SPAIN'S HEALTHCARE SYSTEM!

Running head: SPAIN’S HEALTHCARE SYSTEM 1

Spain’s Healthcare System

HCS 400 Healthcare Systems and Policy

Dr. Lewis

Gina Leymeister

Alvernia University

SPAIN’S HEALTHCARE SYSTEM 2

Abstract

Spain’s healthcare system is very different from The United States. For starters, Spain’s

healthcare system has universal coverage, which ensures that no citizens are left uninsured.

America does not have a system where no one is left behind; in fact many are left behind in the

world of healthcare and neglect in The United States. The uninsured rate in The United States

continues to grow, due to the lack of affordability, and coverage accessibility to the citizens.

Therefore, Spain is ranked one of the best healthcare systems in the world, whereas, America

spends too much and does not have efficient coverage.

Keywords: Spain, The United States, health care, system, coverage


Spain’s Healthcare System

The overall health of an individual is not just based off of medicine, but also the entire

mindset of the country that he or she resides in. The outcome and success rate of health care

differ among each country by making some countries more credible than others. During recent

studies, many have viewed the statistics of healthcare in the United States versus Europe or more

specifically Spain. The results showed that the United States lags behind that of Spain. Spain is

rated among the world’s best universal healthcare coverage with no upfront expenditure from

patients. Therefore ranking Spain as the seventh best country for health care in the world.

(“WHO”)

The history of the development of Spain’s health care system reflects on the

government’s role in the creation of the universal healthcare system. Josep A. Rodriguez and

Jesus de Miguel divided the development of the Spanish health system into five periods. The five

periods were as follows: post-war (1939-1966), expansion (1967-1975), democratization (1976-

1981), and the first socialist government (1982-1986), and lastly, the health reform was initiated

in 1987 with the creation of the National Healthcare System (Blendon, R., Donelan, K., & Jovell

et. al).

Following the Spanish Civil War in the late 1930s, the Francisco Franco government

established a mandatory sickness program called Seguro Obligutorio de Enfermedad , which was

managed through the social security system. The program was funded by the pulsory premium

paid workers. The Franco government built thousands of fully equipped hospital beds in the

urban parts of Spain. However, the local governments were required to provide their own means


of maternity, psychiatric and public healthcare. The healthcare system at this time was divided,

and there was no universal coverage (Blendon, R., Donelan, K., & Jovell et. al).

It was not until Francisco Franco’s death in 1975 that triggered the democratization

period, which resulted in the monarchial and parliamentary constitution of 1978. The Spanish

Constitution required the creation of a universal healthcare system. The universal healthcare

system included guaranteed equal access to preventative, curative, and rehabilitative services for

all Spanish citizens. This coverage is very different than the U.S. Medicare program, because the

Spanish Social Security system is a highly centralized national system of hospitals and clinics,

whereas, the Medicare program is just a very strict health insurance program. However, the

creation of the universal healthcare system has helped with the delivery of care in Spain

(Blendon, R., Donelan, K., & Jovell et. al).

Since healthcare is more than just the delivery of medicine, one has to also look at the

social and economic differences between the two countries. Therefore, Spain and the United

States have similarities and differences between the economic and social status, which affects the

delivery of healthcare. In addition, the lifestyle of those who are natives in each country alters

the disease rates, morbidity rates, and the overall health of the citizens living in the country.

First, one needs to analyze the delivery of healthcare in Spain, which is highly

regionalized. The reason that the healthcare is regionalized is due to each region exercising its

own autonomy. Within each region, there are possible complications that can arise within the

system. More specifically, the Spaniards have to apply for a European Health Insurance Card

(EHIC), which is only granted if one has a social security number. This card is a personal non-

transferable document that certifies the holder's entitlement to receive any necessary medically


related health care benefits. In addition, there is no cost to receive a card. However, under this

card the only service that is not covered is dental care (“The healthcare system in Spain”). In

addition, prescriptions are covered under the plan with 60% paid and the remaining 40% is

covered with the card. Emergency services are only covered at the public health facilities

because the private hospitals are not affiliated with the government funding (“The Healthcare

System in Spain”).

Furthermore, focusing on the population of Spain, an individual who is working in Spain

and is affiliated to the Spanish social security system, will have a deduction from one’s

paycheck, which will give the individual access to healthcare with the aid of a monthly pay slip

as evidence. However, if a person is self-employed, the person first must obtain an NIE (foreign

identification number) from the police and an Alta Fiscal from the Head Tax Office. Next, the

individual will have to take these forms to the nearest social security office, where one will

receive a social security number card entitling them to health care and full medical coverage.

(“What Makes Spain's Health Care System The Best?”).

