Spain’s health system is resilient despite the economic downturn


The underlying principles and goals of the Spanish national health system continue to focus on universality, free access, equity and fairness of financing. At 83, life expectancy in Spain is the highest in the European Union.

Public expenditure in health prevails, with public sources accounting for over for over 71.1% of total health financing. Yet private spending, mainly related to out-of-pocket payments, has increased over time, and it is now above the EU average.

Primary care remains the core element of the health system. Public health efforts over the last decade have focused on increasing health system coordination and providing guidance on addressing chronic conditions and lifestyle factors such as obesity.

The Spanish universal national health system is SMS (Sistema Nacional de Salud). There are separate state mutual funds catering for civil servants, the armed forces and the judiciary (MUFACE, MUGEJU and ISFAS); covering 2.2 million people who can choose to have health care in either the public or private sector. 80% use the private sector.

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.

The common core package of health care services of the SNS includes all health care prevention, diagnosis, treatment and rehabilitation services, as well as emergency medical transportation. It includes acute and chronic care, health promotion and prevention activities, physiotherapy, mother and child care, mental health care, palliative care, medical counselling, basic dental health services, and specialised health care benefits (diagnostic and therapeutic procedure to be provided as out-patient specialised care, inpatient acute or long-term care, day-care surgical or medical care, palliative care, acute or long-term mental health care, home care, organ transplants and emergency care.

Additional package cover, often with cost sharing, varies by local region. Supplementary cover, that can be bought, also varies by region.

Foreigners with legal residence in Spain are entitled to SNS insurance.

The recently elected Spanish Government has started a dialogue process with the regions and the civil society to re-establish the universality of the Spanish National Health System without regional variations.

The private sector is an important player in the Spanish health system. The private sector provides voluntary health insurance schemes to individuals. It provides dental care and optical care not covered by the national health system.

10.7 million people have private health insurance; two thirds being individual cover and the rest corporate.

According to European Union figures for 2015, the latest available year, the number of information requests to the National Contact Point for cross-border healthcare was just 106 requests; 24 previous authorisation requests were submitted and 15 were authorised. The number of requests for reimbursement was 22, with only 50% of them granted, which means just 26 Spaniards had healthcare overseas, funded under the EU Directive.



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