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FEM: Revista de la Fundación Educación Médica

versão On-line ISSN 2014-9840versão impressa ISSN 2014-9832

FEM (Ed. impresa) vol.21 no.1 Barcelona Fev. 2018

 

EDITORIAL

La reforma del Reglamento del Impuesto sobre la Renta de las Personas Físicas en la tributación de la formación continuada: un claroscuro entre tributación y transparencia

The reform of the Personal Income Tax Regulations regarding the taxation of continuing education: a twilight zone between taxation and transparency

The reform of the Personal Income Tax Regulations regarding the taxation of continuing education: a twilight zone between taxation and transparency

Arcadi Gual1  2 

1Departamento de Biomedicina; Facultad de Medicina; Universitat de Barcelona

2Sociedad Española de Educación Médica (SEDEM). Fundación Educación Médica

A few months ago we were both puzzled and uneasy by the appearance of a controversial issue of uncertain origin. It involved the obligation to pay tax as benefits in kind for the payments received for inscriptions at congresses or expenses deriving from travelling, accommodation and other spending related to attendance at different activities organised in connection with continuing medical education (CME). It goes without saying that professionals who spend time on improving their training should enjoy tax conditions that match the purpose and their circumstances. It has been pointed out on numerous occasions and in different forums that training professionals results in a common good and that, with the due transparency, nobody should feel uncomfortable about funding it. It has also been repeated many times that there were and still are the economic resources necessary for this purpose and that there were and still are ways to legally get round taxation. But, before going on and to settle any doubts that might exist on the matter, it should be pointed out that when we talk about expenses, we are referring to what we could call ‘normal' expenses. In other words, amounts that are appropriate to the aim of providing a good CME; luxuries and extravagances can never be regarded as such.

At this point, we inevitably come to a significant element in our considerations: the funder of the CME. It is not our intention at this stage to discuss who the funders of CME are or may be –for instance, the professionals themselves and the contracting company (be it public or private)– but it is clear that the subsidising agent that generates particular concern is the industry, whether we are talking about pharmaceutical companies or those that manufacture and market medical devices or biomedical equipment. The industry may, and indeed does, have the duty to contribute to CME, although this is a matter we will not address in this editorial. The fundamental issue, and one of deep concern, is how it should do it. Simplifying the problem, we could say that the conflict of interests arises when the CME funder is in direct contact with the doctor.

The government decided to modify the law after listening (presumably) to the lobbies involved. Thus, Royal Decree 1074/2017 dated 29 December 2007 was published, which amends the Personal Income Tax Regulations (RD 439/2007), among other aspects, one of which is continuing education. This new Royal Decree increases the amount given in grants for studying and daily subsistence allowances, bringing them closer to more up-to-date values. But the most critical point is the amendment of Article 44 of RD 439/2007, the heading of which reads as follows: ‘Article 44. Study expenses for the training or retraining of personnel that do not constitute remuneration in kind'. This modified article establishes that studies arranged and financed directly or indirectly by institutions, companies or employers to update their staff's skills, to train or to recycle them shall not be considered as remuneration in kind.

Okay, fair enough. Now we can go to a congress sponsored by the industry. Wasn't that the idea? Well, no, that wasn't the idea. Or rather, it wasn't the only idea.

It is clear that the conflict of interest must be resolved by the affected party, by declaring it when necessary or by not getting involved when it is not the right moment to do so. Moreover, it is not a question of obstructing the industry on a whim, but of laying down paths that are easy for everyone to follow: for the doctor, for the institutions and, of course, for the financial backer.

The funding that the industry must channel into CME must flow though interposed structures, such as the healthcare institutions themselves, scientific societies, professional medical associations, foundations, the administration, and so forth, which have to make it clear to the professionals, to the administration and, above all, to society that the purpose of this subsidising is none other than to improve the training of doctors so that they can offer better healthcare.

The amendment of RD 439/2007 undoubtedly improves the taxation of doctors who, as is their ethical obligation, seek to enhance and constantly update their training, but does it improve the transparency of the subsidies from the sponsors of CME activities? Of the two outstanding issues on the financing of CME, we have resolved the first problem, the tax aspects, but we do not appear to have made a great deal of progress on the second: its transparency. It is worrying that, after the tax modification, both professionals and their organisations and industry have maintained a resounding silence.

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