Health care in Spain

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Life expectancy development in Spain by gender Life expectancy by WBG -Spain -diff.png
Life expectancy development in Spain by gender

Spain operates a universal health care system. According to the Organisation for Economic Co-operation and Development, total health spending accounted for 9.4% of GDP in Spain in 2011, slightly above the OECD average of 9.3%.[ citation needed ] Spain's healthcare system ranks 19th in Europe according to the 2018 Euro health consumer index. [1] As of 2016, Spain is ranked 1st in the world in organ transplants. [2] [3]

Contents

In 2000, the Spanish health care system was ranked as the 7th most efficient healthcare in the world, as indicated in a report by the World Health Organization. [4] In 2011, the public sector was the main source of health funding with 73% of health spending funded by public sources, very close to the average of 72% in OECD countries. [5]

Hospitals

Building of the Provincial Hospital, belonging to the hospital complex of the Reina Sofia University Hospital in Cordoba. Hospital Provincial - Hospital Universitario Reina Sofia.JPG
Building of the Provincial Hospital, belonging to the hospital complex of the Reina Sofía University Hospital in Córdoba.

In an emergency, people can go straight to a hospital A&E. For any other type of hospital treatment a referral from a doctor is required. There are public and private hospitals, with the former providing free treatment. As some hospitals offer both private and state healthcare services, the presentation of a social security card, an EHIC, or proof of private insurance is advisable. As hospital doctors do not issue prescriptions, after discharge, patients take the hospital medical report to a pharmacy for prescriptions to be filled.

In Spain patients have the right to read their own patient records, but as of 2015 there was evidence that this is not well publicized. [6]

Decentralization

In Spain, provision of health care services is decentralized, and thus the responsibility of several autonomous communities. In 1998, an analysis of the effects of greater autonomy on legislative performance and policy outcomes for health care observed a positive effect on the former, but no effect on the latter. The analysis noted that a possible explanation for this disconnect was that autonomous communities had only experienced greater autonomy in the area of health care for a short time, and positive effects on policy outcomes could take longer to manifest. [7] In 2009, an analysis of data collected by the Spanish National Health Survey in 2001 showed that autonomous communities with decentralized health services tended to have better equity performance. [8] In 2014, an analysis of data collected by the Spanish Centre of Sociological Research between 1996 and 2009 found that for twenty variables of public satisfaction with health care services, decentralization not only had no effect on 2 measures of primary or specialized care and 1 of hospital care, but actually performed worse on 3 measures of primary or specialized care and 1 measure of hospital care. No statistically significant trend was observed for twelve of the twenty measures of satisfaction. The authors of the analysis stressed that the data was limited due to the subjective nature of patient reports, and the possible inability of some to properly evaluate performance of health care services. [9]

International comparisons

As of 2020, according to the World Economic Forum and to Bloomberg, Spain has the most efficient health system in Europe, and also ranks at the top worldwide along with Hong Kong, Japan and Singapore. [10] [11]

In a sample of 13 developed countries Spain was second in its population weighted usage of medication in 14 classes in both 2009 and 2013. The drugs studied were selected on the basis that, in the previous 10 years the conditions treated had: a high incidence, prevalence and/or mortality; caused significant long-term morbidity; incurred high levels of expenditure or had significant developments in prevention or treatment. The study noted considerable difficulties in cross border comparison of medication use. [12] Ceuta had the highest proportion of practicing doctors per capita of any region in Europe - 871 per 100,000 in 2015. [13]

In 2015, the Euro health consumer index rated Spain 19th of 35 European countries, remarking that there was somewhat of an over-reliance on seeking private care. [14]

Public opinion

According to Van der Schee et al., public opinion about a country's healthcare system is formed by the levels and quality of: trust between a person and their physician, media presentation of the healthcare system as a whole, and the services and care the system provides. [15] When looking at public opinion on Spain's universal healthcare system, generally people seem to agree that the state should be heavily involved in healthcare. Compared to 14 other nations in 2002, Spain ranked third highest for the amount of support the public had for a strong role of the government in healthcare. [16] In terms of public opinion concerning how well the healthcare system actually works, there is a general consensus that the public believes healthcare institutions themselves are doing their jobs well and providing sufficient care. [17] The most overwhelming problem reported by people who took a 2005 survey was that wait times to receive care are too long, though those surveyed reported that this problem could be fixed by the hiring of more physicians. [17]

Voluntary health insurance

Although Spain does have universal health care, it is not the only source of protection available to the Spanish people. In fact, there are three alternatives to relying solely on the provided universal health care: substitutive voluntary health insurance, complementary voluntary health insurance, and supplementary voluntary health insurance. [18] People who work in Spain's public sector are free to opt out of universal health care entirely if they agree to utilize the alternative: a government-subsidized health insurance called MUFACE. [18] This selection of using different health insurance instead of Spain's universal health care is an example of substitutive voluntary health insurance.

