Déficit democrático y problemas ético-jurídicos en el proceso de privatización de la gestión y servicios sanitarios en la Comunidad de Madrid

  1. Moreno Muñoz, Miguel
Revista:
Dilemata

ISSN: 1989-7022

Año de publicación: 2013

Título del ejemplar: Biopolítica y Democracia

Número: 12

Páginas: 95-142

Tipo: Artículo

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Otras publicaciones en: Dilemata

Resumen

El contexto de crisis y restricciones presupuestarias sirve de pretexto para promover en la Comunidad de Madrid la implantación de un modelo dual de gestión de los centros y servicios sanitarios, ampliamente contestado en la calle por profesionales sanitarios, asociaciones, pacientes y usuarios. Este proceso se inicia sin evidencia científico-técnica que avale las presuntas ventajas del modelo de concesión y carece de una evaluación solvente de impacto sanitario, conforme a estándares de transparencia, rendición de cuentas y calidad democrática. Entre los aspectos éticos y jurídicos involucrados en este debate analizo los relacionados con el conflicto de intereses y las evidencias recientes que desaconsejan adoptar en España modelos similares. Tras analizar el desafío que supone el nuevo marco institucional para el ejercicio de la responsabilidad profesional conforme a criterios de equidad y buenas prácticas, se concluye aportando elementos para generar un marco más equilibrado de reformas.

