“A study on global healthcare with respect

to Spain”
Statement of the Problem:
Providing access to quality health care for all is among the foremost objectives of any health
system, because an effective personal health care system can substantially improve many
health outcomes and avert premature mortality. The advancement of population health was
elevated to global agendas with the Alma Ata Declaration of 1978, wherein WHO involved in
the achievement of “health for all” by 2000. Such aspirations garnered new momentum in the
Sustainable Development Goal (SDG) era, with a heightened emphasis on attaining universal
health coverage in this pursuit. Making progress on universal health coverage entails all people
having access to quality health services they need without incurring financial hardship. To
advance toward this ambition, it is crucial to monitor where improvements in health-care
access and quality have occurred, and where progress must be accelerated, across the
development spectrum.

Objectives of the Study:

1. To get an understanding of Spain’s current healthcare system.
2. To compare the healthcare of Spain to healthcare of other countries.
3. To look at the challenges faced by Spain’s healthcare.
4. To analyse the country’s past performance of healthcare.

Scope of the Study:

Geographical Scope:
The scope of the present study is confined to people living only in Mumbai City.
Subject Scope:
This study will focus on the working of the healthcare system of Spain, how it has performed in
the past, the challenges faced by it, what it plans to do in the future and how does it fair when
compared to other healthcare systems.

Significance of the Study:

This study will focus on the healthcare system of Spain. It will aim to get a brief understanding
of how its healthcare system works. Specially during the covid-19 pandemic, there has been a
trend to study how various countries have handled the situation. It mainly shows how effective
the healthcare system was. This study will also review how the country has handled the covid
situation, what were the challenges faced by it, and how effectively it was in handling them.
This study will also state how the healthcare system has evolved over the years, what changes
have been made over the years and what are the things that it plans for the future. This study
will also analyze the performance of the healthcare system, by going through the past data of
various indicators like mortality rates, readmissions in hospitals, patient experience, timeliness,
and effectiveness of services etc. The study will also try to compare Spain’s healthcare with
other countries, understand and analyze what it needs improvements on and what it is already
good at.

Limitations of the Study:

The data used in the study will be secondary data, no primary data has been collected.
The study will only focus on the healthcare system of 1 country, Spain.

Conceptual Framework

Spain has a high-quality healthcare system, guaranteeing universal coverage for all residents.
Healthcare in Spain consists of both private and public healthcare, with some hospitals
(hospitales) and healthcare centers (centros de salud) offering both private (privado) and state
healthcare services (asistencia sanitaria pública).
Around 90% of Spaniards use the public healthcare system, which is called the National Health
System. However, it is very decentralized with service delivery organized at regional level. The
system is overseen by the Spanish Ministry of Health, which develops policy and oversees the
national health budget. Spain ranks 19th on the 2018 Euro Consumer Health Index and receives
praise for its improving health outcomes. On the other hand, poor accessibility and over-
reliance on the private sector remain problematic.

Management
The national system has been decentralized since 2002, which has given the regional healthcare
authorities the autonomy to plan, change and upgrade the infrastructure, leading to enormous
development in the healthcare technology scenario, especially in the usage of information
technology. The reforms, which regionalized the system, were implemented in order to provide
greater and equal access to the population, thus avoiding the concentration of health services
in urban areas. This has also improved response time and increased the participation of the
target community in the development and management of the national healthcare system at
regional and local levels.

Primary Healthcare Services

Primary Healthcare services are available within a 15-minute radius from any place of
residence. The main facilities are the healthcare centers, staffed by multidisciplinary teams
comprising of general practitioners, pediatricians, nurses and administrative staff, as well as, in
some cases, social workers, midwives and physiotherapists. The principles of maximum
accessibility and equity mean that community primary healthcare also provides home care,
whenever necessary and also deal with health promotion and disease prevention.
Specialist care is provided in specialist care centers and hospitals in the form of outpatient and
inpatient care. Patients having received specialist care and treatment are referred back to their
primary healthcare doctor, who assumes responsibility for any necessary follow-up treatment
and care, ensuring the provision of continuous care under equitable conditions, irrespective of
the patient’s place of residence and individual circumstances.

Private Healthcare
Private healthcare insurance for treatment at private hospitals and clinics is not widespread and
mainly used to avoid the sometimes long waiting lists to see specialist doctors in the public
healthcare system. Only 10 percent of the population has voluntary private insurance although
some private services are contracted by the public sector. Only in Catalonia, due to historical
reasons, there are a large number of non-profit, semi-public entities. Private healthcare
companies often offer quicker service to patients but also value-added services such as private
rooms, express mailing of test results and keeping patients informed via email and SMS
messages.

Funding the System

The Spanish healthcare system is principally funded through taxation. The country’s total
healthcare expenditure, amounts to 88,828 million euro, which accounts for 8.5 percent of the
GDP. Public healthcare expenditure accounts for 6.1 percent of GDP and represents an expense
per inhabitant of 1,421 euro. The central government provides financial support to each region
based on population and demographic criteria.
Healthcare Resources
The National Health System has 2,914 health centers and 10,202 local clinics providing basic
healthcare services to the local population. In 2009 there were 804 hospitals operating in Spain.
The National Health System has 315 hospitals, equipped with 105,505 beds, and four Ministry
of Defense’s hospitals contributing with 995 beds. The remainder 465 hospitals are privately
run and have 53,013 beds, which totals to 160,981 beds installed in Spain’s hospitals. Public
hospitals are generally much larger than private hospitals and deal with a much higher number
of patients.

Healthcare Challenges
Spain has among the world’s healthiest people with an average life expectancy of 81, one of the
highest in the EU. The incidence of heart disease in Spain is among the lowest in the world,
however, skin cancer is one of the highest.
Spain also takes a different view to rehabilitation, convalescence and terminal illness, leaving
care in these cases usually to the relatives, meaning that are very few public nursing and
retirement homes. This may prove one of the future challenges, as there is an increasing
potential demand for social support services and benefits by the dependent population, and by
carers.
However, one of the principal problems in Spain remains the limited coordination between the
Autonomous Communities, which increases disparities in services and quality of care between
the regions. Although the national system is overseen by the Ministry of Health and Consumer
Affairs (Ministerio de Sanidad y Consumo) and coordinated by the Inter-territorial Board they
focus more on long-term policies and cooperation and the responsibility of healthcare delivery
lies with the individual regions.

Conclusion
In terms of socio-economic development and in relation to similar countries, the Spanish health
system is generally comparable in almost all dimensions: population coverage, global equity,
access equity, technical quality and economic efficiency.
The Spanish national health system is in itself a great success of Spanish society, for its
technological capacity and human capital, for the accessibility of its service network, for
offering access to the latest advances in medicine and medical technology. For the entire
Spanish population, the national health service represents security and tranquility in case of
illness or accident. All these characteristics have a great consensus and social support, only
clouded by the surprisingly low priority that health—and to a lesser extent other public service
—have on the Spanish political agenda. The sustainability of the system is under debate. There
are basically three ways to guarantee the financing of a quality public health system with
universal coverage and free of charge: to increase the efficiency and effectiveness of the health
provision system, prioritize health spending in relation to other public policies and/or increase
income taxes for that purpose.

Bibliography:
https://www.expatica.com/es/healthcare/healthcare-basics/healthcare-in-spain-101467/
https://www.euro.who.int/__data/assets/pdf_file/0004/128830/e94549.pdf
https://healthmanagement.org/c/it/issuearticle/overview-of-the-spanish-healthcare-system
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462723/