The President of the Independent Authority for Fiscal Responsibility (AIReF), Cristina Herrero, took part today in the 5th Healthcare Monitor Symposium organised by Español-Invertia. During her speech, she considered the evaluation of healthcare spending to be crucial because of its impact on the long-term sustainability of public finances and the ample room for improvement that exists. She also highlighted the contribution of AIReF’s evaluations, which offer independent, data-based analyses of the efficiency and efficacy of policies and consider findings and proposals to be useful for public decision-makers.
Cristina Herrero began by reviewing AIReF’s healthcare spending projections, included in the Opinion on the long-term sustainability of the GG. In this publication, AIReF estimates that healthcare spending will increase its weight of GDP to over 8% by 2050. As to whether this is a sustainable level or not, she considered that aside from the figures, it should be borne in mind that sustainability cannot be broken down and that the important aspect is for public finances as a whole to be sustainable.
AIReF’s projections show that healthcare spending is one of the most important items in terms of the long-term sustainability of public accounts, with the peculiarity of being a form of spending that is managed practically in its entirety by the Autonomous Regions. Furthermore, this spending has a very limited margin for discretion, so gains in efficiency and efficacy are of the utmost importance in identifying areas for improvement.
In this regard, Cristina Herrero highlighted the work of AIReF, which has been evaluating public spending on healthcare for more than six years. The first evaluations formed part of the Spending Review commissioned to AIReF due to a European impetus. Since those first studies, the Central Government’s interest in the evaluation of healthcare has been waning, while the ARs have increased their requests for evaluation in this field. Specifically, AIReF has completed or is carrying out 10 studies on healthcare commissioned by the ARs to date. Many of them have been requested to expand on the findings obtained in the Spending Review of pharmaceutical spending and high-tech equipment. In addition, the ARs have requested new areas of evaluation, such as human resources and public procurement in health.
The Central Government, for its part, has not requested the continuation of the studies on healthcare after the first Spending Review. However, the second Spending Review considers aspects of healthcare through studies on healthcare of the administrative mutual insurance system and temporary disability.
Cristina Herrero highlighted some examples of findings and proposals from AIReF’s evaluations that have been taken into account by the GG to design policies, such as the modification of the Interministerial Commission on Medication and Health Product Prices or the INVEAT Plan to reinforce investment in high-tech equipment in the National Health System.
AIReF as an evaluation body
On another note, she underlined the reasons why AIReF is one of the most suitable institutions for evaluating public policies in Spain, among which she highlighted the fact that AIReF is the institution in charge of ensuring the sustainability of public finances. It also has other comparative advantages, such as the fact that it is an independent body that does not represent any interest group, its ability to access privileged information at all levels of GG, the expertise and technical level it has to tackle evaluations that are far from simple, its ability to make evaluations based on data and evidence, and the design of evaluations with findings and proposals that are useful for decision-making.
Cristina Herrero quoted, by way of example, the study on administrative mutual insurance being carried out by AIReF as part of the second Spending Review. The evaluation is being carried out simultaneously as the new agreement with Muface is being negotiated; accordingly, AIReF has already made an intermediate delivery with preliminary results that could prove useful. As the evaluation of the model goes beyond changes to the premium, AIReF is also analysing the sustainability of the model, whether it is geared towards providing quality healthcare in line with the targets of the National Health System and whether it is efficient or whether there is room for improvement.
