“On 20 November 1975, Spanish General Francisco Franco died in bed, signaling the unceremonious end of one of Europe’s longest dictatorships (1939-1975).”

Source: Andrea Davis, “The Death of Franco,” Current Events in Historical Perspective, History Departments at The Ohio State University and Miami University, Nov. 2020.

“The 1978 Spanish Constitution established a new political organization moving from a highly centralized country to a quasi-federal organization, where the 17 ACs [Autonomous Communities] were created to play an essential role in the provision of the welfare state services (see Section 2.2, Decentralization and centralization).

“Since their inception almost 40 years ago, the role of the ACs has expanded. The ACs’ financing mechanisms issued in 2001 and 2009, and most importantly, the development of the different statutes of autonomy² have resulted in further decentralization for the ACs as well as greater capacity for the planning, financing and provision of health care, education and social protection services. In 2009, the highest figures in the series, the public expenditure managed by the ACs reached €184.2 billion, the equivalent of 17.1% of the Spanish GDP (excluding transfers to the central government and corresponding interests). Since 2009, the ACs’ political context has been determined by the tension between the need to cover welfare state services and the reduction of public expenditure. The adjustment process implied the reduction of €36.6 billion between 2009 and 2012 (20% less than public expenditure in 2009), equivalent to 0.32% of GDP (Bandrés & González, 2015).

“This tension, along with the uneven contribution of the ACs to the reduction of the public debt, has led to strained interterritorial relations and major criticisms of the current financing system (see Section 3.3.3, Pooling and allocation of funds), which is arguably insufficient to cope with the provision of welfare state services and public debt at the same time. Currently, the debate on a new financing system has been officially opened by the Ministry of Finance (Ministry of Finance, 2017a).”

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.

“Spain is the third largest country in western Europe with an extent of 505,955 km2 and a population of 46,528,966 in 2017 (INE, 2017a). The Spanish territory also includes the Canary Islands, located in the Atlantic Ocean in front of the south-eastern coast of Morocco, the Balearic Islands, in the Mediterranean Sea, and two Autonomous Cities, Ceuta and Melilla, placed at the very north of the Morocco border. Administratively speaking, the Spanish territory is organized in 17 Autonomous Communities (Comunidades Autónomas, ACs) (Andalusia, Aragon, Asturias, Balearic Islands, Basque Country, Canary Islands, Cantabria, Castile-La Mancha, Castile-Leon, Catalonia, Extremadura, Galicia, La Rioja, Madrid, Murcia, Navarre, Valencia) and two Autonomous Cities (Ceuta and Melilla) (Fig. 1.1). The Spanish population tends to concentrate in urban and coastal areas.”

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.