While using Spain’s healthcare system, it is important to show the European Health

Insurance Card at every doctor or hospital visit. If one does not have the card to show, then one

is responsible for the entire bill and the amount will not be covered under the European

healthcare system. This card covers new and existing medical conditions. On the other hand, in

addition to the state funded healthcare, there is also public health insurance available for those

who are not covered by the state-run healthcare system.

The public health care insurance that is offered in Spain is based on a special pay-in scheme

(convenio especial). The public health insurance is available nationwide where one will pay a


monthly fee to access state run healthcare. However, children do not have to join Convenio

Especial, because the children are protected under Spanish law for entitled medical coverage.

The autonomous regions manage the public health insurance. The price for this health insurance

differs only by age, and like the state health insurance, there are not pre-existing conditions. The

basis monthly fee for an individual under 65 years of age is 60 € a month (70.17 dollars). The

basis for an individual who is above age 65 is 157€ a month (169.48 dollars). However,

prescriptions are not covered under the public health insurance, so one would have to pay the

prescription cost based off of income (see appendix). The special pay- in scheme is offered in the

following cities of Spain: Madrid, Baleares, Canarias, Galicia, Murcia, and Valencia (“Country-

by-country guide”).

On the other hand, Spain also offers private health insurance. There are numerous reasons

why an individual would want to obtain private health insurance. Some of the benefits of having

private health insurance include gaining more coverage, having more freedom in the selection of

doctors and hospitals, and shorter wait times for healthcare services. When one is going to

purchase private health insurance, it is very important to compare different insurance companies

to select an insurance company that is affordable with one's budget. Likewise, in the United

States it is also recommended to search for the best private health insurance in the marketplace

before choosing an insurance company. The cost of the private insurance varies greatly on the

services that one is searching for specific coverage within the private insurance market

(“Country-by-country guide”).

There is a difference in care that one will receive from a public insurance versus private.

The different variables range from cost, different services, doctor options, hospital options etc. In

addition, it also depends on the health status of the consumer looking for insurance. The reason


that the health status of the consumer is important is due to the different services or specialists

that may be needed for that person's care. Therefore, the cost of healthcare in Spain varies greatly

with the security of universal coverage, unlike that that of the United States.

The cost of healthcare in Spain is peculiar than the cost of healthcare in the United States. The

total health spending accounted for Spain amounts to 9.4% of GDP (Gross Domestic Product);

whereas, the United States spends 17% of its GDP on healthcare. In general, Spain spends 1.4

trillion dollars on health care. On the other hand, the United States spends 3.8 trillion dollars on

health care. The health expenditure per capita per person for Spain amounts to 2,998 dollars,

whereas the United States spends 9,255 dollars per person per capita. Furthermore, Spain has

reduced spending in the area of pharmaceutical medicine. In addition, Spain spends 523 dollars

per person on pharmaceutical prescriptions, and 17.8 % of the health expenditure is spent on

pharmaceutical expenditure. With that health expenditure, 73% is spent on public health

expenditure, and only 20.7 % is spent on out of pocket payments for health care (Blendon, R.,

Donelan, K., & Jovell et. al).

The statistics listed prior are evidence that Spain’s healthcare system is more efficient

than that of the United States. Even though the United States may have leading edge technology,

which could be the reason for increased expenditure; Spain still spends less with successful

outcomes. The numbers prior should be an eye opener to the citizens of the United States. It is a

constant battle to this day on how to effectively reduce health care spending in America, increase

the coverage rates, but at the same time keep the health care professional and allies content.

By looking at the average costs of some of the most common medical procedures being

performed, a general doctor’s visit cost 35 Euros (37.59 US dollars), tooth whitening cost 330


Euros (354.41 US dollars), fillings cost 49 Euros (52.62 US dollars), and lastly varicose vein

removal cost 1400 Euros (1,503.54 US dollars). The author finds these most common

procedures to be interesting. One would not think of the procedures listed above to be the most

common for Spain. However, it does make sense that these are the most common (except for

varicose vein) given that dental care is not covered, but it essential for good health. With that, the

only cost one would have to pay for would be dental care, so it would become top priority since

the rest of one’s healthcare would be covered. In comparison, the costs of these procedures are

reasonable compared to other European countries. In addition to the cost of healthcare

procedures in Spain, the country has also taken measures to reduced costs in certain areas of the

healthcare system (“Country-by-country guide”).

Spain has achieved progress in reducing tobacco consumption over the past decade with

the rate of smokers among adults depleting to 32% in 2001 to 24% in 2011. However, Spain has

not achieved an overall progress with diminishing smokers, because The United States has a

greater progress in reducing tobacco consumption with current smoking rates among adults

below 15%. In addition to each country reducing its overall smokers, the Center for Disease

Control and Prevention (CDC) has been trying to reduce the spread of diseases nationwide


Unfortunately, with disease or illness there is an increase in the mortality rate of the

country. In general, the mortality rate in Spain is 9.64 deaths per 100,00 population. More

specifically, the mortality rate from cardiovascular disease is 204 per 100,00 population, and the

mortality rate from cancer is 201 per 100,00 population. On the other hand, The United States, in

general, has 821 deaths per 100,00 population. The significance of the mortality rates from each

country depicts the difference in the delivery of the care of each country. In addition to the


diseases listed prior for Spain, there is one disease that has reappeared its ugly head in the

country of Spain. This disease is known as Diphtheria. (Disease Daily | HealthMap).

