1. The Spanish National Health System Ministry of Health and Consumer Affairs JOINING EFFORTS TO REACH OPTIMAL QUALITY AND EQUITY Bernat Soria, MD, PhD Minister of Health and Consumer Affairs bsoria@msc.es

2. PARLIAMENTARY DEMOCRACY MEMBER STATE OF THE EUROPEAN UNION (1986) PRESIDENCY ( 2010) EUROPEAN PARLIAMENT 2 - CHAMBERS SPAIN CONGRESSSENATE

3. PYRAMID OF POPULATION IN SPAIN IN SPAIN SpaniardsForeign populations 46.1 million 89.8% (40.9 million) spaniards 11.2% (5.2 million) immigrants Ageing of the population: 16.6% ≥ 65 years

4. SPANISH CONSTITUTION, 1978 General Health Act 1986 NATIONAL HEALTH SYSTEM Universal Coverage (including immigrants) Financed through taxes “Federal-like” system (17 autonomous regions) Extensive portfolio of services SPANISH NATIONAL HEALTH SYSTEM

5. 19862006 Primary Healthcare First Primary Healthcare Centres built UNIVERSAL COVERAGE SOCIAL SECURITY SYSTEM (UNTIL 1986) NATIONAL HEALTH SYSTEM (SINCE 1986) Coverage All citizens coveredInsured population Restricted to active employees and their families Includes immigrants 13.000 Primary Healthcare Centres

6. I. Among the best in the world - Ranked 4 th among the 19 most developed countries Health Affairs ( Health Affairs 27: 58-71 (2008); ) - Ranked 6 th among 191 countries British Medical Journal (2001) - Ranked 7 th among 191 countries WHO (World Health Report 2000. Health Systems. Improving performance ) II. Number one in the world in organ transplantation SPANISH 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)

7. DECENTRALISATION - COORDINATION State General Administration Government Regional Administration Regional Government Regional Ministers are coordinated by the Minister of Health and Consumer Affairs

8. FUNDING SYSTEM Act 21/2001 Federal Taxes: - 15%: EU - 35%: Federal Govt (Justice, Defense, Innovation, etc) - 50%: Regional budgets

9. 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 EXPENDITURE

10. Source: Health at a Glance 2007: OECD Indicators HEALTH STATUS. LIFE EXPECTANCY AT BIRTH

11. SATISFACTION WITH THE HEALTHCARE SYSTEM, SPAIN Source: Ministry of Health and Consumer Affairs. Health System Barometer PERCEPTION OF CITIZEN. USER SATISFACTION Year 2007 4.40.9 25.0 50.5 19.2 Well: 50.5% Fairly well: 19.2% 69.7%

12. OVERALL SATISFACTION ON THE WAY THE PUBLIC HEALTH SERVICE WORKS (SCALE 1-10) 6.0 6.1 6.3

13. Public Health Primary Health Care Specialised Health Care Socio-sanitary Care Emergency Pharmacy Orthoprosthethic devices Nutritional complements Transport (ambulances) EXTENSIVE BENEFITS SPANISH NATIONAL HEALTH SYSTEM

14. EXTENSIVE BENEFITS PRIMARY HEALTH CARE Family Doctor Paediatrics Nursing Care Women healthcare Children healthcare Emergencies Dental healthcare (in process-50%) General benefits Specific benefits Elderly

15. EXTENSIVE BENEFITS SPECIALISED HEALTH CARE - Hospitalisation -“Day hospital” - Outpatient Care - Emergencies - Mental Health and Psychiatric Care - Transplants - SPANISH NATIONAL HEALTH SYSTEM

16. PHARMACEUTICAL BENEFITS EXTENSIVE BENEFITS Anti-allergy vaccines Master preparations and derived products Medicinal products Reimbursed Medical Devices SPANISH NATIONAL HEALTH SYSTEM Aged 0 - 65Aged > 65 Co-payment Prescription drugsYes (40%)No Hospital pharmacy Medical devices, etc. No

17. SPANISH NATIONAL HEALTH SYSTEM

18. SPANISH NATIONAL HEALTH SYSTEM Specialized 66,000 doctors 111,000 nurses Specialized Hospital Surgery Primary Health Care 34,000 GPs 27,000 nurses Emergencies

19. 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

20. 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 CARE HEALTH CARE NETWORK

21. 5 GOALS.12 STRATEGIES 189 PROJECTS HEALTH STRATEGIES CLINICAL EXCELLENCE e-HEALTH KNOWLEDGE MANAGEMENT Back to the future: Quality and Innnovation Strategies

22. 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 2007-2012

23. 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” Redesigned Clinical 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