Changes in spanish healthcare system

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In there were hospitals operating in Spain. The National Health System has hospitals, equipped with , beds, and four Ministry of Defence's hospitals contributing with beds.

The remainder hospitals are privately run and have 53, beds, which totals to , beds installed in Spain's hospitals. Public hospitals are generally much larger than private hospitals and deal with a much higher number of patients. Excluding dialysis equipment, computerised axial tomography CAT is the most widespread high technology in hospitals and dependent facilities, with a total of units and a ratio of Magnetic resonance follows with units and a ratio of 9.

The number of mammography units dependent on hospitals totals There are 4. Spain has among the world's healthiest people with an average life expectancy of 81, one of the highest in the EU.

The incidence of heart disease in Spain is among the lowest in the world, however, skin cancer is one of the highest. Spain also takes a different view to rehabilitation, convalescence and terminal illness, leaving care in these cases usually to the relatives, meaning that are very few public nursing and retirement homes. This may prove one of the future challenges, as there is an increasing potential demand for social support services and benefits by the dependent population, and by carers.

However, one of the principle problems in Spain remains the limited coordination between the Autonomous Communities, which increases disparities in services and quality of care between the regions.

Although the national system is overseen by the Ministry of Health and Consumer Affairs Ministerio de Sanidad y Consumo and coordinated by the Inter-territorial Board they focus more on long-term policies and cooperation and the responsibility of healthcare delivery lies with the individual regions.

Numerous projects to improve national cooperation have been implemented by the Spanish Ministry of Health such as the 'ep- SOS' European patients Smart Open Services pilot project, which aims to develop a practical framework and an ICT infrastructure that will enable secure access to patient health information, particularly with respect to basic patient summaries and ePrescriptions between different European healthcare systems.

This should improve communication between Spanish regions and encourage cooperation. The Spanish Presidency of supported a fully integrated digital healthcare system in the post European Agenda and presented four strategic goals in healthcare, which aimed to:. It was an initiative of the Ministry of Health of the Government of Catalonia during which, meetings of the European health ministers and the European Forum of Regions in eHealth enabled European regions and Spanish autonomous communities to discuss the importance of ICTs for the health systems and the extent to which they have been introduced in their territories.

During the four days of the eHealth week , more than renowned international figures brought in their experience and views in a total of 46 sessions in which they analysed the application of ICTs in the health systems from a variety of perspectives: political, economic, strategic, business and social. Read more. Telemedicine was the most cost-effective and safest solution to offering Evozyne, a fast-growing biology engineering company, today welcomed Mike Hologic, Inc.

Stewart has been elected to the T-Heart, a medtech company developing a truly novel and differentiated Ralph Highnam, founder, transitions from Chief Executive Officer to Download PDF Back. Management The national system has been decentralised since , which has given the regional healthcare authorities the autonomy to plan, change and upgrade the infrastructure, leading to enormous development in the healthcare technology scenario, especially in the usage of information technology.

The current system consists of three organisational levels: 1. Central Organizacion de la Administracion Central The Ministry of Health Ministerio de Sanidad y Consumo , the state's central administration agency, is in charge of issuing health proposals, planning and implementing government health guidelines, and coordinating activities aimed at reducing the consumption of illegal drugs.

Autonomous Community Organizacion Autonomica Each of Spain's 17 Autonomous Communities Comunidades Autonomas is responsible for offering integrated health services to the regional population through the centers, services and establishments of that community. Local Areas de Salud The "areas de salud" are responsible for the unitary management of the health services offered at the level of the Autonomous Community and are defined by taking into account factors of demography, geography, climate, socioeconomics, employment, epidemiology and culture.

The implementation of the SOE changed this panorama for a part of the population. The debate was intense and sometimes took place in the public arena. Although the general press was censored, the huge disagreements on the way the SOE was implemented were aired in several publications, including official ones.

