OVERVIEW OF SPAIN’S NATIONAL HEALTHCARE SYSTEM

Population Insurance Coverage For A Core Set Of Healthcare Services (%) (2017):
Public Coverage: 99.9%; Primary Private Health Coverage: %; Total: 99.9%

Note: “Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”)”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Annual household out-of-pocket payment, current USD per capita (2017): $591

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Oct. 6, 2020.

Remuneration of Doctors, Ratio to Average Wage (2017)
General Practitioners: 2.1
Specialists: 2.4

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

Remuneration of Hospital Nurses, Ratio to Average Wage (2017): 1.3
Remuneration of Hospital Nurses, USD PPP (2017): $56,300

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“The Spanish health system is characterized by three statutory subsystems that coexist: the universal national health system (Sistema Nacional de Salud, SNS); Mutual Funds catering for civil servants, the Armed Forces and the judiciary (MUFACE, MUGEJU and ISFAS); and the Mutualities focused on assistance for Accidents and Occupational Diseases, known as ‘Collaborating Mutualities with the Social Security’.

“The SNS is a national health system based in the principles of universality, free access, equity and fairness of financing, and is mainly funded by taxes. It is organized at two levels – national and regional – mirroring the administrative division of the country. Health competences are transferred to the 17 Autonomous Communities (ACs), with the national level being responsible, under the governance of the Interterritorial Council for the SNS, for certain strategic areas as well as for the overall coordination of the health system, and the national monitoring of health system performance.

“Main actors in the ACs are the Departments of Health, playing the role of a Health Authority (that is, regulation, planning, budgeting and third party payer) backed by specialized agencies, including a health technology assessment agency in some regions. Planning and regulation responsibilities lie essentially with the Ministry of Health when it comes to nationwide laws and plans, and with the Departments of Health of the 17 ACs when it comes to the local implementation of national regulation, or the development of regional regulation and policies.”

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.

“Population coverage by the SNS is almost universal (99.5%) and guarantees quite a comprehensive benefits package to all citizens. Entitlement is independent of employment status and personal wealth (García-Armesto et al., 2010). Civil servants are entitled to choose to have their health care purchased by entities other than the SNS [Sistema Nacional de la Salud], such as the Mutual Fund for State Civil Servants, and around 2 million people opt for this alternative. They continue to pay taxes like everyone else and the SNS pays private insurers a capitation fee to cover their health care costs. Those with this form of private coverage are expected to use private providers only and receive a special health card, different from the SNS health card.

“In 2010, new policies were put in place that reduced access to publicly financed health benefits: user charges were extended to more medicines, access to health care for adult migrants was reduced and the allocation of transfers from the central state to the regions was tightened, leading to spending cuts which have been more severe in some regions (for example, in Catalonia). The latter may have had an impact on the perception among the population of the quality of publicly financed health services and thus the desirability of VHI [Voluntary Health Insurance].”

Source: Joan Costa-i-Font. “Spain.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“Despite the impact of the economic crisis on Spanish society, the underlying principles and goals of the Spanish national health system have remained unchanged in practice. Reforms implemented since 2010, such as budget reductions and new regulations on the scope, breadth and depth of coverage, have not seemingly shown any substantial short-term impacts on health outcomes.

“The achievements of the national health system over the last decade include: the improvement of amenable and preventable outcomes; small inequities in access across socioeconomic groups for preventive services and medical examinations; the good level of financial protection that limits individuals’ financial hardship due to ill-health; productivity improvements within the health system; fairly good results in overall patient satisfaction with the health system; and solid progress in consolidating patients’ rights.

“However, several challenges remain, including trends in behavioural risk factors such as the rising obesity rates for both adults and children. There is also some uncertainty regarding the long-term impact of current socioeconomic conditions in the health and welfare of the Spanish population. Moreover, waiting times for surgery, diagnostic procedures and specialized visits remain high.

“The evolution of performance measures over the last decade show the resilience of the health system in the aftermath of the economic crisis, although some structural reforms may be required to improve chronic care management and the reallocation of resources to high-value interventions.”

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 Sept. 22, 2021 by Doug McVay, Editor.