Referencias bibliográficas

  • [Bufete] López Rodó & Cruz Ferrer, and AFEM. 2013. “[Informe Afem] Sobre La Inconstitucionalidad De La Concesión De Los Servicios Sanitarios De Hospitales y Centros De Salud Por La Comunidad De Madrid.” http://www.asociacionfacultativos.com/images/comunicados/inconstitucional.pdf.
  • [Consejo General de Enfermería y de la Organización Médica Colegial]. 2013. “La Alternativa De Los Médicos y Enfermeros Para Garantizar La Sostenibilidad Del Sistema Nacional De Salud (Abril2013).” h t t p : / / w w w. a c t a s a n i t a r i a . c o m / f i l e s e t / f i l e _ _ Re s u l t a d o s _ 8 5 _ A l t e r a n t i v a s _ S N S _ M e d i c o s _ y _ Enfermer_6694431042059128656.pdf.
  • Acerete, Basilio, Anne Stafford, and Pamela Stapleton. 2011. “Spanish Healthcare Public Private Partnerships: The ‘Alzira Model’.” Critical Perspectives on Accounting 22 (6) (August): 533–549. doi:10.1016/j.cpa.2011.06.004. http://linkinghub.elsevier.com/retrieve/pii/S1045235411000785.
  • Artundo Purroy, Carlos, and Ana Rivadeneyra Sicilia. 2008. “Hacia Una Nueva Organización De Los Dispositivos De Salud Pública En España. Informe SESPAS 2008.” Gaceta Sanitaria 22, Supple (0) (April): 96–103. doi:http://dx.doi.org/10.1016/S0213-9111(08)76080-1. http://www.sciencedirect.com/science/article/pii/S0213911108760801.
  • Ayala, L. 1994. “Social Needs, Inequality and the Welfare State in Spain: Trends and Prospects.” Journal of European Social Policy 4 (3) (January 1): 159–179. doi:10.1177/095892879400400301. http://esp.sagepub.com/cgi/doi/10.1177/095892879400400301.
  • Barlow, James, Jens K Roehrich, and Steve Wright. 2010. “De Facto Privatization or a Renewed Role for the EU? Paying for Europe’s Healthcare Infrastructure in a Recession.” Journal of the Royal Society of Medicine 103 (2) (February): 51–5. doi:10.1258/jrsm.2009.090296. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2813788&tool=pmcentrez&rendertype=abstract.
  • Barlow, James, Jens Roehrich, and Steve Wright. 2013. “Europe Sees Mixed Results from Publicprivate Partnerships for Building and Managing Health Care Facilities and Services.” Health Affairs (Project Hope) 32 (1) (January): 146–54. doi:10.1377/hlthaff.2011.1223. http://www.ncbi.nlm.nih.gov/pubmed/23297282.
  • Bini Smaghi, Lorenzo. 2009. “Conflicts of Interest and the Financial Crisis.” International Finance 12 (1) (May): 93–106. doi:10.1111/j.1468-2362.2009.01238.x. http://doi.wiley.com/10.1111/j.1468-2362.2009.01238.x.
  • Brauer, S. 2009. “Age Rationing and Prudential Lifespan Account in Norman Daniels’ Just Health.” Journal of Medical Ethics 35 (1) (January): 27–31. doi:10.1136/jme.2008.024398. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2603281&tool=pmcentrez&rendertype=abstract.
  • Brock, Dan W, and Daniel Wikler. 2006. “Chapter 14 Ethical Issues in Resource Allocation , Research , and New Product Development.” In Disease Control Priorities in Developing Countries, 2nd Edition, ed. Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, and Philip Musgrove, 259–270. 2nd ed. Washington (DC): World Bank.
  • Brock, Dan W. 1989. “Justice, Health Care, and the Elderly.” Philosophy & Public Affairs 18 (3): 297–312.
  • Brown, Tim. 2009. “Health Services Restructuring.” In International Encyclopedia of HumanGeography, ed. Thrift B T Nigel and Rob Kitchin, 51–57. Oxford: Elsevier. doi:http://dx.doi.org/10.1016/B978-008044910-4.00341-2. http://www.sciencedirect.com/science/article/pii/B9780080449104003412.
  • Brown, Tim, and Craig Duncan. 2002. “Placing Geographies of Public Health.” Area 34 (4) (December): 361–369. doi:10.1111/1475-4762.00093. http://doi.wiley.com/10.1111/1475-4762.00093.
