The Spanish System
Today we lay out the case for the Spanish Healthcare system and again taken from the CATO institute. The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World Michael D. Tanner Cato Institute: Policy Analysis
Spain
Spain’s national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions. The Spanish Constitution guarantees all citizens the “right” to health care, including equal access to preventive, curative, and rehabilitative services; but responsibility for implementing the country’s universal system is being devolved to regional governments. The degree and speed of devolution is uneven, however, with some regions only recently achieving maximum autonomy.(111)
Coverage under the Spanish system is nearly universal, estimated at 98.7 percent of the population. The system provides primary health care, including general health and pediatric care, outpatient and inpatient surgery, emergency and acute care, long-term disease management, and prescription drugs (although some drugs may require a co-payment). Many mental health services, particularly outpatient services, are excluded, as is cosmetic surgery.(112)
The federal government provides each region with a block grant. The money is not earmarked: the region decides how to use it. The block grant itself is based primarily on a region’s population with some consideration given to other factors such as the population’s demographics. Regions may use their own funds to supplement federal monies.
Not surprisingly, health care spending varies widely from region to region. The differences in expenditures, as well as in spending priorities, lead to considerable variance in the availability of health resources. For example, Catalonia has more than 4.5 hospital beds per 1,000 residents, while Valencia has just 2.8.(113)
Spanish patients cannot choose their physicians, either primary care or specialists. Rather, they are assigned a primary care doctor from a list of physicians in their local community. If more specialized care is needed, the primary care physician refers patients to a network of specialists. Unlike U.S. managed care, it is not possible to go “out of network” unless the patient has private health insurance (see below). This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting lists.
Waiting lists vary from region to region but are a significant problem everywhere. On average, Spaniards wait 65 days to see a specialist, and in some regions the wait can be much longer. For instance, the wait for a specialist in the Canary Islands is 140 days. Even on the mainland, in Galacia, the wait can be as long as 81 days. For some specialties the problem is far worse, with a national average of 71 days for a gynecologist and 81 days for a neurologist.(114) Waits for specific procedures are also lengthy. The mean waiting time for a prostatectomy is 62 days; for hip replacement surgery, 123 days.(115)
Some health services that U.S. citizens take for granted are almost totally unavailable. For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives. There are very few public nursing and retirement homes, and few hospices and convalescence homes.(116)
As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 12 percent of the population currently has private health insurance. (This amounts to double coverage since opting out of the government system is not allowed.(117)) In larger cities such as Madrid and Barcelona, the number of privately insured reaches as high as 25 percent. Overall, private insurance payments account for 21 percent of total health care exenditures.(118) More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24 percent of health care spending in Spain is out of pocket, more than any European country except Greece and Switzerland, and even more than the United States.(119)
Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.(120)
There are also shortages of modern medical technologies. Spain has one-third as many MRI units per million people as the United States, just over one-third as many CT units, and fewer lithotripters.(121) Again, there is wide variation by region. For example, two regions, Ceuta and Melilla, do not have a single MRI unit.(122) The regional variation is important because Spaniards face bureaucratic barriers in trying to go to another region for treatment.
