Spanish healthcare

Dr Eduardo de la Sota Guimón reports on the appointment of a new Minister and increasing costs

In July 2007, Bernat Soria Escoms, one of the world's leading experts in stem cell research, became Spain's new Health Minister, when his predecessor Elena Salgado was moved to Public Administration.

From left: Prime Minister Zapatero and Trinidad Jiménez, Minister of Health...
From left: Prime Minister Zapatero and Trinidad Jiménez, Minister of Health and Social Policy, with King Juan Carlos

On hearing of his appointment, one of his first comments was that it came as ‘something of a surprise’. I wonder what he is thinking, just 22 months later, now that Trinidad Jiménez has taken his place, and with an extended title: Minister of Health and Social Policy.
Among the social policies added to the Ministry, the most important is the one regulated by the new dependency law, with the latest numbers showing that nearly a million people have requested aid.
 

In two years, three different Ministers, but that is not the main change. The services and costs derived from the dependency law will alter Health and Social Care in Spain for the next decades.
The Spanish NHS The National Health System (NHS) is organised in keeping with the basic values and principles that should underpin its work. The principles of universal coverage and solidarity mean that the NHS must ensure equal access to healthcare services for all citizens. In addition, because the NHS is financed with public funds, expenditure must be based on the principle of cost-effectiveness. The NHS healthcare delivery system is therefore structured into two healthcare levels, primary and specialist healthcare.
 

Decentralisation
Within the scope of their authority, Autonomous Communities can establish their respective package of services, which must include all the basic services that all NHS users must be guaranteed.
On top of these, they can add in techniques, technologies or procedures not included in the general package of services. None of these supplementary services is NHS funded; they must therefore provide the necessary additional resources. Anyway, these supplementary services are not included in the general benefits funding of the NHS.
Expenditures
The latest official figures (2006) set Spanish public health expenditure (including long-term care) at 58,466 million euros, which accounts for 71.2% of Spain’s total health expenditure (82,064 million euros).
Total health expenditure in Spain accounts for 8.4% of the GDP. Respectively, the country’s public and private healthcare expenditure account for 6.0% and 2.4% of the GDP.
Financing Healthcare is a non-contributory benefit financed out of general taxation and included in the general budget of each Autonomous Community. Healthcare is one of the main instruments of the Spanish redistributive income tax system, aimed to redistribute income amongst Spanish citizens: all citizens contribute to general taxation in proportion to their level of wealth, and receive healthcare services according to their own particular needs.
Social Care
Dependency In 2006, Spain‘s Congress of Deputies passed the Dependency Law to promote self-sufficiency and provide medical care for people with disabilities. Spanish Prime Minister Jose Luis Rodriguez Zapatero described the new law as a ‘historic milestone’ and thanked all parties for their participation in its creation. ‘This law recognized a new state pillar in (promoting) well being, which sustains Spanish cohesion,’ he said.
 

Those who asked for help would be given an evaluation and offered support based on the level of dependency. The support would take the form of domestic help or financial help. It also recognized the following rights in Spanish law: homecare, access to residential or day care centres for the aged, state funds for buying private services.
 

The law will first target the most dependent citizens and in years up to 2015 it will extend to a broader range of dependent people. There has been a high demand for the Government’s new dependency law, with the latest numbers showing that nearly a million people have requested aid (June 2009). Of these, 625,000 have been told that they indeed qualify for help, but of those only 400,000 have received any help so far. The numbers emerged in Congress in June, when Minister for Health Trinidad Jimenez was called to appear before the Health Commission. The Minister used her appearance to announce new measures, on the development of a new Public Health Law, and another on Food Safety regulations. She also said that new sexual health and healthy pensioner programmes are to be started, and said that the health card system with electronic prescriptions would be established in all regions of the country by the end of this year.
Dependency Law evaluation: Services, employment and costs
 

The Dependency Law, which began application in 2007, is scheduled to come into force gradually over an eight-year period, starting with cases of severe care needs. According to Esteban Villarejo and Joseph Maria Rojo-Pijoan, at the CIREM Foundation, presently it is still difficult to evaluate the levels of employment created or regularised as a result of the new law. The Centro de Investigación Polibienestar (poly-welfare research institute) at the University of Valencia calculates that total employment creation in this regard amounted to 77,604 people in 2007 and to 125,987 people in 2008.
 

The new law requires a complex co-ordination between the central government and autonomous regions. Between both levels of administration some discrepancies have arisen concerning competences and financial obligations. At the same time, the provision of financial resources has encountered two obstacles: the forecasts of needs were undervalued and the current economic crisis is contributing to a reduction in public income. These factors have led to a certain delay in the application of the law, mainly in some autonomous regions. However, the central government has increased its financial contribution.
 

By 1 October 2008, some 606,466 requests of assistance had been received, equivalent to 1.34% of the total population. So far, the recognised beneficiaries amount to 378,378 people; they fall into the category of severe dependants. The number of employees in proportion to that population group appears to be about 80% of the number of dependants – in other words, about 300,000 workers. The statistics do not indicate how many employees previously worked for these dependent people. As noted, the Polibienestar Research Institute calculates that in 2007 the total employment creation in this area was 77,604 people, and it forecast 125,987 new jobs in 2008.
Data are scarce on the subject. Some 16,132 applications have been accepted for the new social security agreement for non-professional carers. Concerning the financial resources applied, the State contribution in 2008 was slightly over e240 million. It is estimated that, on the whole, the State contributions are similar to those of the autonomous communities.

01.07.2009

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