  • Cabiedes, Laura, and Ana Guillén. 2001. “Adopting and Adapting Managed Competition: Health Care Reform in Southern Europe.” Social Science & Medicine 52 (8) (April): 1205–1217. doi:http://dx.doi.org/10.1016/S0277-9536(00)00240-9. http://www.sciencedirect.com/science/article/pii/S0277953600002409.
  • Chen, Yi-Tui, and Chung-Chiang Chen. 2012. “The Privatization Effect of MSW Incineration Services by Using Data Envelopment Analysis.” Waste Management 32 (3) (March): 595–602. doi:http:// dx.doi.org/10.1016/j.wasman.2011.11.007. http://www.sciencedirect.com/science/article/pii/ S0956053X11005265.
  • Costa-Font, Joan, and Joan Gil. 2009. “Exploring the Pathways of Inequality in Health, Health Care Access and Financing in Decentralized Spain.” Journal of European Social Policy 19 (5) (December 1): 446–458. doi:10.1177/0958928709344289. http://esp.sagepub.com/cgi/content/abstract/19/5/446.
  • Daniels, N. 2001. “Justice, Health, and Healthcare.” The American Journal of Bioethics : AJOB 1 (2) (January): 2–16. doi:10.1162/152651601300168834. http://www.ncbi.nlm.nih.gov/pubmed/11951872.
  • Daniels, Norman. 1981. “Health-care Needs and Distributive Justice.” Philosophy & Public Affairs 10 (2) (January): 146–79. http://www.ncbi.nlm.nih.gov/pubmed/11661955.
  • DANIELS, NORMAN, and JAMES SABIN. 1997. “Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers.” Philosophy & Public Affairs 26 (4) (October): 303–350. doi:10.1111/j.1088-4963.1997.tb00082.x. http://doi.wiley.com/10.1111/j.1088-4963.1997.tb00082.x.
  • Deutscher Ethikrat. 2011. Medical Benefits and Costs in Healthcare: The Normative Role of Their Evaluation. Berlin. http://www.ethikrat.org/files/der-opinion-medical-benefits.pdf.
  • Dorn, Nicholas. 2012. “Knowing Markets: Would Less Be More?” Economy and Society 41 (3) (August): 316–334. doi:10.1080/03085147.2012.668032. http://www.tandfonline.com/doi/abs/10.1080/03085147.2012.668032.
  • Edwards, Nigel. 2009. “Economic Downturn.” Journal of the Royal Society of Medicine 102 (3) (March): 86–7. doi:10.1258/jrsm.2009.09k011. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2746840&tool=pmcentrez&rendertype=abstract.
  • Farhi, Maryse, and Marcos Antonio Macedo Cintra. 2009. “The Financial Crisis and the Global Shadow Banking System.” Revue De La Régulation (5) (June 10). http://regulation.revues.org/7473.
  • FENIN Federación Española de Empresas de Tecnología Sanitaria. 2007. La Aportación De Las Empresas De Tecnología Sanitaria a La Sostenibilidad Del Sistema Sanitario Español. http://www.fenin.es/pdf/estudio_sostenibilidad.pdf.
  • Friedman, Alex. 2008. “Beyond Accountability for Reasonableness.” Bioethics 22 (2) (February): 101–12. doi:10.1111/j.1467-8519.2007.00605.x. http://www.ncbi.nlm.nih.gov/pubmed/18251770.
  • Galizzi, Monica, Petra Miesmaa, and Laura Punnett. 2010. “Injured Workers ’ Underreporting in the Health Care Industry : An Analysis Using Quantitative , Qualitative , and Observational Data” 49 (1): 22–43.
  • Garrido, Marcial Velasco, Markus Wörza, and Reinhard Bussea. 2004. “Ley De Modernización Del Sistema Sanitario : La Penúltima Reforma Alemana.” Rev Adm Sanit. 2 (2): 287–298. http://www.elsevier.es/es/revistas/revista-administracion-sanitaria-siglo-xxi-261/ley-modernizacion-sistema-sanitariopenultima-reforma-alemana-13063443-originales-2004?bd=1.
  • Gracia, Diego. 2013. “Prudencia Política.” Bioética Complutense Marzo (14): 5–9.
  • Guillén, Ana M, and Laura Cabiedes. 1997. “Towards a National Health Service in Spain: The Search for Equity and Efficiency.” Journal of European Social Policy 7 (4) (November 1): 319–336. doi:10.1177/095892879700700403. http://esp.sagepub.com/cgi/content/abstract/7/4/319.
