Spain: Health System Review

This review of the Spanish health system analyses recent developments in health organization and governance, financing, health care provision, recent reforms and health system performance. Overall health status continues to improve in Spain, which presents the highest life expectancy in the European Union - although some socioeconomic inequalities in health persist and risk factors such as overweight, tobacco and alcohol consumption and illegal drug use remain a concern. The Spanish national health system (SNS) provides universal coverage, and it is mainly funded by taxes. Health competences are transferred to the regions, while the Ministry of Health is responsible for the overall coordination of the SNS. Health spending has seen a large increase as a percentage of GDP, following the COVID-19 pandemic in 2020, remaining high in 2021 (10.8% of GDP). While the benefits package is comprehensive, cost-sharing is required for pharmaceuticals and some prostheses; nonetheless, out-of-pocket (OOP) payments do not result in catastrophic spending for households. Co-payments have been largely reformed with further exemptions in place since 2020. Primary care remains at the centre of the SNS, with the Family Doctor 1 acting as the gatekeeper to specialized and hospital care. The 2019 Strategic Framework for Primary and Community Care aims for primary care to adapt to and address new epidemiological, societal and technological challenges that have emerged over the last decade. Regarding provision of care, there is a shortage of physicians in some specialties and problems in covering vacancies in some rural areas of the country, particularly for primary care physicians. Health system reforms since 2018 have focused on widening the population covered by the health system, reducing co-payments, improving the scope of coverage in terms of increasing provided services, and the reinforcement of primary care. Future challenges for the health system include addressing access gaps, such as the limited coverage of some services (such as dental and optical care), and large waiting lists for some services. Some gaps in efficiency remain, such as the low numbers of qualified personnel in some medical specialties, the shortage of mental health resources, the underuse of effective treatments, and the overuse of non-appropriate or ineffective procedures.