Complementary voluntary health insurance comes into play with citizens who use Spain's universal health care but still want additional private insurance to cover services which may not be protected under the universal plan. [18] While Spain's universal health care covers a substantial amount including many basic primary and pharmaceutical services, it fails to cover many important dental and gynecological services among other things. [19] If a Spanish citizen is seeking care outside that which is covered by the state, they have the option to purchase their own private health insurance to ensure that they are covered for any services they may need.

Lastly, supplementary voluntary health insurance is an option for those Spanish citizens who use the available universal health care, but would also like additional private insurance which may provide them better or more suitable options & benefits. [18] In this case, having supplementary voluntary health insurance is often a luxury that helps people secure faster, more convenient, or better available treatment.

According to the OECD, in 2002 about 5% of the Spanish population was covered by one of the above types of voluntary health insurance. [20]

Equality

Due to universal health care coverage, inequality is reduced substantially. Inequality in Spain is even further reduced in that co-payments do not usually apply, limited to special medicines and services that are not covered by the National Health System. Therefore, an individual's financial status does not typically determine access to general healthcare. [21]

Some inequality does arise in those areas that the NHS does not cover, such as dental care. [21] [22] On the other hand, people in a disadvantaged social class will typically rely more on the public system for primary health care than those of higher social status. Around 10% of the Spanish population uses private health insurance, generally implying higher socio-economic status, which facilitates access to primary health care. While health care services are universal and continue to see an increase in use within Spain, there are still issues among those with disadvantaged backgrounds. [21]

Immigrants

Immigration was seen as one of the most problematic issues for Spain in 2006 by their population. [23] Migrants are entitled to full public health care benefits, regardless of their legal status. This is due to the goals set by Minister Ernest Lluch in the General Health Law of 1986, which was based on universality of health care. [24] Soon following through many reforms, the Public Health Law of 2011 was enacted, giving all people in Spain the right to free health care regardless of their legal status. While this was overturned through royal decree in 2012, making legality a necessary factor for healthcare, the law was once again reestablished in 2018 after the resignation of Prime Minister Mariano Rajoy, providing all people in Spain universal access to healthcare. [25] [26]

Regarding the use of health care services, there are multiple studies conducted to show the differences between immigrants and nationals. In 2006, studies showed that immigrants had seen a larger number of visits towards emergency rooms when compared to visits from nationals. Conversely, immigrants had shown a lower frequency of visits to general practitioners, fewer days in hospitals, and visits to specialists had seen a lower amount than those reported by Spaniards. [23] In more recent years, a 2016 study shows that global use of healthcare in Spain was utilized more by nationals than by immigrants in all areas. Along with this, the costs for annual prescription drugs showed a much lower price for immigrants when compared to the prices that are given to nationals. [27] The costs for healthcare in Spain are typically higher for those natives than they are for foreign born immigrants, the mean price being nearly 6.8 times higher. These differences, as referenced in the research study, could be explained in part due to migrants being younger and in healthier conditions, or potentially through possible inequalities among Spanish healthcare providers.

When compared to other European countries, most immigrants typically see more physician, general practitioners, and hospital stays than nationals. In a similar fashion, the health of immigrants in other countries are typically in worse shape when compared to natives, Spain being an exception where native-born are considered to be less healthy when compared to their immigrants. Along with this, more individual immigrants in Spain typically have full coverage for costs than is seen by nationals. [28]

See also

Related Research Articles

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

<span class="mw-page-title-main">Social services</span> Range of public services

Social services are a range of public services intended to provide support and assistance towards particular groups, which commonly include the disadvantaged. They may be provided by individuals, private and independent organizations, or administered by a government agency. Social services are connected with the concept of welfare and the welfare state, as countries with large welfare programs often provide a wide range of social services. Social services are employed to address the wide range of needs of a society. Prior to industrialisation, the provision of social services was largely confined to private organisations and charities, with the extent of its coverage also limited. Social services are now generally regarded globally as a 'necessary function' of society and a mechanism through which governments may address societal issues.

