Hixinio Beiras*, Manuel Martín**
Understanding, explaining, organising and occasionally succeeding: recent experiences promoting opposition to neoliberal counter reform in Spain
*Cardiologist in Vigo, president of Galician Regional NHS Defence Association (AGDSP, member of Federación de Asociaciones para la Defensa de la Sanidad Pública, FADSP)
**Specialist in Family and Community medicine in Marín, Pontevedra, Secretary of FADSP (Federation of Associations for NHS Defence).
Contact: Hixinio Beiras
In spite of the appreciable overall results, and the cost/benefit relationship in the Spanish NHS, the conservative government has devoted itself to its dismantling and privatisation, following the European 1980�s conservative approach focused on the privatisation of public services, increase of copayments, rationing publicly financed benefits, and increasing the role of private health insurance. Following these trends, the conservative government is applying important modifications to the Spanish NHS:
The introduction of the market through the finance/provision split with the intention of transforming NHS into a large number of smaller enterprises known as �Fundaciones� in the case of hospitals, similar to UK�s Hospital Trusts.
An increase in outsourcing to private enterprises some or all public health services, even awarding public companies the hospital care of some local communities, a policy inspired also by the UK�s Private Finance Initiative (PFI).
The limitation of healthcare services remains a menace only held back by the opposition of public opinion and pensioners.
The reinforcement of private health insurance, mainly through economic support to MUFACE (private mutualities for some public servants), and a 36% tax reduction for companies who privately insure their workers.
These reforms began in Galicia in 1995 before being extended to the rest of the country. Against this policy, the FADSP promoted the creation of unitary organisations of NHS supporters altogether with political parties, trade unions, professional associations and civic, neighbour, consumer and patient organisations. These Platforms for NHS defence (PNHSD) led growing actions against privatisation in Galicia and promoted the People�s Legislation Initiative campaign in 1998-99.
The success of PNHSD in the creation of a professional and social opposition, simultaneously with the extension of neoliberal policies, extended them across the country.
Further conflicts with health authorities have taken place, some of which ended with success of PNHSD. The most relevant experiences being the important demonstrations in the Madrid against the conversion of a hospital into a Fundación, the social opposition altogether with religious charity associations to the demolition of the old Santiago General Hospital and in demand of its conversion into a long term care institution. Also, the mobilisation of Pontevedra, the local and surrounding municipalities �some governed by the party in power- in demand of a new public hospital. Finally, the research led by the Vigo PNHSD promoted by the municipal authorities to investigate local health care resources and needs as a starting point to settle down demands before the regional health authorities in Primary Care, Hospital reforms, new social health services and mental health facilities, a change as it overcomes simple opposition with the proposal of practical outcomes.
At a national level, PNHSD�s have addressed the public through the media, making Health Policy a matter of public interest, generating opposition to neoliberal counter reforms, making the Ministry of Health abandon their principal policy of converting hospitals into Fundaciones.
Main steps have been understanding complex conservative policies, creation of PNHSD�s, and the introduction of simple but in this field new communication and propaganda methods.
International Association of Health Policy 