All hospital-based physicians and approximately 75 percent of all other physicians are considered quasi–civil servants and are paid a salary rather than receiving payment based on services provided. Compensation is based on years of practice or the attainment of certain professional credentials, with across-the board annual increases unrelated to merit, performance, or patient satisfaction.(123)
As a result, Spain has fewer physicians and fewer nurses per capita than most European countries and the United States. The lack of primary care physicians is particularly acute.(124)
Even so, Spaniards are generally happy with their system. Nearly 60 percent describe their system as good, the second highest favorability rating in Europe. (France was first.)(125) Accordingly, health care reform does not rank high on the average Spaniard’s political agenda. One observer described health care as “conspicuous by its absence as a major issue” in recent elections.(126) Only about 46 percent of Spaniards describe the need for reform as “urgent,” while 35 percent see reform as “desirable.” And Spaniards are less inclined toward market-based reforms than most other European countries. Only 42 percent of Spaniards believe that it should be easier for patients to spend their own money on health care, and only 58 percent believe that giving patients more control over spending will improve quality. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with waiting lists.(127)
Spain
Spain’s national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions. The Spanish Constitution guarantees all citizens the “right” to health care, including equal access to preventive, curative, and rehabilitative services; but responsibility for implementing the country’s universal system is being devolved to regional governments. The degree and speed of devolution is uneven, however, with some regions only recently achieving maximum autonomy.(111)
Coverage under the Spanish system is nearly universal, estimated at 98.7 percent of the population. The system provides primary health care, including general health and pediatric care, outpatient and inpatient surgery, emergency and acute care, long-term disease management, and prescription drugs (although some drugs may require a co-payment). Many mental health services, particularly outpatient services, are excluded, as is cosmetic surgery.(112)
The federal government provides each region with a block grant. The money is not earmarked: the region decides how to use it. The block grant itself is based primarily on a region’s population with some consideration given to other factors such as the population’s demographics. Regions may use their own funds to supplement federal monies.
Not surprisingly, health care spending varies widely from region to region. The differences in expenditures, as well as in spending priorities, lead to considerable variance in the availability of health resources. For example, Catalonia has more than 4.5 hospital beds per 1,000 residents, while Valencia has just 2.8.(113)
Spanish patients cannot choose their physicians, either primary care or specialists. Rather, they are assigned a primary care doctor from a list of physicians in their local community. If more specialized care is needed, the primary care physician refers patients to a network of specialists. Unlike U.S. managed care, it is not possible to go “out of network” unless the patient has private health insurance (see below). This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting lists.
Waiting lists vary from region to region but are a significant problem everywhere. On average, Spaniards wait 65 days to see a specialist, and in some regions the wait can be much longer. For instance, the wait for a specialist in the Canary Islands is 140 days. Even on the mainland, in Galacia, the wait can be as long as 81 days. For some specialties the problem is far worse, with a national average of 71 days for a gynecologist and 81 days for a neurologist.(114) Waits for specific procedures are also lengthy. The mean waiting time for a prostatectomy is 62 days; for hip replacement surgery, 123 days.(115)
Some health services that U.S. citizens take for granted are almost totally unavailable. For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives. There are very few public nursing and retirement homes, and few hospices and convalescence homes.(116)
As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 12 percent of the population currently has private health insurance. (This amounts to double coverage since opting out of the government system is not allowed.(117)) In larger cities such as Madrid and Barcelona, the number of privately insured reaches as high as 25 percent. Overall, private insurance payments account for 21 percent of total health care exenditures.(118) More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24 percent of health care spending in Spain is out of pocket, more than any European country except Greece and Switzerland, and even more than the United States.(119)
Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services.(120)
There are also shortages of modern medical technologies. Spain has one-third as many MRI units per million people as the United States, just over one-third as many CT units, and fewer lithotripters.(121) Again, there is wide variation by region. For example, two regions, Ceuta and Melilla, do not have a single MRI unit.(122) The regional variation is important because Spaniards face bureaucratic barriers in trying to go to another region for treatment.
