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Barcelona to launch Spain’s first public (and cheap) dentistry service

The Catalan capital is looking to launch Spain’s first public orthodontist service, offering treatments for up to 40 percent less than through the private sector.

Published: 11 January 2019 12:58 CET
Barcelona to launch Spain's first public (and cheap) dentistry service
Photos: AFP

Barcelona residents with dental problems will soon be able to receive treatments on the public healthcare system thanks to a new measure spearheaded by the city’s mayor Ada Colau. 

If approved by Barcelona’s Social Rights Commission on January 15th, it will be the first comprehensive public dentistry service of its kind in Spain.

Having a filling put in will cost €55 – 13 percent less than the average private rate – according to Spanish consumer rights group Facua.

A root canal will cost €160 (30 percent lower) whereas a deep dental clean will be €30 (43 percent lower).

Barcelona Town Hall will make the public service available to all its citizens after initially launching it only for its most cash-strapped residents through mutual insurance company PANEM.

The public health service add-on will help 36,000 people annually, Barcelona authorities have estimated.

“More than 12 percent of our population doesn’t go to the dentist because they can’t afford it, even though it’s essential to live a healthy life,” Barcelona left-leaning mayor Ada Colau is quoted as saying by El Periódico.

“And it’s not just physical health I’m talking about, there are also the emotional and psychological implications to consider.”

A number of opposition parties including Ciudadanos and Spain’s Popular Party have called the measure “implausible” and “unsustainable”, whereas socialist PSOE MP Xavier Trias labelled the move an “improvisation to gather votes”.

Barcelona City Council representatives have argued in response that the public dentistry clinic is “completely viable financially” in that it will be self-sufficient, as the initial €500,000 of public funds that will be invested will be recovered through dentistry earnings.

Barcelona’s first municipal dentist is likely to be based in either the district of Sant Martí, Nou Barris or Sant Andreu, where the need for cheaper dentistry services is greater among its cash-strapped residents.

Spain’s public health system was ranked as the world’s third best by Bloomberg in 2018, but the country’s social security system doesn’t cover dentistry services, aside from certain treatments for children.

According to orthodontist association SEPA, Spaniards have the worst dental hygiene and oral health in southern Europe.

“Dental care has always been considered a luxury in Spain,“ Javier Sanz, of Primary Health Care Association Semergen, told El Pais.

“Healthcare isn’t free, we pay for it with our taxes.

“Providing public dental treatments around Spain would mean having to take funds away from other fields, which could be very detrimental.”
 

JOHN LICHFIELD

ANALYSIS: How sick is the French health system?

Amid warnings that parts of the French health system are on the verge of collapse and a new government plan for health reform, John Lichfield takes a look at exactly what - if anything - is wrong with healthcare in France.

Published: 23 February 2023 15:13 CET
Updated: 25 February 2023 08:42 CET
ANALYSIS: How sick is the French health system?

Within 10 kilometres of my home in deepest, rural Normandy I have access to six doctors, a dozen nurses and a medical centre.

Two of the small towns within 30 kilometres have full-service hospitals. A little further away in Caen, there is one of the biggest and best hospitals in France.

Maybe I’m lucky. In the next département to the south, Orne, there are large areas where there are no doctors  at all – “medical deserts” as the French call them. One in ten French people has no GP or médecin traitant. Over 600,000 French people with chronic illnesses have no doctor.

Twenty years ago, the World Health Organisation declared the French health system to be the best in the world. In more recent surveys, France often comes in the top ten and sometimes in the top five.

You can hear John talking healthcare with the team at The Local in the latest episode of the Talking France podcast – download HERE or listen on the link below

And yet the French public hospital system is, we are told, close to collapse, exhausted by Covid and years of under-investment. Some GPs are threatening to go on strike for a doubling of their official fee of €25 for a consultation (less, as they point out, than you pay for a hair-cut or a manicure).