In a General Health Law was passed to update the previous one of The law established the basis of the various national health services and encouraged harmonisation both among them and with the educational and research systems. Nevertheless, there was no coordination, and the Spanish health sector had dozens of organisations each with its own political agenda, frequently resulting in the duplication of services. Although the disagreement was mainly based on the in-fighting among the different political sectors supporting Franco, he denounced the neglect of preventive medicine in favour of the growing healthcare structures, and the lack of coordination Palanca, 58, ; ; Noguera, According to Palanca, from the outset the sickness insurance scheme carried the burden of the hegemony of political interests over technical criteria.

They were required to care for a number of insured workers and their families, but their salaries were calculated on the basis of the number of medical cards, one for each worker, and failed to take into account the actual number of beneficiaries in an age when families were large.

This situation and the increase in the population covered by the system, due to the extension of the income bracket for compulsory enrolment, caused constant complaints from doctors. There was no time for clinical examination and this feature of health care did not improve over the years Bravo et al. Doctors visited patients at home for more serious sicknesses, and hospitals were only for surgical operations and childbirth.

Physicians had the freedom to prescribe medicines without limit Bravo et al. Medicines were free for all beneficiaries, although the number of weeks they were entitled to health care was limited, especially for the families of those in the scheme 26 weeks for enrolled workers, 13 for their families.

Beneficiaries had previously only enjoyed limited access to drugs, and now sought to recover their contributions by asking for prescriptions. Doctors, with no time to examine patients, used medicines as the only way to avoid dissatisfaction and tension. The press published news items on this topic, with comments highlighting the dangers of this behaviour for the sustainability of the system. Finally, the approach chosen was to finance only a limited number of drugs.

In , a committee drew up the list of drugs to be prescribed with funding from the SOE, but the reform was not implemented until The advisers to the Minister of Labour had serious doubts about the restriction. To legitimise the controls, a poll was held in workplaces in which employees had to choose between two options. The reform was unsuccessful, and pharmaceutical expenditure continued to rise over the years. Below, we set out some examples of opinions of doctors and the population on these changes.

Their demands included pay rises and changes to the recruitment system. These questions deserve special attention that goes beyond the scope of this article but it is fair to say that there was widespread dissatisfaction with the healthcare system. The system intended to provide one doctor for every insured worker and his family, depending on their place of residence.

Although there was some room to change the designated doctor, and this became more clearly regulated over the years, the choice was still limited to those available in the area. Neither beneficiaries nor doctors had any previous connection and were perfect strangers on the first occasion they met at the surgery. Although the heads of these associations were appointed by the authorities, which explains the mildness of their opposition to the new system, doctors were able to express their complaints through sections organised by those hired by the SOE De Soroa, This may be true because, as we have seen, the Minister of Labour considered the generous policy of prescriptions as a cornerstone of the health insurance scheme.

These concerns were stronger among Catalan doctors. From to , doctors working for the SOE in Barcelona published a monthly bulletin, Horizonte , in which they voiced their criticism of the way the SOE was being implemented. This development was fragmentary and regulated from onwards by a new insurance law. In the s, in a political context that was more tolerant of dissidence, the official medical associations opposed the maintenance of the system used to assign doctors and also specialists, who had increasingly entered the system during the s.

In , ABC , the main newspaper published in Madrid, used letters from readers on health care and other benefits of the system as a formula to explain how it worked. The letters were in all likelihood fictitious, but the range of problems covered gives us an idea of the conflicts that arose: the unpopularity of the list of subsidised medicines, the insufficient period of healthcare entitlement, the difficulties caused by the system of referral among services i.

The corporate organisation of doctors in colegios medical associations offered them a level of influence that wage earners could not match. Censorship prevented any criticism from SOE members in the press. The author, who considered the SOE a system in urgent need of assistance, used narratives of therapeutic pathways in order to describe its defects.

He humorously described an episode of a housewife asking for prescriptions for every member of her family Candel, The report included the data from a survey of a stratified and randomised sample of 2, homes. In every household, the head of the family and the housewife were interviewed. The report shows the great regional differences in the implementation of the system.