All hospital-based physicians and approximately 75 percent of all other physicians are considered quasi–civil servants and are paid a salary rather than receiving payment based on services provided. Compensation is based on years of practice or the attainment of certain professional credentials, with across-the board annual increases unrelated to merit, performance, or patient satisfaction.(123)
As a result, Spain has fewer physicians and fewer nurses per capita than most European countries and the United States. The lack of primary care physicians is particularly acute.(124)
Even so, Spaniards are generally happy with their system. Nearly 60 percent describe their system as good, the second highest favorability rating in Europe. (France was first.)(125) Accordingly, health care reform does not rank high on the average Spaniard’s political agenda. One observer described health care as “conspicuous by its absence as a major issue” in recent elections.(126) Only about 46 percent of Spaniards describe the need for reform as “urgent,” while 35 percent see reform as “desirable.” And Spaniards are less inclined toward market-based reforms than most other European countries. Only 42 percent of Spaniards believe that it should be easier for patients to spend their own money on health care, and only 58 percent believe that giving patients more control over spending will improve quality. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with waiting lists.(127)
Labels: healthcare reform, Spain
posted by Anonymous at 5:45 AM
6 Comments:
Wow. No choice of physicians. Long waiting lines. A mobile society moving around to long for shorter lines. Fewer doctors and nurses. No medical innovation. A lack of advanced medical devices like the MRI. Sounds like a Liberal utopia. The only good thing is the report that private insurance is supplementing the failed socialist system. I wonder if Montana Senator Max Baucus (read: Balk Us) has studied any of these great socialist systems before he put together his monstrosity of a proposal? Mandatory enrollment. Fines for those who do not sign up, etc. etc. I find it interesting that when he announced his plan to the media, that Senator Max Balk Us was standing alone. It appears that he was successful in alienating both Democrats and Republicans. His plan is (using a medical term) DOA.
Very nice forum exposing the weaknesses of health systems across the world that the idiot big government puppets want us to adopt.
How about looking at how we can restore value to our currency and begin to control a government that spends like a teenager with permission to use their parent's credit card. There is currently a resolution in the House and Senate to give the Congress the right to oversee the actions of the Federal
Reserve. It started in the House by Ron Paul, Audit the Fed, has nearly 300 signatures by the House and is in the Senate now with nearly 30 signatures. If we can begin to reign in the Fed maybe we can begin to control big government spending and bring back value to the dollar which has dropped in value from 100 cents in 1913, the year the Federal Reserve began, to today's value of barely 3 cents. Jefferson once stated that he feared bankers more than standing armies and he was right. Contact your Senators and Reps and light a fire under them. Bringing back control and value to the currency will also help the health care industry.
Very nice forum exposing the weaknesses of health systems across the world that the idiot big government puppets want us to adopt.
How about looking at how we can restore value to our currency and begin to control a government that spends like a teenager with permission to use their parent's credit card. There is currently a resolution in the House and Senate to give the Congress the right to oversee the actions of the Federal
Reserve. It started in the House by Ron Paul, Audit the Fed, has nearly 300 signatures by the House and is in the Senate now with nearly 30 signatures. If we can begin to reign in the Fed maybe we can begin to control big government spending and bring back value to the dollar which has dropped in value from 100 cents in 1913, the year the Federal Reserve began, to today's value of barely 3 cents. Jefferson once stated that he feared bankers more than standing armies and he was right. Contact your Senators and Reps and light a fire under them. Bringing back control and value to the currency will also help the health care industry.
I'm waiting to read your regurgitation of Cato's description of the U.S. System.
Since you guys are so knowledgeable, I'd like to hear your ideas on improving our health care system and making it cost neutral.
I just read this blog and I am not surprised about the healthcare battle we are currently experiencing in the US.
I would recommend to the posting individual and the ones that believe and commented on it to do some research before executing judgment. Spanish healthcare is considered the 9th in the world by the WHO, while the US is the 37th (judge by the same standards). Also they use only a 7.6% of their GDP for Universal Healthcare versus 16-17%
in the US where 47 million people still have not access.
The posting was full of inaccuracies, starting with the fact that spaniards CAN choose now their physicians (implemented by the Socialist Party). Regarding waiting times,hmmm... I live in the US and have a PPO. I have to make an appointment for my annual physical/woman a year in advance because my gyno is too busy. For my endo it takes me 2-3 months and the dermatologist another 3 months. I pay 20% of the cost...So much for private healthcare. I have experienced both systems, I lived in Spain for half of my life, and currently live in the US and I will take their system anytime. While I was there I never have to think twice about going to see a doctor out of fear of not being able to pay the bill. Tell that to the fellow americans that filed bankruptcy do to medical bills (65% of the bankrupties)
I could keep going on...
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