Amancio Ortega is not going to change Spanish healthcare because he cannot, but it opens a key debate for the future
Amancio Ortega, the founder of Inditex and one of the richest people in the world, is in the process of donating 320 million euros to Spanish public health to renew "equipment for cancer diagnosis and treatment". The last to get on the bandwagon has been the Community of Madrid, which will receive 46 million euros. And, again, the controversy over the relationship between philanthropy and public health fills the pages of the newspapers with people in favor and people against.
At Xataka, we have talked a lot about other great donations that have been made in recent years and about their nature. For this reason, it seemed interesting to us to put aside the political struggle and analyze, as on other occasions, the problems and opportunities for philanthropy to enter the world of public health.
What (little) research tells us about it
In science, the effect of philanthropy is well studied. That allowed us to very accurately x-ray the "weaknesses, strengths, threats, and opportunities" presented by large donations like Zuckerberg's famous 3 billion to "cure all diseases."
Instead, and here the first surprise jumps, the world of donations of this type in public health systems is not too studied. There is an important reason for this, these types of donations have not been the great problem of public-private coexistence in health.
The big problem has been donations from companies and corporations with strong commercial interests in health care that used these routes to inoculate conflicts of interest at the heart of the system. And professional law and regulation has been geared toward controlling these expensive, unethical, and deeply questionable practices.
It is not that this type of philanthropy is new in most countries with public health systems, it is that (with some exceptions that we will talk about later) it has always been the smallest and least conflictive part of health donations.
Donation in context
Actually, it still is. As experts say, neither Amancio Ortega (nor any other philanthropist) will change the way of financing Spanish healthcare. And not because they don't want to, but simply because they don't have the financial capacity to do so.
Despite the media attention that these 320 million euros arouse, they are no longer a drop in the more than 60,000 million public health spending that are executed annually during the last few years.
The problems of philanthropy
Therefore, surely the greatest risk is that, as in the case of science, private funds end up conditioning the nature of medical care and incorporate priorities that become counterproductive. Especially when we know that projects of this type are very often not very effective. The best example perhaps is the child health program that launched the Gates Foundation in India and which has been a resounding and incontestable failure.
Why does this happen? In the final season of The West Wing of the White House, C.J. He figured out what philanthropic work he would do in Africa if he had an obscene amount of resources at his disposal. "Roads," he replies. Philanthropy tends to create hospitals, schools, or markets, but it forgets about the roads that carry medical supplies, teachers, or food to those facilities. And, without basic infrastructure, the rest is meaningless.
In other words, "the hobbyist focuses on strategy, while the professional focuses on logistics." And in this, inevitably, great philanthropists are usually amateurs. Therefore, the little research that we have, indicates that the central knot of the relationships between philanthropy and public health is to develop tools so that this relationship does not compromise the health governance of the institutions.
Precisely, the final nature of the donations of the Amancio Ortega Foundation (as of the majority) is a central issue of the controversy. While it is clear that this 'renewal plan' for cancer instruments is something necessary, it is worrying that administrations change their long-term priorities in order to receive this type of donation.
The future of the relationship between philanthropy and healthcare?
While, to this day, it does not seem possible to tackle global health problems without the help of philanthropic programs; In countries with developed health systems, philanthropy has a very different role. As they say on the No Thank you platform, if we are able to think of a framework in which the collaboration between 'Big Pharma' and healthcare is beneficial for all; There is no reason to think that there is no framework for these other types of donations.
Therefore, the only solution that research on the subject offers us is, let's say, common sense: for philanthropy and health systems to work well we need specific regulation that ensures the governance of the health system and avoids risks (and conflicts of interest) more evident.
The United Kingdom is perhaps the country where the coexistence between public health and the strong philanthropic sector has more tradition. And, with greater or lesser fortune, he is one of the pioneers in creating regulatory frameworks that make it possible to get the most out of this relationship.
A few months ago we said that the digital transformation was reaching the philanthropic sector as it has already reached almost all sectors. We also said that this was going to present new challenges that we had to solve in a new way. And if Amancio Ortega's donations allow us anything, it is to reflect and look for that framework where we all benefit.
Images | Javier Padilla and 401 (K) 2012