Diphtheria is “an acute toxic-mediated disease caused by the bacterium Corynebacerium

diphtheria" (Disease Daily | HealthMap). The transmission of the disease occurs via person-to-

person contact. The symptoms of this disease include weakness, sore throat, fever, and swollen

glands in the neck. The only prevention from contracting the disease is to be vaccinated. If a

person is not vaccinated then the likely hood of contracting the disease is very possible, which

happened to be the case for the boy from the town of Olot. (Disease Daily | HealthMap).

The first case of Diphtheria dates back to early June of 1986. After 28 years of no

reoccurrence, a six-year-old boy from Olot (a town in the Catalonia region of the country) was

diagnosed with the disease. The case investigation has led health authorities to conduct testing on

individuals who had close contact with the boy. The investigation led to the conclusion that Olot

case resulted in the lack of vaccination from the diphtheria disease. Therefore, Spain’s general

secretary for health services, Ruben Moreno, had to contact Russia for a dose of the vaccine,

given that no other country had the vaccine readily available. With that, Spain is testing all close

relatives to the child to ensure that the disease is contained. In addition to disease and mortality

rates speaking volumes about the type of care in the country, the life expectancy of the country is

vital information to the consumer by informing he or she of the successful healthcare delivery of

that country. (Disease Daily | HealthMap).

The life expectancy of Spain differs greatly from The United States. Spain has a life

expectancy for women as 84.7 years and for men as 78.57 years, but the average life expectancy

is 82.5 years. On the other hand, The United States has a life expectancy for women as 81 years


and for men as 76 years, but the average life expectancy is 79 years. The life expectancy of a

country sends a message to the world how successful that country is taking care of its natives.

The overall health status of a country also differs between The United States and Spain


The current health status of The United States is fairly poor compared to Spain.

According to Health People 2020, in 2008, 107 million Americans, (almost one out of every two

adults age eighteen or older) had at least one of six reported chronic illnesses. The chronic illness

reported were as follows: Cardiovascular disease, Arthritis, Diabetes, Asthma, Cancer, and

Chronic Obstructive Pulmonary Disease (COPD). All of the chronic illness listed prior

contribute to the poor health status of The United States. In addition to the chronic illnesses, in

2007, 9.5 percent of individuals in The United States reported their health to be fair or poor. This

self-assessment report became a good indicator to the country of the overall health of its citizens.

However, Spain’s citizens’ health status is good compared to The United States, even though as

mentioned prior in the document with the one disease outbreak (Blendon, R., Donelan, K., &

Jovell et. al).

The Spaniards think quite the contrary of the healthcare system. Whereas, the rest of the

world views Spain has a leader in the healthcare system, the natives of a country do not feel the

same way. During this past year, The Harvard School of Public Health conducted a study to

retrieve information on thoughts from Spanish on their healthcare system. The survey was

organized in Madrid (Spain’s capital) and to be sent throughout the country for feedback

information from Spain’s citizens. The concluding results of the survey showed that Spaniards

think that their nation spends too little money on health care and that an increase in healthcare

spending should be a first priority for the government. (Blendon, R., Donelan, K., & Jovell et. al)


Furthermore, the study also concluded the majority of Spaniards think that there is a

waste and inefficiency of the government money that could be reallocated to health care without

requiring new taxes. The survey showed that Spaniards have the lowest satisfaction with their

healthcare system. However, in contrast, 71 percent of Spaniards reported in the survey that they

were satisfied with their personal health services that they and their families utilized within the

past year. This survey is a vital piece of information for the government to use for future

directives in health care (Blendon, R., Donelan, K., & Jovell et. al).

The author would now like to discuss the healthcare system of The United States. Spain

has a universal healthcare system with the option of private and public insurances, whereas The

United States has an insurance market with only the option of state or private insurances. The

United States healthcare system is funded partially by the state and the rest is individual

coverage through the marketed insurance companies or self-pay resources. The United States has

many flaws within the healthcare system, just like many other health care systems nationwide.

However, the main difference between The United States and other healthcare systems is the

lack of universal healthcare coverage. (Kominski 2014).

The lack of universal healthcare coverage affects the Americans on a daily basis. There

are still 48.6 million persons still uninsured in The United States. Those who are still uninsured

are affecting the cost of healthcare by using the Emergency Room as one's only means of care.

