The Spanish Health System

Philosophy and Culture The Spanish health system (“Instituto Nacional de la Salud” ) has been through many changes. A Universal and decentralised health care system was declared in the Spainish General Health Bill 1986, this was preceded by a centralised healthcare system under General Franco which slowly got better towards his death. When Franco died the task was set to decentralize the healthcare system and was eventually completed in 2002. Equality of access for all Spanish residents was the main philosophical underpinning of the Health bill, this could be because the inequity under Franco has induced a yearning for equality for all.

Spain’s conservative government in 2003 passed the Cohesion and Quality Law. Which states: “The purpose of this law is to establish the legal framework for coordination and cooperation of the public health authorities in the exercise of their powers, so as to ensure equity, quality and social participation in the National Health and the active collaboration of this in reducing health inequalities. Even conservative politics in Spain supports a Universal model of health, unlike the US where conservatives actively see it as a violation of freedom.

The Beveridge model of health is employed in Spain that is; the health system is the government’s responsibility and relies on taxes, The fact that the Spanish people vote for free health is a consensus of the public’s perception of the values expressed through the Beveridge model. Broad Organisation and funding of the system The Spanish health system follows fairly closely to T. R. Reid’s understanding of the Beveridge model, the public is taxed and the government finances the healthcare system with the revenue.

Financing of Spanish healthcare system is roughly proportional, indicating that every citizen contributes to the finance of health care by similar fraction of his/her earnings, regardless of their total level of health. ” There are many hospitals owned by the government also some private. You only pay if you have not contributed to social security i. e. oreigners (although the I-JK citizens can get free healthcare) But there is also a certain amount of hybridity in the fact that people choose to go private over the “Instituto Nacional de la Salud” because there is a shorter waiting list in private hospitals.

Beveridge models such as the UK’s NHS usually have a centralising policy although recently plans have been discussed to decentralise in the I-JK. Spain has been decentralising for some years now, decentralizing can be controversial, because it can be problematic to allocate resources evenly because it means reducing funding in some areas. There is discrepancy about whether the Spanish health system should limit its ‘regional diversity due to differences in resources.

Ideally, a decentralised Spanish health system should define the ‘minimum’ set of benefits and implicitly allow regions to develop additional coverage at the expense of their own fiscal effort, thus transferring risk management to the Autonomous communities. Critical issues Although Spain uses a Beveridge model 27% of health care funding is spent on out- of-pocket and private health insurance. This is because of universal healthcare’s is a low amount compared to more privatized countries and a relatively high occupancy rate of 78% which is also higher than more privatized health systems.

Spain spends 8 % of GDP on health care which is an average amount of spending for a developed country and is unlikely to be increased because if the government is short on money so is the healthcare service they are more connected than an out-of- pocket model. Even though Spain’s system is a (mostly) Beveridge system, Spains overnment uses an economic analysis on the system. i. . using economic data to determine how efficient the system is, or using economic data in order to find cheaper alternative technologies.

Economic analysis assesses how well the system is working in terms of “efficacy, effectiveness, safety, equity, or ethical implications. These terms would make sense in a simple relationship between their meaning and application, but with the subtext of the “economic” the values are distorted in order to either save money or make profit and we get terms like; cost-benefit, cost-utility, ost-effectiveness and cost-minimization analyses. This paradigm of thinking not only complicates the healthcare systems actual goal (to help people in need of healthcare) it actively chooses cheaper technologies which are potentially more dangerous to the population.