<span class="mw-page-title-main">Health care</span> Prevention of disease and promotion of well-being

Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, and tertiary care, as well as in public health.

<span class="mw-page-title-main">Publicly funded health care</span> Form of health care financing

Publicly funded healthcare is a form of health care financing designed to meet the cost of all or most healthcare needs from a publicly managed fund. Usually this is under some form of democratic accountability, the right of access to which are set down in rules applying to the whole population contributing to the fund or receiving benefits from it.

<span class="mw-page-title-main">Healthcare industry</span> Economic sector focused on health

The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care. It encompasses the creation and commercialization of products and services conducive to the preservation and restoration of well-being. The contemporary healthcare sector comprises three fundamental facets, namely services, products, and finance. It can be further subdivided into numerous sectors and categories and relies on interdisciplinary teams of highly skilled professionals and paraprofessionals to address the healthcare requirements of both individuals and communities.

Universal health care is a health care system in which all residents of a particular country or region are assured access to health care. It is generally organized around providing either all residents or only those who cannot afford on their own, with either health services or the means to acquire them, with the end goal of improving health outcomes.

<span class="mw-page-title-main">Comparison of the healthcare systems in Canada and the United States</span> Healthcare system comparison

A comparison of the healthcare systems in Canada and the United States is often made by government, public health and public policy analysts. The two countries had similar healthcare systems before Canada changed its system in the 1960s and 1970s. The United States spends much more money on healthcare than Canada, on both a per-capita basis and as a percentage of GDP. In 2006, per-capita spending for health care in Canada was US$3,678; in the U.S., US$6,714. The U.S. spent 15.3% of GDP on healthcare in that year; Canada spent 10.0%. In 2006, 70% of healthcare spending in Canada was financed by government, versus 46% in the United States. Total government spending per capita in the U.S. on healthcare was 23% higher than Canadian government spending. U.S. government expenditure on healthcare was just under 83% of total Canadian spending.

<span class="mw-page-title-main">Healthcare in Canada</span>

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."

Health care in Ireland is delivered through public and private healthcare. The public health care system is governed by the Health Act 2004, which established a new body to be responsible for providing health and personal social services to everyone living in Ireland – the Health Service Executive. The new national health service came into being officially on 1 January 2005; however the new structures are currently in the process of being established as the reform programme continues. In addition to the public-sector, there is also a large private healthcare market.

<span class="mw-page-title-main">Health care in Sweden</span> Overview of the health care system in Sweden

The Swedish health care system is mainly government-funded, universal for all citizens and decentralized, although private health care also exists. The health care system in Sweden is financed primarily through taxes levied by county councils and municipalities. A total of 21 councils are in charge with primary and hospital care within the country.

<span class="mw-page-title-main">Healthcare in Germany</span> Overview of healthcare in the Federal Republic of Germany

Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance and private health insurance.

<span class="mw-page-title-main">Health care in Turkey</span> Overview of the health care system in Turkey

Healthcare in Turkey consists of a mix of public and private health services. Turkey introduced universal health care in 2003. Known as Universal Health Insurance Genel Sağlık Sigortası, it is funded by a tax surcharge on employers, currently at 5%. Public-sector funding covers approximately 75.2% of health expenditures.

<span class="mw-page-title-main">Healthcare in South Korea</span>

Healthcare in South Korea is universal, although a significant portion of healthcare is privately funded. South Korea's healthcare system is based on the National Health Insurance Service, a public health insurance program run by the Ministry of Health and Welfare to which South Koreans of sufficient income must pay contributions in order to insure themselves and their dependants, and the Medical Aid Program, a social welfare program run by the central government and local governments to insure those unable to pay National Health Insurance contributions. In 2015, South Korea ranked first in the OECD for healthcare access. Satisfaction of healthcare has been consistently among the highest in the world – South Korea was rated as the second most efficient healthcare system by Bloomberg. Health insurance in South Korea is single-payer system. The introduction of health insurance resulted in a significant surge in the utilization of healthcare services. Healthcare providers are overburdened by government taking advantage of them.

Healthcare in Finland consists of a highly decentralized three-level publicly funded healthcare system and a much smaller private sector. Although the Ministry of Social Affairs and Health has the highest decision-making authority, specific healthcare precincts are responsible for providing healthcare to their residents as of 2023.

