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The Spanish National Health SystemThe Spanish National Health System
Ministry of Health and Consumer Affairs
JOINING EFFORTS TO REACH OPTIMAL QUALITY AND EQUITY
Bernat Soria, MD, PhDMinister of Health and Consumer Affairs
PARLIAMENTARY DEMOCRACY
MEMBER STATE OF THE EUROPEAN UNION (1986)
PRESIDENCY (2010)
EUROPEAN PARLIAMENT
2 - CHAMBERS
SPAINSPAIN
CONGRESSCONGRESS SENATESENATE
PYRAMID OF POPULATIONPYRAMID OF POPULATION
IN SPAININ SPAIN
Spaniards Foreign populations
46.1 million 89.8% (40.9 million) spaniards
11.2% (5.2 million) immigrants
Ageing of the population:
16.6%
≥ 65 years
SPANISH CONSTITUTION, 1978SPANISH CONSTITUTION, 1978
General Health ActGeneral Health Act 19861986
NATIONAL HEALTH SYSTEMNATIONAL HEALTH SYSTEM
• Universal Coverage (including immigrants)
• Financed through taxes
• “Federal-like” system (17 autonomous regions)
• Extensive portfolio of services
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
1986 2006
Primary Healthcare
First Primary Healthcare
Centres built
UNIVERSAL COVERAGEUNIVERSAL COVERAGE
SOCIAL SECURITY SOCIAL SECURITY SYSTEM (UNTIL 1986)SYSTEM (UNTIL 1986)
NATIONAL HEALTH SYSTEM NATIONAL HEALTH SYSTEM (SINCE 1986)(SINCE 1986)CoverageCoverage
All citizens coveredInsured population
Restricted to active employees and their
families
Includes immigrants
13.000 Primary Healthcare
Centres
I. Among the best in the worldI. Among the best in the world
- Ranked 4th among the 19 most developed countries Health Affairs ( Health Affairs 27: 58-71 (2008);)
- Ranked 6th among 191 countries
British Medical Journal (2001)
- Ranked 7th among 191 countries WHO (World Health Report 2000. Health Systems. Improving performance )
II. Number one in the world in organ transplantationII. Number one in the world in organ transplantation
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
FIRST IN THE WORLD IN CADAVERIC ORGAN DONATION. SPAIN, EU-27 AND USA
COUNTRIES
Population
(million inhabitants)
SPAIN
45.2
EU-27
492.3
USA
303.9
Cadaveric Organ Donor
(Rate –pmp-)
1,550
(34.4)
8,293
(16.9)
8,089
(26.6)
DECENTRALISATION - COORDINATIONDECENTRALISATION - COORDINATION
State General Administration
Government
Regional Administration
Regional Government
Regional Ministers are coordinated by the Minister of Health and Consumer Affairs
FUNDING SYSTEMAct 21/2001
Federal Taxes:- 15%: EU- 35%: Federal Govt (Justice, Defense, Innovation, etc)- 50%: Regional budgets
82 billion euros
2006
6.0 % of GDP
PUBLIC HEALTH EXPENDITURE
PRIVATE HEALTH EXPENDITURE
58,5 billion euros
8.4% of GDP
23,5 billion euros
2.4% of GDP
Source: Ministry of Health and Consumer Affairs. Public Health Expenditure Statistics, 2006
- Spain: €1,800/inhab. per year ($2,500)
- USA: $6,000/inhab. per year
HEALTH EXPENDITUREHEALTH EXPENDITURE
Source: Health at a Glance 2007: OECD Indicators
HEALTH STATUS. HEALTH STATUS. LIFE EXPECTANCY AT BIRTHLIFE EXPECTANCY AT BIRTH
SATISFACTION WITH THE HEALTHCARE SYSTEM, SPAIN
Source: Ministry of Health and Consumer Affairs. Health System Barometer
PERCEPTION OF CITIZEN.PERCEPTION OF CITIZEN. USER SATISFACTIONUSER SATISFACTION
Year 2007
19,2
4,4 0,9
25
50,5
Works well though needs changes Works fairly well
