“The political situation since 2016 has moved the political scenario from an absolute majority where major decisions were made through Royal Decree Laws (executive legislation) to a fragmented parliament, the consequence of two consecutive electoral processes, in which the public debate on the health system remained marginal. Nevertheless, topics that will very probably be on the political agenda in the near future will be: (a) a return to the legislation previous to RDL 16/2012 when it comes to insurance entitlement; (b) the reform of the current co-payment system as current thresholds are just barely progressive and, according to recent evidence, may have a negative short-term impact on patients’ adherence to chronic care treatments (González LópezValcárcel, Puig-Junoy & Rodríguez-Feijoo, 2017); (c) the expansion of some regional initiatives on good governance in public health systems (Basque Country and Madrid have pioneered this debate at local level); and (d) a public debate on taxation of sugary beverages (already initiated in Catalonia).

“The aforementioned initiatives on value-based care, in particular the monitoring of the “do-not-do” recommendations, will materialize in local disinvestment projects that will very likely fuel public debate. Lastly, over the years some first steps have been taken to include patients’ voices in the development and implementation of clinical guidelines; once the raising awareness cycle has come to an end, the National Programme of Clinical Guidelines, GuíaSalud, has initiated a new project on patient participation that is supposed to yield outcomes in the next few years.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“After the onset of the crisis and subsequent reforms, participation in preventive services has been retained. Differences across educational quintiles have not significantly widened in the case of breast and cervical cancer. So, for example, in 2014, the number of women who never had a mammogram as breast screening reached 7.2% in those with the lowest educational attainment versus 3.2% in those with the highest attainment, a negligibly larger difference than the one in 2008 (8.2% versus 5.7%). The percentage of women who never underwent a smear test for cervical cancer prevention was 20.9% in those with the lowest educational attainment versus 11.3% in those with the highest one, a similar difference to that in 2008 (24.9% versus 16.4%). New legislation is in progress aiming to include the organized programme of cervical cancer screening in the basic services of the SNS [Spain’s National Health System]. For colorectal cancer screening, the overall improvement (from 90% of eligible individuals not covered in 2008 to 80.8% in 2014) also differed across education levels: 82.8% were not covered in the lower educational level versus 76.6% in the higher education levels (Eurostat, 2017e). This fact has no apparent association with the health reforms it is rather related to colorectal cancer screening being initially implemented in urban populations, where individuals with higher education are generally more frequent.”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

“Latest data for unmet needs for medical examinations (for any reason) show negligible differences between the better and worse-off, Spain being one of the countries with the smallest difference (Fig. 7.2).

“The percentage of unmet needs for medical examination due to economic reasons followed a similar pattern; while better-off individuals declared no unmet needs for economic reasons neither in 2008 nor in 2015, less affluent respondents reported a negligible increase of unmet needs from 0.2% in 2008 to 0.4% in 2015.

“This was not the case for unmet needs in dental care (due to economic barriers) as the percentage increased in the lowest income quintiles. While in the better-off, figures decreased (from 1.2% in 2008 to 0.9% in 2015), in the worse-off individuals unmet needs rose from 7.0% in 2008 to 10.5% in 2015. However, the underlying cause should not be seen as a collateral effect of the coverage reforms, as dental care has never been part of the package of benefits, but as a consequence of the impact of the crisis on household budgets.

“Finally, in view of the aforementioned access barriers, the self-reported health status of the immigrant population has been worsening over the years compared with native population, very probably as a consequence of a differential impact of the economic crisis (Gotsens et al., 2015).”

Source: Bernal-Delgado E, García-Armesto S, Oliva J, Sánchez Martínez FI, Repullo JR, PeñaLongobardo LM, Ridao-López M, Hernández-Quevedo C. Spain: Health system review. Health Systems in Transition, 2018;20(2):1–179.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated May 16, 2021 by Doug McVay, Editor.