  • Guillén, Mauro F., and Sandra L. Suárez. 2009. “Markets on Trial: The Economic Sociology of the U.S. Financial Crisis: Part A (Research in the Sociology of Organizations, Volume 30).” In , ed. Michael Lounsbury and M. Paul Hirsch, 30:257–279. Emerald Group Publishing Limited. doi:10.1108/S0733-558X(2010)000030A012. http://www.emeraldinsight.com/books.htm?chapterid=1870849.
  • Heyes, Anthony. 2005. “The Economics of Vocation or ‘why Is a Badly Paid Nurse a Good Nurse’?” Journal of Health Economics 24 (3) (May): 561–569. doi:10.1016/j.jhealeco.2004.09.002. http://linkinghub.elsevier.com/retrieve/pii/S0167629604001043.
  • Hodge, James G, Dan Hanfling, and Tia P Powell. 2013. “Practical, Ethical, and Legal Challenges Underlying Crisis Standards of Care.” The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics 41 Suppl 1 (March): 50–5. doi:10.1111/jlme.12039. http://www.ncbi.nlm.nih.gov/pubmed/23590741.
  • Jones, Erik. 2009. “They Have No Idea . . . Decision-Making and Policy Change in the Global Financial Crisis.” SSRN Electronic Journal. doi:10.2139/ssrn.1550892. http://www.ssrn.com/abstract=1550892.
  • Kikuzawa, Saeko, Sigrun Olafsdottir, and Bernice A Pescosolido. 2008. “Similar Pressures, Different Contexts: Public Attitudes Toward Government Intervention for Health Care in 21 Nations.” Journal of Health and Social Behavior 49 (4) (December 1): 385–399. doi:10.1177/002214650804900402. http://hsb.sagepub.com/cgi/content/abstract/49/4/385.
  • Langevoort, D. C. 2010. “Global Securities Regulation After the Financial Crisis.” Journal of International Economic Law 13 (3) (December 3): 799–815. doi:10.1093/jiel/jgq032. http://jiel.oxfordjournals.org/cgi/doi/10.1093/jiel/jgq032.
  • Maluka, Stephen Oswald. 2011. “Strengthening Fairness, Transparency and Accountability in Health Care Priority Setting at District Level in Tanzania.” Global Health Action 4 (January). doi:10.3402/gha.v4i0.7829. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3211296&tool=pmcentrez&rendertype=abstract.
  • Martinez-Espineira, R., M. A. Garcia-Valinas, and F. Gonzalez-Gomez. 2009. “Does Private Management of Water Supply Services Really Increase Prices? An Empirical Analysis in Spain.” Urban Studies 46 (4) (April 1): 923–945. doi:10.1177/0042098009102135. http://usj.sagepub.com/cgi/doi/10.1177/0042098009102135.
  • McKee, Martin, Nigel Edwards, and Rifat Atun. 2006. “Public-private Partnerships for Hospitals.” Bulletin of the World Health Organization 84 (11) (November): 890–6. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2627548&tool=pmcentrez&rendertype=abstract.
  • Nunes, Rui, and Guilhermina Rego. 2013. “Priority Setting in Health Care: A Complementary Approach.” Health Care Analysis : HCA : Journal of Health Philosophy and Policy (March 20). doi:10.1007/s10728-013-0243-6. http://www.ncbi.nlm.nih.gov/pubmed/23512613.
  • Nunes, Rui, Guilhermina Rego, and Cristina Brandão. 2009. “Healthcare Regulation as a Tool for Public Accountability.” Medicine, Health Care, and Philosophy 12 (3) (August): 257–64. doi:10.1007/s11019-008-9177-4. http://www.ncbi.nlm.nih.gov/pubmed/19137451.
  • OCDE. 2012. Base De Datos De La OCDE Sobre La Salud 2012 España En Comparación. http://www.oecd.org/spain/BriefingNoteESPANA2012inSpanish.pdf.
  • OECD. 2009. Health at a Glance 2009 OECD INDICATORS. OECD. doi:10.1787/health. http://www.oecd.org/health/health-systems/44117530.pdf.
  • OECD. 2012. Health at a Glance: Europe 2012. OECD Publishing. doi:10.1787/9789264183896-en. http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2012_9789264183896-en.
