.
|1| AAVV: Asociaciones de Vecinos (Neighbourhood Associations)
|2| From May 2016, the number of public service positions in Congress, the Senate, the Assembly of Madrid, State Governments and public service positions under investigation increased to 6,086. The number of reports on businesses related to different sectors of economic activity was 512.
|4| The Gürtel case and Operation Púnica show how corruption has infiltrated the Community of Madrid and forms part of the system’s structure. We suspect that the found cases of corruption in the public health system are just the tip of the iceberg of a more generalised fraud that occurs on all levels of the healthcare system.