[1] Scientific research provides welfare benefits to society when funding is increased and knowledge is effectively communicated. [2] The Spanish national health system guarantees universal coverage at a low cost per capita compared to countries like the US, and is ranked among the best in the world. [3] The system has strategic value by ensuring workforce health, generating wealth, and providing high-quality jobs that support other industries like biotechnology and tourism.

1. Investigación Biomédica, Bienestar
Social y el Valor Estratégico del Sistema
Nacional de Salud
Universidad Internacional Menéndez Pelayo, 21 Agosto 2009
y , g
Bernat Soria, MD, PhD
CABIMER (Centro Andaluz de Biología Molecular y Medicina Regenerativa)
C/ Américo Vespucio s/n, Isla de la Cartuja, 41092 Sevilla
bernat.soria@cabimer.es
bernat soria@cabimer es
bsoria@msc.es

2. 1.- Research and the search for a
solution of the economical crisis

3. 1771 “Industrial Revolution
agnation
n
1829 Steam engine and railways
Sta
1875 Steel , Engineering
1908 Oil, cars
Oil cars, mass production
1971 Informatics, Computers and Telecommunications
Five Technological Revolutions in 230 years

4. XXth century
1900
2000
Steel
St l
1
Computers, Communications
Oils, Cars, Mass Production
1908-1918
1908 1918
Depression 30’sand 1rst World War
MATURITY
1960-74
Social Crisis MATURITY
W
1rst World War
cession
1943-59 Social Crisis
VietNam War
SYNERGY
Rec
SYNERGY 1920-29
“Belle Epoque” Frenzy
development
Depre
1987-2000’s
(20´s) Frenzy
1908-1920 1971-87 development
Birth Financing Regulations Birth
“Bretton Woods/Keynes”
Welfare /Marshall
Mass Production 90’s
Informatics
1971
1908 Crash Micro-
Ford Model-T 1929 processor ?
Intel

5. Two Phases in a Wave
INSTALATION PERIOD SPREAD PERIOD
MATURITY
Politics
R SINERGY
Production
E
Diffusion
S
E
A
R
C
FRENZY H
Finance
BIRTH
Finance “of its own accord”
Technology Biased prosperity
Bubble
Explosion of novelty
Decline of the old Time
Big-Bang Siguiente
big-bang
CRASH

6. 2.- Scientific Research as a value and
its impact in society and its values

7. Value is defined as the degree
to which one’s ideas have
contributed to knowledge and
impacted the thinking of others
Evolution of science
contributes to social
social, Both
B th society and
i t d
political and political, economical
economical and legal systems
development influence the
development of
science

8. Science and Society:
towards a new alliance of values
Research as a service to society
implies
p
Freedom for Communication with
its citizens.
development Identify their needs

9. Science and Society: towards a new alliance of values
A global society needs universal access to therapies
derived from research
Ethics: Service to Economics:
mankind Decrease of innovation costs,
because of increase of
beneficiaries

10. Aggregated Value of Products
Productivity
P d ti it =
Costs
Options: 1. Decrease Costs
2. Increase Value= Innovation
However, Innovation Is Not Enough

11. Investigación Biomédica y Bienestar Social
(una relación biunívoca que no siempre se cumple)

12. RESEARCH IN HEALTH: GUARANTEES WELFARE
Increase in R+D+i
I i Improvement of welfare
I t f lf
Concepts NOT always linked

13. Health Indicators
USA SPAIN
1986 2005 1986 2005
Life expectancy Females 78,2 80,4 79,9 83,7
Males 71,2 75,2 73,4 77,0
Infant
I f t mortality
t lit 10,4
10 4 6,9
69 9,2
92 3,8
38
Deaths/1.000 live births
Potential years of life lost
y 6.471 4.965 4.968 3.201
All causes <year/100.000
Causes of mortality 261,1 144,6 104,9 77,9
(ischaemic h t di
(i h i heart diseases
males deaths/100.000)

14. HEALTH STATUS
LIFE EXPECTANCY AT BIRTH
Source: Health at a Glance 2007: OECD Indicators

15. SPAIN NHS: AN EFFICIENT SYSTEM
Expenditure Perinatal
(aprox)/ Mortality
inhabitant
i h bit t per
year:
SPAIN 2.000 $ 4,9 x 1000
(1.300 €)
USA 6.000
6 000 $ 6,7
6 7 x 1000
(4.500 €)
OECD Health Data 2008.