  • Parr, Hester. 2004. “Medical Geography: Critical Medical and Health Geography?” Progress in Human Geography 28 (2) (April 1): 246–257. doi:10.1191/0309132504ph484pr. http://phg.sagepub.com/cgi/doi/10.1191/0309132504ph484pr.
  • Pérez-Molina, José A, and Federico Pulido Ortega. 2012. “Evaluación Del Impacto Del Nuevo Marco Legal Sanitario Sobre Los Inmigrantes En Situación Irregular En España: El Caso De La Infección Por El Virus De La Inmunodeficiencia Humana.” Enfermedades Infecciosas y Microbiología Clínica 30 (8) (October): 472–8. doi:10.1016/j.eimc.2012.07.004. http://www.ncbi.nlm.nih.gov/pubmed/22939565.
  • Piqué, Josep M. 2013. “¿Dónde Está y Hacia Dónde Va Nuestro Sistema Sanitario?” Medicina Clinica (January 4). doi:10.1016/j.medcli.2012.10.018. http://www.ncbi.nlm.nih.gov/pubmed/23294630.
  • Pollock, Allyson M, Jean Shaoul, and Neil Vickers. 2002. “Private Finance and ‘value for Money’ in NHS Hospitals: a Policy in Search of a Rationale?” BMJ 324: 1205–1209. http://www.bmj.com/content/324/7347/1205.
  • Puerto, Kàtia Lurbe i. 2003. “Accessibility of the Public Health System in Spain to Immigrants from non-EU Countries.” Transfer: European Review of Labour and Research 9 (3) (August 1): 532–540. doi:10.1177/102425890300900313. http://trs.sagepub.com/cgi/content/short/9/3/532.
  • Repullo, José R, and José M Freire. 2008. “Gobernabilidad Del Sistema Nacional De Salud: Mejorando El Balance Entre Los Beneficios y Los Costes De La Descentralización. Informe SESPAS 2008.” Gaceta Sanitaria 22, Supple (0) (April): 118–125. doi:http://dx.doi.org/10.1016/S0213-9111(08)76083-7. http://www.sciencedirect.com/science/article/pii/S0213911108760837.
  • Rhodes, Robert P. 1992. Health Care Politics, Policy, and Distributive Justice – the Ironic Triumph. Albany: State University of New York Press. http://books.google.es/books?id=zk9WANlgkeEC&pg=PA38&lpg=PA38&dq=Norman+Daniels++Health+Care+Needs+and+D istributive+Justice&source=bl&ots=gjRL_pUD79&sig=2A9L4irJhWXFl537zE1gNUQJvsw&hl=es&sa=X&ei=WAZ4UeDHPK7A7Ab myYGABw&ved=0CIUBEOgBMAk#v=onepage&q=Norman Daniels Health Care Needs and Distributive Justice&f=false.
  • Rodriguez, Josep A, and Jesus M de Miguel. 1990. “The Case of Spain.” Health Policy 15 (2–3) (August): 119–142. doi:http://dx.doi.org/10.1016/0168-8510(90)90006-Y. http://www.sciencedirect.com/science/article/pii/016885109090006Y.
  • Rodríguez, Marisol, Richard M Scheffler, and Jonathan D Agnew. 2000. “An Update on Spain’s Health Care System: Is It Time for Managed Competition?” Health Policy 51 (2) (March): 109–131. doi:http://dx.doi.org/10.1016/S0168-8510(99)00080-9. http://www.sciencedirect.com/science/article/pii/S0168851099000809.
  • Rodríguez-Piñero Durán, M, C Rodríguez Burgos, and C Echevarría Ruiz de Vargas. 2009. “Gestión Del Conocimiento II: Generación y Transmisión Del Conocimiento.” Rehabilitación 43 (3) (June): 111–117. http://www.sciencedirect.com/science/article/pii/S0048712009714896.
  • Rueda, Juan Ramon. 2005. Guía Para La Evaluación Del Impacto En La Salud y En El Bienestar De Proyectos, Programas o Políticas Extrasanitarias. Investigación Comisionada. Informe No: Osteba D-05-04. Vitoria-Gasteiz: Servicio Central de Publicaciones del Gobierno Vasco.
  • Segura Benedicto, Andreu, and Manuel Oñorbe de Torre. 2010. “Cambios En La Salud Pública: El Papel Del Estado y De Las Autonomías. Informe SESPAS 2010.” Gaceta Sanitaria 24, Supple (0) (December): 19–22. doi:http://dx.doi.org/10.1016/j.gaceta.2010.06.004. http://www.sciencedirect.com/science/article/pii/S0213911110001846.