Needs fundamental changes It's so bad it needs to be redone completely
Don't know / no reply
4.4 0.9
25.0
50.5
19.2
Well: 50.5%
Fairly well: 19.2%
69.7%
OVERALL OVERALL SATISFACTION ON THE SATISFACTION ON THE WAY THE PUBLIC HEALTH WAY THE PUBLIC HEALTH
SERVICE WORKS (SCALE 1-10)SERVICE WORKS (SCALE 1-10)
6,0 6,1 6,3
1
2
3
4
5
6
7
8
9
10
2003 2005 2007
Year
Pe
rce
nta
ge 6.0 6.1 6.3
Public Health
Primary Health Care
Specialised Health Care
Socio-sanitary Care
Emergency
Pharmacy
Orthoprosthethic devices
Nutritional complements
Transport (ambulances)
EXTENSIVE BENEFITSEXTENSIVE BENEFITS
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
EXTENSIVE BENEFITSEXTENSIVE BENEFITS
PRIMARY HEALTH CARE
Family Doctor
Paediatrics
Nursing Care
Women healthcare
Children healthcare
Emergencies
Dental healthcare (in process-50%)
General benefitsGeneral benefits Specific benefitsSpecific benefits
Elderly
EXTENSIVE BENEFITSEXTENSIVE BENEFITS
SPECIALISED HEALTH CARE
- Hospitalisation
-“Day hospital”
- Outpatient Care
- Emergencies
- Mental Health and Psychiatric Care
- TransplantsTransplants
-
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
PHARMACEUTICAL BENEFITS
EXTENSIVE BENEFITSEXTENSIVE BENEFITS
Anti-allergy vaccinesMaster preparations and derived products
Medicinal productsReimbursed Medical Devices
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
Aged 0 - 65 Aged > 65
Co-paymentPrescription drugs Yes (40%) No
Hospital pharmacy Medical devices, etc.
No No
SPANISH NATIONAL HEALTH SYSTEMSPANISH NATIONAL HEALTH SYSTEM
SPANISH NATIONAL SPANISH NATIONAL HEALTH SYSTEMHEALTH SYSTEM
Specialized
66,000 doctors111,000 nurses
SpecializedHospitalSurgery
Primary Health Care34,000 GPs
27,000 nurses
Emergencies
Emergencies
BOTH PUBLIC AND PRIVATE HEALTHCARE CARE CO-EXIST
23,000 M€_
PRIVATE HEALTH CARE
PUBLIC HEALTH CARE
CONCERTED/CONTRACT
_
or
60,000 M €PUBLIC
+
- Hospital- Service- Diagnosis
FREE
1,350 inhabitants per physician
1,656 inhabitants per nurse
33,482 generalists and paediatricians
Possibility of choice of general practitioner
(GP)
300 millions generalist and paediatrician visits/year
6.6 visits per inhabitant-year
PRIMARY HEALTH PRIMARY HEALTH CARECARE
HEALTH CARE NETWORKHEALTH CARE NETWORK
5 GOALS.12 STRATEGIES
189 PROJECTS
HEALTH STRATEGIES
CLINICAL EXCELLENCE
e-HEALTH
KNOWLEDGE MANAGEMENT
Back to the future: Quality and Innnovation Strategies
Strategies to improve Primary Healthcare:
Common basic portfolio of benefits (2006)
Fostering Quality.
Effectiveness and problem solving (clinical guidelines and protocols)
Care continuity (regional initiatives).
Participation and professional development.
Efficiency, management and organization.
Nursing home care initiative
Project AP-21: Initiatives 2007-2012Project AP-21: Initiatives 2007-2012
EMPOWER CITIZEN:
HEALTH PROMOTION/PREVENTION
PARTICIPATION/INTERACTION
MULTI-CHANNEL APPROACH
EMPOWER HEALTH PROFESSIONAL:
Involve in definition of Strategy Work together in improving skills Share knowledge and avoid “silos”
RedesignedClinical P
Redesigned Clinical Processes
from an Integrated Perspective
PRIMARY CARE (solving 80% Health Issues) SPECIALIZED CARE
CONTINUITY OF CARE BASED ON INTEGRATED PROCESSES AND INFORMATION