16. RESEARCH IN HEALTH: GUARANTEES WELFARE
Increase in R+D+i Improvement of welfare
Concepts NOT always linked
USA NEEDS HEALTH STRUCTURE
World N. 1 in R+D+i WHICH TRANSFORMS KNOWLEDGE
WELFARE
Lacks a good health system
Bad health indicators THE NATIONAL HEALTH SYSTEM

17. 3.- Strategic Value of the
National Health System

18. SPANISH NATIONAL HEALTH SYSTEM
SPANISH CONSTITUTION, 1978
General Health Act 1986
NATIONAL HEALTH SYSTEM
• Universal Coverage (including immigrants)
• Financed through taxes
g
• “Federal-like” system (17 autonomous regions)
• Extensive portfolio of services

19. UNIVERSAL COVERAGE
SOCIAL SECURITY NATIONAL HEALTH
Coverage
SYSTEM (UNTIL SYSTEM (SINCE 1986)
1986)
Insured population
All citizens
covered
(Includes
Restricted to active immigrants)
employees and their
p y
families
1986 2006
Primary
First 13.091
Primary Healthcare Primary
Healthcare Healthcare
Centres built Centres

20. SPANISH NATIONAL HEALTH SYSTEM
• I. Among the best in the world
• - Ranked 4th among the 19 most developed countries
• Health Affairs ( Health Affairs 27: 58-71 (2008);)
• -R k d
Ranked 6th among 191 countries
ti
• British Medical Journal (Evans DB & cols. Comparative efficiency of national health
systems: cross national econometric analysis. BMJ. 2001 Aug 11;323(7308):307-10)
• - Ranked 7th among 191 countries
• WHO (World Health Report 2000. Health Systems. Improving performance )
• II. Number one in the world in organ transplantation
FIRST IN THE WORLD IN CADAVERIC ORGAN DONATION. SPAIN, EU-27 AND USA
,
COUNTRIES SPAIN EU-27 USA
Population
(million inhabitants) 45.2 492.3 303.9
Cadaveric Organ Donor 1,550 8,293 8,089
(Rate –pmp-) (34.4) (16.9) (26.6)

21. SPANISH NATIONAL HEALTH SYSTEM
STRATEGIC VALUE (I)
1. Warrants the state of health of the country's workforce
2. Since healthcare is covered, citizens may take on other
economical risks (buying houses etc.)
houses, etc )
3. Provides of direct high-quality employment that cannot
high-
be delocalised
Labour Force Survey: 5.85 % of total employment
(
(1,119,200 employees, women > men)
y )

22. SPANISH NATIONAL HEALTH SYSTEM
STRATEGIC VALUE (II)
4. Direct source of wealth generation with a Return on Investment Factor
(Drag Factor) = 40%
2006 Expenditure €82,064 million → Return €32,825 million
5. Niche for the traditional business fabric's diversification :
Biotechnology, Pharmacy Industry, Services and Tourist Industry (our
first industry: 60 million visitors/year)

23. 4.- Spanish NHS: an efficient system

24. HEALTH EXPENDITURE
2006
82 billion euros
billi
PUBLIC HEALTH PRIVATE HEALTH
EXPENDITURE EXPENDITURE
58,5 billion euros 23,5 billion euros
6.0 % of GDP 2.4% of GDP - Spain: €1,800/inhab. per
year ($2,500)
- USA: $
$6,000/inhab. per year
8.4% of GDP
Source: Ministry of Health and Consumer Affairs. Public Health Expenditure Statistics, 2006

25. BOTH PUBLIC AND PRIVATE HEALTHCARE CARE CO-EXIST
CO EXIST
_
∼ 23,000 M€
FREE
PRIVATE HEALTH CARE or
- Hospital CONCERTED/CONTRACT
- Service
- Diagnosis
+
PUBLIC HEALTH CARE
_ PUBLIC
∼ 60,000 M €

26. SPANISH NATIONAL HEALTH SYSTEM
EXTENSIVE BENEFITS
Public Health
Primary Health Care
Specialised Health Care
Socio-sanitary Care
Emergency
Pharmacy
Orthoprosthethic devices
p
Nutritional complements
Transport (ambulances)

27. SPANISH NATIONAL HEALTH SYSTEM
EXTENSIVE BENEFITS
PRIMARY HEALTH CARE
General benefits Specific benefits
Family Doctor Women healthcare
Paediatrics Children healthcare
Nursing Care Emergencies
Elderly
Dental healthcare (in
process-50%)

28. SPANISH NATIONAL HEALTH SYSTEM
EXTENSIVE BENEFITS
SPECIALISED HEALTH CARE
- Hospitalisation
-“Day hospital”
- Outpatient Care
- Emergencies
- Mental Health and Psychiatric Care
- Transplants