President Emmanuel Macron and his health minister, François Braun, agree that there is a problem. Macron is a doctor’s son. Braun is a doctor. They have diagnosed a number of problems; partly a shortage of money at the point where it is needed, partly chronic disorganisation and poor administration.

French health minister: We must reform the health system to reflect the France of today

President Macron, in his New Year message to health workers last month, promised that all the 600,000 sick people without a doctor would be offered one before the end of the year. He promised that there would be 10,000 “medical assistants” instead of 4,000 by the end of 2024.

He also promised an end to what he called the “hyper-rigidity” in the system of financing, administering and staffing of hospitals. (In other words, he gave no promise of extra money but the government has already committed to spending an additional €19 billion on hospitals over ten years.)

This is not just a French problem, as anyone who follows the news in Britain will know. All health systems in the world are struggling to cope with ageing populations, expensive advances in medical treatment and restraints on public spending.

The French health service is, overall, less impressive than it was 23 years ago when the WHO declared it to be the world’s finest. The same is probably true of all of the others.

The explanation for the French decline is partly universal and partly French; partly about money and partly about French politics, French attitudes and even French geography.

More than prescriptions: 10 things you can do at a French pharmacy

In purely financial terms, France  spends a huge amount of money on  health. Overall, the country invests 12.4 percent of its annual GDP on health care (mostly channelled through the state). This compares to 12.8 percent in Germany, 11.9 percent in the UK and 17.8 percent in the United States (much of it private).

In both GDP terms and cash terms, the amount has been rising despite the fact that investment in public hospitals was severely restrained for 15 years by Presidents Chirac, Sarkozy and Hollande. In terms of health outcomes France, according to the OECD, remains the second best-performing country in the world, just behind Japan.

And yet there is something odd and unbalanced about how France spends money on health – an imbalance which has become more problematic as cash become scarcer.

Although France spends almost as much overall as Germany, it has fewer doctors and nurses and pays them far less. It has fewer hospital beds than Germany but many more hospitals.

The share of French health spending which goes on administration is 7 percent, compared to 5.5 percent in Germany.

The proliferation of hospitals is one explanation for this high admin burden. France has 4.42 hospitals for every 100,000 people, compared to 3.62 in Germany and 2.86 in the UK.

It should be remembered, however, that the number of hospitals is partly imposed by the fact that France is a comparatively large, empty country. Medium-size towns have their own hospital because it is a long drive by ambulance to a big city. Closing down rural hospitals would – rightly – provoke an outcry.

Even more striking – and less justified – is the French addiction to drugs and pharmacies. My neighbouring small towns in Normandy have two or three pharmacies each; almost every large street in Paris has at least one. It is scarcely surprising that medicines, and their distribution, account for 18 percent of all health spending in France, compared to 15 percent in Germany.

READ ALSO Why do the French love medication so much?

Another ‘French’ factor which has put enormous pressure on the French health service in the last two decades has been the 35-hour working week. Its effects on industry and office working have sometimes been benign; in the staffing of hospitals, it has been a calamity.

Macron in his New Year health address identified the application of the 35-hour week as one of the areas of “hyper-rigidity” in the administration of hospitals that he wanted to change this year. He has been accused of wanting to abolish the 35-hour week in the health service. That is not quite what he said.

As the more reasonable medical commentators’ admit, Macron (the doctor’s son) has done more for the French health service than his predecessors. Apart from the €19bn for hospitals, he has spent an extra €12bn on pushing up doctors’ and nurses’ incomes (which remain lower than they should be).

He also removed the absurd cap on the number of doctors which French medical schools were allowed to produce each year.

Macron is asking for trouble if he thinks he can resolve the present crisis without spending more money. But it is wrong to suggest, as some do, that France has the worst of all possible health services. 

The debate on the  French health service suffers from the same crippling ailment which afflicts other areas of political life in France: a catastrophism which ignores what is going well and fails to identify what needs to be changed.

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