+ Healthcare in Spain Presented By: Wes Bates, Megan Saksefski, Katie Butler, and Victoria Lyon

+ Basic Information The national healthcare system is decentralized in order to provide greater and equal access to the population, thus avoiding the concentration of health services in urban areas. Recent reforms have regionalized the system to provide improved response time and increase the participation of the targeted community at local levels. The system consists of three organizational levels: Central (Organizacion de la Administracion Central) Autonomous Community (Organizacion Autonomica) Local (Areas de Salud)

+ Central Level (Organizacion de la Administracion Central) The state's central administration agency is the Ministry of Health (Ministerio de Sanidad y Consumo) This agency is in charge of: Issuing health proposals Planning and carrying out the execution of the government's health guidelines Coordinating the activities aimed at reducing the consumption of illegal drugs.

+ Autonomous Community Level (Organizacion Autonomica) The territorial administration of health services is the responsibility of each of Spain's 17 Autonomous Communities (Comunidades Autonomas) Each Autonomous Community must offer integrated health services to the population through the centers, services and establishments of that community.

+ Local Level (Areas de Salud) The Areas de Salud are defined by taking into account factors of demography: geography socioeconomics employment epidemiology culture. To increase operability and efficiency, the areas de salud are subdivided into smaller units called zonas basicas de salud. There is a minimum of one Area de Salud per region

+ Cost Per Capita Per capita cost is 1,421 Total Health Expenditure million euros 71.8% of the health expenditure is focused on Public Health ( million euros)

+ Funding the Healthcare System Main (public) healthcare system is funded through tax dollars and government funds. Private sector is funded through private investment and payment.

+ Payment Patient payment for services is covered by the Spanish healthcare system. There is no out-of-pocket cost for the patient. Patient receives services and healthcare after proving that they are a Spanish citizen or permanent residence.

+ Cost for Institutions The average hospital visit in Spain costs the healthcare system

+ Ratio of Private Hospitals to Public Hospitals In Spain, there are 465 private hospitals and 339 public hospitals.

+ Quality Health Indicators: Spain GLOBAL HEALTH RANKING: 7 th IN THE WORLD Life expectancy at birth (years): 78 for males / 85 for females Probability of dying under five (per 1000 live births): 4 Total expenditure on health per capita (Intl $, 2009): 3,150 Total expenditure on health as % of GDP (2009): 9.7 Figures are for 2009, Source: Global Health Observatory - WHOGlobal Health Observatory - WHO

+ Focus of Spanish Healthcare The Spanish healthcare system places a large emphasis on primary care. Spain has many government run programs to encourage healthy eating and exercise. Government provides subsidies to fruit and vegetable farmers. Spanish health system contains programs to quit smoking and cure additions. Large amounts of money are spent to increase public knowledge of how to live a healthy life.

+ Technology Since Spain's accession to the European Community in 1986, the Spanish scientific and technological system has been incorporated into the European system. In 1995 a regulation for basing the introduction of new procedures and medical equipment on the assessment of safety, efficacy, and efficiency was issued. The Spanish healthcare system is highly dependent on foreign technology and advancement. Spanish healthcare system does not provide a large amount of funds for research. Limited amount of experimental treatments.

+ Access 100% of Spanish citizens are covered. Non-nationals who contribute to the Social Security Network and their family members are also covered by public healthcare. Immigrants who are not citizens of the EU but are registered residents can obtain private healthcare. Illegal immigrants have the right to emergency care and mother and child attendance.

+ Citizens Knowledge of the System Most Spanish understand the system generally, ssues that are unclear because the system is so big. Issues may arise in:

+ Influence of Socioeconomic Status Economic status does not effect Spanish access to healthcare. A Spanish citizen can receive care whether or not they are contributing to Social Security.

+ Distribution of Care In some parts of the country, particularly the outlying islands, patients may have to travel some distance to find a state healthcare provider.

+ Medical Decision Making and Rationing of Care