Healthcare in the United States is largely provided by private sector healthcare facilities, and paid for by a combination of public programs, private insurance, and out-of-pocket payments. The U.S. is the only developed country without a system of universal healthcare, and a significant proportion of its population lacks health insurance.

<span class="mw-page-title-main">Healthcare in Greece</span> Healthcare in Greece

Healthcare in Greece consists of a universal health care system provided through national health insurance, and private health care. According to the 2011 budget, the Greek healthcare system was allocated 6.1 billion euro, or 2.8% of GDP. In a 2000 report by the World Health Organization, the Greek healthcare system was ranked 14th worldwide in the overall assessment, above other countries such as Germany (25) and the United Kingdom (18), while ranking 11th at level of service.

Examples of health care systems of the world, sorted by continent, are as follows.

<span class="mw-page-title-main">Health in Latvia</span> Overview of health in Latvia

A new measure of expected human capital calculated for 195 countries from 1990 to 2016 and defined for each birth cohort as the expected years lived from age 20 to 64 years and adjusted for educational attainment, learning or education quality, and functional health status was published by The Lancet in September 2018. Latvia had the twenty-first highest level of expected human capital with 23 health, education, and learning-adjusted expected years lived between age 20 and 64 years.

<span class="mw-page-title-main">Healthcare in the Czech Republic</span>

The Czech Republic has a universal health care system, based on a compulsory insurance model, with fee-for-service care funded by mandatory employment-related insurance plans since 1992. According to the 2018 Euro health consumer index, a comparison of healthcare in Europe, the Czech healthcare is ranked 14th, just behind Portugal and two positions ahead of the United Kingdom.