Generally speaking the SOE was assessed positively by men and women, especially by those insured under the scheme. The more privileged social classes, who were outside the system, were more negative in their appraisal. Housewives who had requested a home call had the most positive views. There was a clearly favourable assessment of health premises and professionals and a negative verdict on the bureaucratic organisation of the SOE. A significant feature was the low level of care for pregnant women and especially children.

When the Regime abandoned the autarchic system and embraced liberal economics, a major reform was needed. A new Social Security system, including health care, was finally implemented after long discussion on 1 January The new regulations were designed to unify the different types of subscription to the various social insurances, and to extend cover to the entire working population.

However, universal cover was ruled out for economic reasons. Funding continued to depend on the contributions of employers and employees, with minimal state support in only 1. The system had serious defects including the de facto continuation of different terms of cover according to the economic sector. The way they made decisions on disease matters was modified by the incorporation of new values, meanings and ideas which developed from the SOE and how it operated. The more prescient doctors warned of the loss of care quality and even of the ethical dilemmas that would arise under the SOE.

Nevertheless, access to SOE health care for ever broader sectors of the population in Spain reinforced a medical culture rooted firmly in the idea of the almost miraculous effects of industrial medicines Comelles, Free prescriptions undermined the argument still present in the work of Carulla 73 in relation to the lower costs of such traditional care options as folk medicine. As highlighted in research into medical pluralism Perdiguero-Gil and Comelles, , the role of folk medicine had been marginalised by the end of the s.

The SOE played an important role in the medicalisation of the population, which increasingly migrated from the countryside to urban areas. Until the s, the health system had paid little attention to the health education of the population.

Finally, doctors determined a model of the surgical and maternity hospital which led to the hegemony of hospital-centrism during the Transition Comelles et al. Twenty years after the implementation of the SOE, Spain still suffered from a lack of public hospital beds in comparison with European standards. Such insurance companies, which were also used as providers and managers of health care, were widespread in the most industrialised regions, especially in Catalunya.

But it is clear that there were serious inequalities in regional distribution and the private sector retained great relevance. However, the group had no practical influence in the short term. Many of those that worked as consultants at public hospitals in the morning had private practices in the evening, and the reputations they gained in their public posts guaranteed them high earnings in their work with private patients.

Consequently, hospitals proved tempting to young doctors with the ambition to develop a prestigious and profitable career practising high-tech medicine. This partially accounts for the central role of the hospital in the plans for reforming the Spanish healthcare system, even though the rhetoric focused on the social determinants of health, preventive medicine and health education.

In such European countries as France, the central role of the hospital had become an established fact by the s Steudler, ; Herzlich and Pierret, This occurred in a context in which, paradoxically, the institution appeared to have less to offer due to the ever-increasing demand for treatment for chronic and hereditary-degenerative conditions. Rural areas, however, followed a different path, which requires a separate analysis. Towns and villages were divided into various categories, depending on population, which determined the salary of the district doctor.

The smallest villages were to join together to form a medical district. The doctors had not only to visit the poor in each locality but also to carry out public health activities assigned to them by the authorities.

In fact, they were the medical officers of the villages where they practised. In the larger villages, the better-off received private treatment. From , only in the larger towns were APD doctors paid by the municipalities; in the case of villages with under 10, inhabitants, their salaries were paid from the general state budget.

Rural workers had to pay for prescriptions a percentage of the price , while SOE beneficiaries obtained their drugs free of charge. They had to cope with serious problems, such as the infant mortality rate higher in rural areas , endemic diseases, usually linked to poverty, and the absence of sanitation infrastructure such as sewerage or piped water. On occasions, given the lack of nearby hospitals, they were required to carry out quite complex surgical operations. All these local health professionals, less privileged than their colleagues who practised in urban areas, undertook their work with a vocation and commitment which is explicit in the correspondence 27 published in professional journals De Lera, The rhetoric on vocation did not prevent the APDs from making numerous complaints about their salaries.

