«We need to be able to translate words into actions, as Dr Espriu did with his co-operative health movement.» their asset capabilities: resources available, although there is a long waiting list. This is simply a reflection of the limitations on public funding resources, which cannot meet all the demands permitted by the available supply. Those wishing to decide on their own account and avoid being treated as an employee, which they find unacceptable, will at least need to share in the daily financial difficulties of their patrons. They must be aware that autonomy means accepting the consequences of one’s own decisions, including in financial matters. If we want health institutions to govern their professionals effectively, then this should correspondingly mean that they agree to be “shareholders”, to be bound to “results”. That implies that they must be prepared to underwrite the capital, the cost of the facilities granted to them for management, if they are public, either through their own initial funding or through future remuneration received in part in the form of “paper”, which is the co-operative return or value of the shares in the management companies which they could themselves own. And this must be performed on a voluntary basis, respecting the rights
acquired, without any enforced retroactivity. And not only through public limited companies, but also mutual co-operatives, as created by Dr Espriu, or other mixed economy organisations. And if civil society becomes a part of boards of trustees and government organs, it must be reminded that it is assuming a responsibility before the community, with civil and criminal consequences. Meanwhile, those calling to exclude such matters from public administration, using hybrid forms in public-private dealings, with flexible budgetary and accounting management, must be aware that this means competing for funding based on private competition rates, without being able to consolidate and generate guaranteed funding year after year, irrespective of the levels of efficiency achieved. This is in any case demanded by the European Public Accounting System in order to take advantage of such classification, beyond fine words, lest anyone forget. The health care dynamic in this country today features a wealth of public partnerships, foundations, consortia, professional associations, co-operatives, all of which make their contribution to improving management, outside the traditional model which has no further mileage left in it. But unless we are precise in identifying the issues we discuss, we could well find ourselves reaching agreements which we do not understand. The acid test is in this sense to achieve unequivocal “action” rather than ambiguous “talk”. To move from speaking to doing, in the way that doctor Espriu exemplified.
october november december 2014
43