By comparing this to those uninsured in Spain, one would find that every person is entitled to

healthcare access. The healthcare system in America does not establish a common goal to keep

the citizens of the country healthy. The only programs in America that cover a group of the

population are Medicaid and Medicare. However, even with these programs in place, there is still

a coverage gap that the government fails to reach with healthcare coverage. (Kominski 2014)


Another policy that America has in place is the Affordable Care Act, which has indeed

increased the number of those insured by the Medicaid expansion and by allowing children to

stay on their parents insurance until the age of 26. However, The United States is trying to

insure the entire population but is consequently failing. In relation to cost, The United States

spends too much and Spain spends too little. The contrasting difference between the two

countries relates back to the underlying differences in relation to the countries deliverance of

care. The effectiveness of a countries health care can inform an individual of the overall well-

being of those who reside within the country (Kominski 2014).

A vast portion of the healthcare system is made up of the healthcare professionals.

Health care professionals are essential to having a successful healthcare system. Healthcare

providers in Spain are paid less than those in The United States. A doctor working in Spain can

earn 60,000€ a year, which equates to 64,728 dollars, whereas a doctor in The United States

earns minimally on average 188,440 dollars. Spain's doctors are the lowest paid doctors in

Europe but are part of the seventh best care healthcare system in the world (Pfuntner).

In general, Spain’s population is overall healthy due to the accessible coverage through

the universal healthcare policy. It is extremely important for the population to feel comfortable in

the healthcare system and find it easy to access health care. Since Spain has a state-run system, it

is easier to apply for health care coverage, and to also find doctors and hospitals that accept the

coverage. In contrast, it is extremely hard for someone to navigate his or her way through the

American healthcare system.

Spain’s healthcare system compares and contrasts to the American system in many ways.

Both healthcare systems have their own strengths and weaknesses. Spain has most of its


healthcare through the government itself while the U.S. has most of its healthcare through private

insurance companies. However, Spain does have one of the best healthcare systems in the

country, unlike The United States. One notable quote about health care the author thinks stands

out states, "We need for America to get back to basics and focus on the middle-class quality of

life. Healthcare reform is vital to restoring that standard of living” (Famous Quotes). This quote

remarks on the vital importance of having a healthcare system in America that reaches all classes

of society, especially the middle class.

In conclusion, the differences between each system create a learning experience for an

individual in either country. The use of universal healthcare coverage in Spain demonstrates

equal access to care for the citizens. The use of public and private insurance companies in The

United States demonstrates the lack of universal health care access. The author thinks that the

universal healthcare system in Spain is a more reliable system than the healthcare system in The

United States.


References

Blendon, R., Donelan, K., Jovell, A., Pellise, L., & Lombardia, E. (2013, November 13). At the

Intersection of Health, Health Care and Policy. Retrieved from

http://content.healthaffairs.org/content/10/3/216.full.pdf

Country-by-country guide. Retrieved from

http://www.nhs.uk/NHSEngland/Healthcareabroad/countryguide/Pages/healthcareinSpain

.aspx

Disease Daily | HealthMap. Retrieved from http://www.healthmap.org/site/diseasedaily

Famous Quotes. Retrieved from http://www.brainyquote.com

Key Facts about the Uninsured Population. Retrieved from

http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

Kominski.G., ed.(2014). Changing the U.S. Health Care System. San Francisco, Calf. Jossey-

Bass Press.

Pfuntner, A. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK132428/

Spanish Town Guides. Retrieved from

http://www.spanish-town-guides.com/Healthcare_Spain.htm

The Healthcare System in Spain. Retrieved from

http://www.expatica.com/es/healthcare/healthcare/Getting-healthcare-in-

Spain_101467.html


What Makes Spain's Health Care System The Best? Retrieved from

http://www.npr.org/templates/story/story.php?storyId=112014770

World Health Organization's Ranking of the World's Health Systems. Retrieved from

http://thepatientfactor.com/canadian-health-care-information/world-health-organizations-

ranking-of-the-worlds-health-systems/


Appendix

Annual income Social situation

% of contribution

Capped at

Less than €18,000 (19,431.27 U.S. dollars )

Working age

40% No cap

State pensioner

10% €8/month(8.64 U.S. dollars )

Between €18,000 and €100,000 ( 107,951.50 U.S. dollars)

Working age

50% No cap

State pensioner

10% €18/month 19.43 U.S. dollars)

Over €100,000 Working age

60% No cap


State pensioner

60% €60/month (64.77 U.S. dollars)

Blendon, R., Donelan, K., Jovell, A., Pellise, L., & Lombardia, E. (2013, November 13). At the

Intersection of Health, Health Care and Policy. Retrieved from

http://content.healthaffairs.org/content/10/3/216.full.pdf

* This table depicts the different amounts a resident of Spain would be required to pay for a

prescription medication.

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