They believed that their social situation and economic hardships were an affront to their inherent technical and intellectual abilities as university graduates. Prioritising the world of rural Spain was an ideologically based decision. The Regime considered that peasants personified the traditional Spanish values that the Movement wished to restore. Spanish fascist thought was strongly pro-agrarian and sought to combat the marginalisation and abandonment of many rural communities.

They worked almost as volunteers, receiving only a small stipend for their labour. Many came from the same villages in which they worked, since it was accepted that volunteers from the city would find it difficult to carry out their assigned roles in rural areas.

Each team included a medical doctor. They initiated their work in , and between and were present in almost all provinces. Their functions included educating women in home economics and providing various forms of social support. Through the rural populariser, who was part of the team, they played a role in health education; administered basic care, vaccines and medication; and distributed kitchen and home utensils Maceiras-Chans et al.

In addition to living quarters for the teaching staff and health professionals, and mobile classrooms, some convoys included a clinical truck equipped with X-ray equipment, an autoclave, an examination table and a small laboratory.

They probably played a significant although difficult to evaluate role in the improvement of hygiene and the reduction of child mortality and brought medical services to rural areas.

The health popularisers wore white aprons with the Falangist coat of arms and other Falangist symbols. The rural popularisers gathered data on all aspects of the social life of the villages in which they worked. Furthermore, they embraced the task of encouraging the population to respect the Catholic sacraments: baptisms, communions, weddings and so on. Such efforts were not welcomed by many sectors of the population. By the late s child mortality was no longer a serious health problem in Spain.

A contributing factor to this in urban areas was the extension of maternal SOE and childcare at a time when there was massive rural-to-urban migration. The role of the popular care providers diminished. Although in the s and s anthropologists still described the activities of popular healers Kenny and De Miguel, ; Primeres Jornades [ Nonetheless, professional journals did continue to report on popular medicine in country areas.

However, from various perspectives, the health system was judged to be unsustainable. The organisation responsible for health care, the National Welfare Institute, had proved unable to overcome the many problems it faced: an economic deficit, failings in cover and management, low-quality primary health care, an inadequate hospital network and dissatisfied health workers and users.

The Economic and Social Development Plans , and 32 had scant influence in the health sector De Miguel, After the introduction of the SOE as a propaganda weapon exalting the peace and social justice established by the dictatorship, the state did not make an economic commitment to health insurance, but rather over the years maintained a merely nominal contribution to the plan. The issue of universal health care did not arise; given that the system was linked to the insurance of workers, it was economically inviable.

The SOE developed without technical criteria, coherence or coordination. As a result, the hospital network did not respond to the needs of the population but rather to the interests of professional groups and the construction companies that built it.

The government was slow to react and not until the end of 33 did it set up a committee to study health reform, which produced its report at the end of June By then, doctors belonging to the forbidden left-wing parties prior to their legalisation in and trade unions 35 had published plans for replacing or reforming this term was less common the Francoist Social Insurance scheme.

There was a clear preponderance of plans written from Catalunya for Catalunya, although some came from Madrid and Valencia. The fight to preserve health, and the special focus on environmental and social factors, was considered a powerful tool in establishing democracy and the first step towards a socialist society.

There was no way to improve social conditions without a new political system. Health had a revolutionary role and, at the same time, was only possible with political change.

Health boards organised at different levels national, regional and local , with the involvement of health authorities, health professionals and the general public, were thus proposed as popular control mechanisms.

Importantly, the plans gave a pivotal role to health education, on a par with health care, and highlighted the absence of these activities during Francoism.

This meant different levels of health care were established in particular zones or regions. It also included devolving the management of health care and public health activities to the autonomous regions approved by the Constitution. The same year, a first draft of a health law was produced by the new department of Health and Social Security. Two further reports, also coordinated by Mayor Domingo 39 a, b , were published on the health needs, healthcare resources and health in the rural milieu.

