Maria Jesus Salvador is President of the Spanish Society of Cardiology and has represented Spain in the Council for Cardiology Practice for several years. The National Health System in Spain is one of the most complete in Europe. Every person who lives in Spain is covered by it. The National Health System organization gives medical attention at the hospital but also in outpatients’ clinic and in some cases at home. But this extraordinary organization cannot avoid problems in attending the huge demands.
On the other hand, there is an old habit in the high and middle class population that is, to have also a private medical insurance. People pay twice, for public health and for private insurance. This formula allows them to be assisted more rapidly by their doctors.
Some patients even pay for each medical need.
This situation gives a variety of possibilities: the patient can visit the public health system, the private system and also share both systems.
All doctors from the private practice must be members of the College of Physicians (Colegio de Médicos) with independence of the speciality. This College establishes the standards for each medical act but at the same time insurance companies tend to pay less than 100% of their standards.
On the contrary to other countries, insurance companies pay for each medical act and not for pathologies. Doctors are free to visit patients as often as patients require but always “with common sense”. This allows them to accomplish with the guidelines. Medical insurances companies have strict control on the use of visits and tests; they control the expenses but not directly the medical quality.
Health authorities are trying to control medical quality through the continuous medical education. A certain number of credits will be needed to revalidate your title, but today it’s only an exercise useful in some cases for working in public health but not in private practice. Nevertheless, there are a great variety of possibilities for updating the medical knowledge that comes predominantly from the Scientific Societies such as the Spanish Society of Cardiology, with unrestricted grants from pharmaceutical and medical devices companies. Usually cardiologists in private practice attend CME courses at the Heart House or abroad, Congresses and Symposiums. It’s more difficult to find clinical investigators. Research in private practice is usually closed to private hospitals related to the University.
The profile of the cardiologist in private practice in Spain is not homogeneous. One third of cardiologists (575) members of the SSC are working at hospitals in the morning and in private practice in afternoon/evening. They combine the public with the private practice. Only 20 % of cardiologists’ members of the SSC are working in private practice only, in or out of private clinics. Cardiologists in private practice can work alone, but at least more than a half works in a team, trying to satisfy the needs of the patients. Teamwork is stimulating for knowledge and improves services.
There are a few private clinics related to private or public Universities. As private clinics tend to take on the structure of a public hospital, they feel the need to be close to the University.
In conclusion Cardiology private or public is only one. The work of cardiologists must also be one and my suggestion is to coordinate public and private health in order to give the best Cardiology to our patients and in general to our population. On the other hand Cardiology in the private practice has an important role with the creation of new guidelines because it knows which are the problems at the moment of implementation. The European Society of Cardiology has the same opinion and invites the Council for Cardiology Practice to participate in the Guidelines Committee.
Last survey realised by the SSC in 2007 gives a rough situation close to the current situation about cardiologists in Spain:
Active Cardiologists Members of SSC: 1760
Cardiologists non Members of SSC: 832
Total: 2.592 cardiologists in Spain (5, 6 cardiologists/100.000 inhabitants)
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