References

  1. ↑ "2018 European Health Consumer Index" (PDF). Retrieved 9 April 2020.
  2. ↑ "How Spain became the world leader in organ transplants". www.thelocal.es. 2017-09-15. Retrieved 2019-06-23.
  3. ↑ "Global leader Spain carries out its 100,000th transplant". www.thelocal.es. 2016-02-25. Retrieved 2019-06-23.
  4. ↑ World Health Organization, World Health Staff (2000). Haden, Angela; Campanini, Barbara (eds.). Health systems: improving performance. The world health report 2000. Geneva, Switzerland: World Health Organization. ISBN   92-4-156198-X.
  5. ↑ "OECD Health Statistics 2014 How does Spain compare?" (PDF). Archived from the original (PDF) on 2014-08-02.
  6. ↑ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
  7. ↑ Antón, R., Macías, JI; Muñoz de Bustillo, R; Fernández Macías, E (May 2014). "Effects of health care decentralization in Spain from a citizens' perspective" (PDF). The European Journal of Health Economics. 15 (4): 411–431. doi:10.1007/s10198-013-0485-0. PMID   23660932. S2CID   27819088.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ↑ Costa-Font, Joan; Gil, Joan (December 2009). "Exploring the pathways of inequality in health, health care access and financing in decentralized Spain". Journal of European Social Policy. 19 (5): 446–458. doi:10.1177/0958928709344289. S2CID   154007289.
  9. ↑ Gonzalez, Pablo; Fraile, Marta (October 1998). "Regional Decentralisation of Health Policy in Spain: Social Capital Does Not Tell the Whole Story". West European Politics. 21 (4): 180. doi:10.1080/01402389808425277.
  10. ↑ "Spanish healthcare, once again leading world rankings". #ThisIsTheRealSpain. 2020-02-21. Retrieved 2020-04-19.
  11. ↑ "Bloomberg - Healthcare efficiency scores in 56 countries". Bloomberg.com. 19 September 2018. Retrieved 2020-04-19.
  12. ↑ Office of health Economics. "International Comparison of Medicines Usage: Quantitative Analysis" (PDF). Association of the British Pharmaceutical Industry. Archived from the original (PDF) on 11 October 2017. Retrieved 2 July 2015.
  13. ↑ Ballas, Dimitris; Dorling, Danny; Hennig, Benjamin (2017). The Human Atlas of Europe. Bristol: Policy Press. p. 83. ISBN   9781447313540.
  14. ↑ "Outcomes in EHCI 2015" (PDF). Health Consumer Powerhouse. 26 January 2016. Archived from the original (PDF) on 6 June 2017. Retrieved 27 January 2016.
  15. ↑ Gille, Felix & Smith, Sarah & Mays, Nicholas. (2017). Towards a broader conceptualisation of 'public trust' in the health care system. Social Theory & Health. 15. 25–43.
  16. ↑ Wendt, Claus; Kohl, Jürgen; Mischke, Monika; Pfeifer, Michaela (1 April 2010). "How Do Europeans Perceive Their Healthcare System? Patterns of Satisfaction and Preference for State Involvement in the Field of Healthcare". European Sociological Review. 26 (2): 177–192. doi:10.1093/esr/jcp014.
  17. 1 2 Jovell Albert; et al. (2007). "Public trust in the Spanish health‐care system". Health Expectations. 10 (4): 350–357. doi:10.1111/j.1369-7625.2007.00466.x. PMC   5060419 . PMID   17986071.
  18. 1 2 3 4 Mossialos, Elias; et al. (2002). Funding Health Care: Options for Europe. United Kingdom: Open University Press. pp. 129–131. ISBN   0-335-20924-6.
  19. ↑ World Health Organization (2000). Health Care Systems in Transition: Spain. World Health Organization. p. 43.
  20. ↑ Colombo, F.; Tapay, N. (1 January 2004). "Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems" (PDF). OECD Health Working Papers (15). Paris: OECD Publishing. doi: 10.1787/527211067757 . ISSN   1815-2015.
  21. 1 2 3 Palència, Laia; Espelt, Albert; Rodríguez-Sanz, Maica; Rocha, Katia B.; Pasarín, M. Isabel; Borrell, Carme (2013). "Trends in Social Class Inequalities in the Use of Health Care Services within the Spanish National Health System, 1993–2006". The European Journal of Health Economics. 14 (2): 211–219. doi:10.1007/s10198-011-0362-7. ISSN   1618-7598. JSTOR   23357791. PMID   22072321. S2CID   12393140 . Retrieved 11 June 2020– via JSTOR.
  22. ↑ Garrido-Cumbrera, Marco; Borrell, Carme; Palència, Laia; Espelt, Albert; Rodríguez-Sanz, Maica; Pasarín, M. Isabel; Kunst, Anton (2010). "Social Class Inequalities in the Utilization of Health Care and Preventive Services in Spain, A Country with a National Health System". International Journal of Health Services. 40 (3): 525–542. doi:10.2190/HS.40.3.h. ISSN   0020-7314. JSTOR   45131351. PMID   20799674. S2CID   27327906 . Retrieved 11 June 2020– via JSTOR.
  23. 1 2 Antón, José-Ignacio; de Bustillo, Rafael Muñoz (2010). "Health Care Utilisation and Immigration in Spain". The European Journal of Health Economics. 11 (5): 487–498. doi:10.1007/s10198-009-0204-z. ISSN   1618-7598. JSTOR   40963270. PMID   19898881. S2CID   18693901 . Retrieved 11 June 2020– via JSTOR.
  24. ↑ HealthManagement.org. "Radiology Management, ICU Management, Healthcare IT, Cardiology Management, Executive Management". HealthManagement. Retrieved 2020-06-11.
  25. ↑ Legido-Quigley, Helena; Pajin, Leire; Fanjul, Gonzalo; Urdaneta, Elena; McKee, Martin (2018-08-01). "Spain shows that a humane response to migrant health is possible in Europe". The Lancet Public Health. 3 (8): e358. doi: 10.1016/S2468-2667(18)30133-6 . ISSN   2468-2667. PMID   29980489.
  26. ↑ "Approval of Universal Healthcare July 27 2018". Citizens Advice Bureau Spain. 2018-07-30. Retrieved 2020-06-11.
  27. ↑ Gimeno-Feliu, Luis A.; Calderón-Larrañaga, Amaia; Diaz, Esperanza; Poblador-Plou, Beatriz; Macipe-Costa, Rosa; Prados-Torres, Alexandra (27 May 2016). "Global healthcare use by immigrants in Spain according to morbidity burden, area of origin, and length of stay". BMC Public Health. 16 (1): 450. doi: 10.1186/s12889-016-3127-5 . PMC   4882823 . PMID   27230885.
  28. ↑ Solé-Auró, Aïda; Guillén, Montserrat; Crimmins, Eileen M. (2012). "Health Care Usage among Immigrants and Native-Born Elderly Populations in Eleven European Countries: Results from SHARE". The European Journal of Health Economics. 13 (6): 741–754. doi:10.1007/s10198-011-0327-x. ISSN   1618-7598. JSTOR   23275619. PMC   3591521 . PMID   21660564.
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