In the following years, there was a number of regulations, drafts, publications and public debates, including those on the transfer of health competencies to the autonomous regions, which began in Estudios sobre Hospitales y Beneficencia , 5, Bravo, F.

M, Polo, R. Barcelona: Ariel. Busfield, J. The concept of medicalisation reassessed. Sociol Health Illn. Candel, F. Ser obrero no es ninguna ganga. Barcelona: Laia. Carreras, A. Carulla, V. Barcelona: La Neotipia. Castel, R. Une Chronique du salariat.

La Sonrisa de Falange: Auxilio Social en la guerra civil y en la posguerra. Barcelona: Espasa. Destino , , Clos, J. La medicina en el medi rural. Comelles, J. Porras Gallo, P. Samblas Tilve and M. Cuenca: Universidad Castilla-La Mancha. De la Quintana, P. Seguro de Enfermedad.

De Gispert, I. Barcelona: Selecta. De Miguel, J. Madrid: Akal. Por los caminos de la medicina rural. Salamanca: Graficesa. De Soroa, A. La medicina en el seguro de enfermedad. Cooperativismo sanitario. Barcelona: El autor. Criterio personal sobre la propuesta de reforma del sistema asistencial de la seguridad social.

Ewald, F. Comentarios sobre el Seguro de Enfermedad. Madrid: Jefatura Provincial de Sanidad. Flexner, A. Medical Education in the United States and Canada. A report to the Carnegie Foundation for the Advancement of Teaching. Bulletin Number Four. Foucault, M. El Seguro Social de enfermedad y las recetas de complacencia.

Horizonte , 1 1 , 2. Ministro de Trabajo sobre el seguro de Enfermedad. El Futuro del Pasado , 3, Gorsky, M. Soc Hist Med , 21 3 , Am J Public Health , 3 , Madrid: Exlibris.

Helman, C. Folk models of infection in an English suburban community, and their relation to medical treatment. Cult Med Psychiatry , 2 2 , Suburban Shaman. A Journey through medicine. Cape Town: Double Storey. Herzlich, C.

Paris: Payot. Ignaciuk, A. Madrid: Los Libros de la Catarata. Edificios Sanitarios para el Seguro de Enfermedad. Plan Nacional de Instalaciones Sanitarias.

Madrid: Ministerio de Trabajo. Instalaciones Sanitarias del Seguro de Enfermedad. El Estado como aliado. Asclepio , 49 1 , Uso racional de los medicamentos. Madrid, Farmaindustria. Horizonte , 2, Kenny, M. Barcelona: Anagrama. Lamata Cotanda, F. El Sistema Nacional de Salud: una realidad y un proyecto de responsabilidades compartidas.

Rev Admin Sanitaria , 1 4 , Zarzoso and J. Arrizabalaga Eds , Al servicio de la salud humana: la historia de la medicina ante los retos del siglo XX pp. Lobo Aleu, F. Maceiras-Chans, J. Huertas and R. II, pp. Mayor Domingo, F.

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The demonstration attracted about 30, protesters, a regional government spokesman said. Protesters say the regional government is dismantling public health services and favouring private health providers. Dressed as the Grim Reaper and bearing a mock scythe, one protester held a sign reading, "I am Ayuso's plan for the emergency ward. The problem is that they do not allow us to give proper care to patients," Ana Encinas, 62, a doctor who has worked in primary care in Madrid for 37 years, told Reuters.

Ayuso denies the accusation that her administration is dismantling public health services in favour of the private sector and says the protests and strikes are being orchestrated by left-wing parties in the run-up to municipal and regional elections this year to undermine the conservative regional government.

In November, tens of thousands of people marched through central Madrid in support of health workers calling for better working conditions. Skip to main content. Read Next. Visit emeraldpublishing. Answers to the most commonly asked questions here. To read this content please select one of the options below:.

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Abstract This paper offers an overview of the defining traits of the Spanish National Health Service Sistema Nacional de Salud, in Spanish , as well as an account of its current trends in both spending and organisational changes. Join us on our journey Platform update page Visit emeraldpublishing.