Up next: Marina Geli, minister for health in Catalonia since 2003.

(I missed the beginning - was in the rush to grab a translation headset!)

Catalonia is a European region with 1 million increase in population in last 10 years. High life expectancy and low birth rate GDP is mid-high for Europe. Lots of tourists and visitors, especially older people come here to use our services.

The healthcare system is part of the national system but has been decentralized since 1981. We get some general funding from taxation but have discretion over the allocation to healthcare.

We think our system is distinguished by virtue of: being financed by taxes; being decentralised; having universal coverage; providing free access; and having a comprehensive public portfolio. We have a public insurance system that covers everyone and the private sector which is complementary. 24% have their own insurance in addition to that provided by the stat. Catalan citizens think this is a good model though of course it can be improved.

The private sector has to follow the rules set by the Health Ministry - so it’s co-operation not independence. Spain has decentralized government generally since the mid-1980s. Pharma policy, international policy and decisions on the distribution of funds are all handled by the region.

We think it’s succesful because it brings

• financial sustainability
• bringing services closer to people
• adaptation to local circumstances
• improved efficiency and effectiveness

Here’s an example: we spend 4.7% of GDP on healthcare systems - this is less than EU average and Spain as a whole, although Spain as a whole spends more than the EU average.

We shared challenges with many European regions and nation states:

• Changes in population: ageing; immigration; low birth rate
• Epidemiological and sociological changes
• Scientific and technological advancement
• Economic sustainability

Our predictions show an aging population but also more diversity in immigration including older people and people from the poorer EU states.

Our priorities are:

• quality
• fairness
• decentralisation
• efficiency
• mainstreaming
• integration
• participation
• transparency
• substitutability

We have to find a new way of administrating health care and a new way of managing health care - reforming institutions, following the money, paying for performance and implementing information technology improvements.

We’re working on the participation of key agents; involving citizens and involving professionals in management in policy.

We are focusing on changing the funding allocation and improving feedback on our performance. We are reforming our key institutions making full use of European strategies including information systems electronic records and prescriptions as well as how we get professionals to communicate with each other particularly across big distances virtually.

We are aiming for a “big healthcare agreement” between politicians, professionals and citizens. In order to consolidate our model we need further reforms based on decentralization, comprehensiveness, effective provision, sustainable model, putting the citizens at the heart, professionalism as the main asset, working efficiently and transparently and making use of research innovation and excellence.

Q: Catalonia has 7 million people which is bigger than some EU states so it’s an important region. What surprised me was healthcare as a proportion of GDP - what’s the background to it being lower than the average for Spain?

A: We spend 1100 euros per person per year but we still have good outcome indicators - we don’t pay our professionals properly - we are trying to grow and get up to the average. On the other hand we know that our system is just more efficient - particularly the cooperation between public and private services.

Q: Catalonia is attractive to people coming from elsewhere. What effect is that having?

A: EU citizens are entitled to services. We have many people whose second home is Catalonia. This means a growing expense. We also have 1 million immigrants from poorer countries. We are receiving customers in the private sector not just making public provision and getting more customers for our private colleagues is good for them.