  • Sharek, Zachariah, Robert E Schoen, and George Loewenstein. 2012. “Bias in the Evaluation of Conflict of Interest Policies.” The Journal of Law, Medicine & Ethics : a Journal of the American Society of Law, Medicine & Ethics 40 (2) (January): 368–82. doi:10.1111/j.1748-720X.2012.00670.x. http://www.ncbi.nlm.nih.gov/pubmed/22789052.
  • Sikka, Prem. 2008. “Enterprise Culture and Accountancy Firms: New Masters of the Universe.” Accounting, Auditing & Accountability Journal 21 (2): 268–295. doi:10.1108/09513570810854437. http://www.emeraldinsight.com/10.1108/09513570810854437.
  • Sikka, Prem. 2009. “Financial Crisis and the Silence of the Auditors.” Accounting, Organizations and Society 34 (6-7) (August): 868–873. doi:10.1016/j.aos.2009.01.004. http://linkinghub.elsevier.com/retrieve/pii/S036136820900018X.
  • Smith, Denis. 2002. “Not by Error, But by Design Harold Shipman and the Regulatory Crisis for Health Care.” Public Policy and Administration 17 (4): 55–74. doi:10.1177/095207670201700405. http://ppa.sagepub.com/cgi/content/abstract/17/4/55.
  • Stiglitz, Joseph E. 2009. “Interpreting the Causes of the Great Recession of 2008.” http://policydialogue. org/files/events/Stiglitz_Interpreting_the_Causes_of_Great_Recession_of_2008.pdf.
  • Suleiman, AB, MS Lye, Rohaizat Yon, SC Teoh, and Alias Mymoon. 1998. “Impact of the East Asian Economic Crisis on Health and Health Care: Malaysia’s Response.” Asia-Pacific Journal of Public Health 10 (1) (January 1): 5–9. doi:10.1177/101053959801000102. http://aph.sagepub.com/cgi/content/abstract/10/1/5.
  • Tallman, Ruth. 2012. “Valuing Lives and Allocating Resources: A Defense of the Modified Youngest First Principle of Scarce Resource Distribution.” Bioethics (July 29). doi:10.1111/j.1467-8519.2012.01994.x. http://www.ncbi.nlm.nih.gov/pubmed/22845668.
  • Urbanos, Rosa. 2010. “Recomendaciones Para Una Futura Ley De Salud Pública En España.” Gaceta Sanitaria 24 (1) (January): 89–94. doi:http://dx.doi.org/10.1016/j.gaceta.2009.08.006. http://www.sciencedirect.com/science/article/pii/S0213911109003355.
  • Villalonga, Belén. 2000. “Privatization and Efficiency: Differentiating Ownership Effects from Political, Organizational, and Dynamic Effects.” Journal of Economic Behavior & Organization 42 (1) (May): 43–74. doi:http://dx.doi.org/10.1016/S0167-2681(00)00074-3. http://www.sciencedirect.com/science/article/pii/S0167268100000743.
  • Warner, Mildred E. 2008. “Reversing Privatization, Rebalancing Government Reform: Markets, Deliberation and Planning.” Policy and Society 27 (2) (November): 163–174. doi:http://dx.doi.org/10.1016/j.polsoc.2008.09.001. http://www.sciencedirect.com/science/article/pii/S1449403508000271.
  • Wikler, Daniel. 2012. “Personal and Social Responsibility for Health.” Ethics & International Affairs 16 (02) (September 28): 47–55. doi:10.1111/j.1747-7093.2002.tb00396.x. http://www.journals.cambridge.org/abstract_S0892679400002690.
  • World Health Organization. 2013. The European Health Report 2012 : Charting the Way to Wellbeing. Copenhagen. http://www.euro.who.int/__data/assets/pdf_file/0003/184161/The-European-Health-Report-2012,-FULL-REPORT-wcover.pdf.
  • Zuberi, Daniyal M, and Melita B Ptashnick. 2011. “The Deleterious Consequences of Privatization and Outsourcing for Hospital Support Work: The Experiences of Contracted-out Hospital Cleaners and Dietary Aids in Vancouver, Canada.” Social Science & Medicine 72 (6) (March): 907–911. doi:http://dx.doi.org/10.1016/j.socscimed.2010.12.024. http://www.sciencedirect.com/science/article/pii/S0277953611000372.
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