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Spain Hit Covers:Web Health Systems in Transition Vol. 8 No. 4 2006 Spain Health system review Antonio Durán • Juan L Lara Michelle van Waveren European Editor: Vaida Bankauskaite on Health Systems and Policies Health Systems in Transition Written by Antonio Durán, Técnicas de Salud, Spain Juan L Lara, Técnicas de Salud, Spain Michelle van Waveren, Técnicas de Salud, Spain Edited by Vaida Bankauskaite, European Observatory on Health Systems and Policies Spain: Health System Review 2006 The European Observatory on Health Systems and Policies is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Greece, Norway, Slovenia, Spain and Sweden, the Veneto Region of Italy, the European Investment Bank, the Open Society Institute, the World Bank, CRP-Santé Luxembourg, the London School of Economics and Political Science, and the London School of Hygiene & Tropical Medicine. Keywords: DELIVERY OF HEALTH CARE EVALUATION STUDIES FINANCING, HEALTH HEALTH CARE REFORM HEALTH SYSTEM PLANS – organization and administration SPAIN © World Health Organization 2006, on behalf of the European Observatory on Health Systems and Policies All rights reserved. The European Observatory on Health Systems and Policies welcomes requests for permission to reproduce or translate its publications, in part or in full. Please address requests about this to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/PubRequest The views expressed by authors or editors do not necessarily represent the decisions or the stated policies of the European Observatory on Health Systems and Policies or any of its partners. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the European Observatory on Health Systems and Policies or any of its partners concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Where the designation “country or area” appears in the headings of tables, it covers countries, territories, cities, or areas. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the European Observatory on Health Systems and Policies in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The European Observatory on Health Systems and Policies does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. Printed and bound in the United Kingdom by TJ International, Padstow, Cornwall. Suggested citation: Durán A, Lara JL, van Waveren M (2006). Spain: Health system review, Health Systems in Transition, 2006; 8(4):1–208. ISSN 1817-6127 Vol. 8 No. 4 Health systems in transition Spain Contents Preface ............................................................................................................ v Acknowledgements ......................................................................................vii List of abbreviations......................................................................................ix List of tables and figures ...............................................................................xi Executive summary ...................................................................................... xv 1 Introduction ................................................................................................ 1 1.1 Overview of the health system....................................................... 1 1.2 Geography and sociodemography ................................................. 1 1.3 Economic context .......................................................................... 3 1.4 Political context ............................................................................. 5 1.5 Health status .................................................................................. 8 2 Organizational structure ........................................................................... 15 2.1 Historical background .................................................................. 15 2.2 Organizational overview .............................................................. 18 2.3 Decentralization and centralization ............................................. 30 2.4 Population coverage ..................................................................... 32 2.5 Entitlements, benefits and patient empowerment ........................ 34 3 Financing ................................................................................................. 45 3.1 Revenue mobilization .................................................................. 46 3.2 Allocation to purchasers .............................................................. 55 3.3 Purchasing and purchaser–provider relations .............................. 56 3.4 Payment mechanisms................................................................... 58 3.5 Health care expenditure ............................................................... 61 4 Planning and regulation ........................................................................... 71 4.1 Regulation .................................................................................... 71 4.2 Planning and health information management ............................ 79 iii Health systems in transition Spain 5 Physical and human resources ................................................................. 85 5.1 Physical resources ........................................................................ 85 5.2 Human resources ....................................................................... 102 6 Provision of services .............................................................................. 115 6.1 Public health .............................................................................. 115 6.2 Patient pathways ........................................................................ 121 6.3 Primary/ambulatory care ........................................................... 122 6.4 Secondary/inpatient care ............................................................ 127 6.5 Pharmaceutical care ................................................................... 132 6.6 Rehabilitation/intermediate care ................................................ 134 6.7 Long-term and social care ......................................................... 135 6.8 Palliative care ............................................................................. 138 6.9 Mental health care ..................................................................... 139 7 Principal health care reforms ................................................................. 147 7.1 Analysis of recent reforms ......................................................... 147 7.2 Future developments .................................................................. 163 8 Assessment of the health system ............................................................ 171 8.1 Stated objectives of the health system and its contribution to health improvement ..................................................................... 171 8.2 The distribution of the health system’s costs and benefits across the population ....................................................................... 175 8.3 Efficiency of resource allocation in health care ......................... 177 8.4 Technical efficiency in the production of health care ................ 179 8.5 Accountability of payers and providers ..................................... 180 8.6 Other outstanding issues ............................................................ 181 9 Conclusions ............................................................................................ 183 10 Appendices ............................................................................................ 187 10.1 References ............................................................................... 187 10.2 Web links ................................................................................. 200 10.3 List of laws .............................................................................. 201 10.4 HiT methodology and production process ............................... 204 iv Health systems in transition Spain Preface he Health Systems in Transition profiles are country-based reports that provide a detailed description of a health system and of reform and policy Tinitiatives in progress or under development in a specific country. Each profile is produced by country experts in collaboration with the Observatory’s research directors and staff. In order to facilitate comparisons between countries, the profiles are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a profile. Health Systems in Transition profiles seek to provide relevant information to support policy-makers and analysts
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