29. SPANISH NATIONAL HEALTH SYSTEM
1 million consultations /day
13.091 PC Centres 325 Hospitals
38.913 GPs 112.000 Beds
27.000 Nurses 82.000 Physicians
300 million consultations/year 111.000 Nurses
70 million Consultations/year
4 million Discharges/year

30. OVERALL SATISFACTION ON THE
WAY THE PUBLIC HEALTH
SERVICE WORKS (SCALE 1-10)
10)
10
9
8
7
6.1 6.3
6,3
6.0 6,1
rcentage
6,0
6
5
Per
4
3
2
1
2003 2005 2007
Year
Source: Ministry of Health and Consumer Affairs. Health System Barometer

31. PERCEPTION OF CITIZEN.
USER SATISFACTION
SATISFACTION WITH THE HEALTHCARE SYSTEM, SPAIN
4.4 4,4 0.9
0,9
25.025
Well: 50.5%
50.5
50,5 Fairly well: 19.2%
69.7%
19,2
19.2
Works well though needs changes Works fairly well
Needs fundamental changes It's so bad it needs to be redone completely
Don't k
D 't know / no reply
l
Year 2007
Source: Ministry of Health and Consumer Affairs Health System Barometer
Affairs.

32. 5.- Quality & Innovation
• Health care strategies
• e Health
e-Health
• Key indicators

33. Back to the future:
Quality and Innnovation Strategies
5 GOALS.12 STRATEGIES
189 PROJECTS
HEALTH STRATEGIES
CLINICAL EXCELLENCE
e-HEALTH
KNOWLEDGE MANAGEMENT

34. 6.-
6 Fighting the Crisis
a) Innovation
• Organ donation & transplantation
• Stem Cell therapies
• eHealth
b) Creating Structures that convert knowledge in
wealth and welfare

35. Spain up to 2004
Restrictions to Research Freedom
Legal restrictions
Religious, ethical,
Religious ethical cultural
Lack of budget
Rare diseases
Orphan drugs

36. Legislation in force before 2007: insufficient for the development of
research
•Medicament Act (1990)
•Code of Medical Ethics and Deontology OMC (1999)
•Guarantees and Rational Use of Medicaments Act (2006)
Guarantees
•Patient Autonomy Act (2002)
•Assisted Reproduction Techniques Acts (35/1998 and
14/2006)
•Donation and Use of E b
D ti dU f Embryos and Human Foetuses or
dH F t
their Cells
•RD 1301/2006 on Quality and Safety Regulations for
Donation, Obtention, Evaluation, Processing, Preservation,
Storage and Distribution of Human Cells and Tissues
•Several Acts on Organ and Tissue Donation, Extraction
and Transplant, and Regenerative Medicine (Act 30/1979,
RD 426/1980 RD 411/1996 RD 2070/1999 RD 174/2004
426/1980, 411/1996, 2070/1999,

37. ACT 14/2007 ON BIOMEDICAL RESEARCH
Legal framework regulating biomedical research in Spain
Use of human embryonic cells and tissues
Invasive procedures
Genetic testing
Biological samples and biobanks
REGULATES:
Requirements for donation and use of human embryos and
foetuses for research
Authorizes nuclear transfer

38. hESC Nuclear
N l Number f
N b of Orphan Drugs
and Rare
Research Transfer Projects Diseases
2004 Forbidden Forbidden 0 2
2008 Allowed Allowed 65 36

39. RESEARCH
•stem cell research
•orphan drugs
h d
•others

40. NEED FOR THE INTRODUCTION OF ADVANCED THERAPIES
•Genetic and oncological diseases
Genetic
-Gene Therapy •Neurodegenerative diseases
•Parkinson’s, ALS
-Cellular Therapy
Cellular •Alzheimer’s, Friedrich s Ataxia
Alzheimer s, Friedrich’s
Somatic cells: •Autoimmune diseases
Embryonic cells or •Multiple sclerosis
Reprogrammed cells (IPS) •Diabetes
•Spinal injuries
-Tissue Engineering •Burns
•Bone reconstruction

41. STEPS UNDERTAKEN
1. 2008,
1 - 2008 DG for Advanced Therapies and Transplants
2.- Legal regulations
Assisted H man Reproduction Act 2006
Human Reprod ction Act,
Biomedical Research Act, 2007

42. STEPS UNDERTAKEN
3.- Non-regulatory actions
g y
- Training
- E l ti
Evaluation, A th i ti and R i t
Authorization d Registry
- Support Office for Independent Research
- Creation of the Advanced Therapies European Forum
- Development of productive infrastructures (white rooms)
4.-Financing

43. Seville (Spain)
( p )
Cartuja 93- Scientific and Technological Park

44. Muchas gracias