Spain: #21 in the 2022 World Index of Healthcare Innovation
Spain’s single-payer system has rebounded from the financial crisis but continues to restrict access to new therapies.
By Gregg Girvan, Grant Rigney, and Avik Roy
Introduction
Spain ranked 21st overall in the 2022 World Index of Healthcare Innovation, up from 22nd in 2021 and 24th in 2020. Notably, Spain ranked 17th for Quality, 13th for Choice, 20th for Science and Technology, and 23rd for Fiscal Sustainability.
The global recession from 2009 to 2015 reduced Spain’s per capita GDP by 20 percent, but a gradual economic recovery has lifted the country’s financial standing in the years since. Accordingly, Spain’s health expenditure is approximately nine percent of its GDP. Furthermore, Spain’s life expectancy is the highest in the European Union (EU) at 82 years, two years above the EU average. This longevity has given Spain a patient population with more chronic disabilities and health challenges that are associated with old age.
Background
Spain’s national health system (Sistema Nacional de Salud, or SNS) is organized at the national and regional levels, with health competencies apportioned among Spain’s 17 autonomous communities. The national level oversees federal laws, regulations, and plans, while the autonomous communities handle the local administration of healthcare services. Public expenditures — mainly through taxes — account for 71.1 percent of total healthcare financing. Moreover, private payments— such as out-of-pocket spending — exceed the EU average. Individual co-payments, moreover, correlate with household income.
Supplemental private health insurance is common in Spain, offering patients a way to pay for non-covered benefits and gain quicker access to medical care. Approximately a quarter of the Spanish population owns supplemental health insurance, including 80 percent of civil servants.
Quality
Spain ranked below the median in Quality at 17th. It also ranked below the median in patient-centered care (19th), infrastructure (17th), and pandemic preparedness and response (19th). However, Spain fared well in disease prevention, ranking 10th, a six-place improvement from 2021.
Choice
Spain ranked around the median for Choice at 13th. Impressively, Spain achieves near-universal coverage, with 99.1 percent of the population insured. The country placed 12th for access to new treatments and 22nd for affordability of health insurance. Spain retained its 16th rank in freedom to choose healthcare services.
Science & Technology
Spain ranked 20th for Science and Technology. Spain scored slightly below the median in medical advances (19th) and scientific discoveries (21st). Spain’s adoption of electronic health records and other health IT advances earned it a respectable 15th ranking in health digitization.
Fiscal Sustainability
Spain’s economic struggles during the Great Recession, especially its sizeable debt-to-GDP ratio, are evident in the country’s below-the-median rankings in the WIHI dimension for fiscal sustainability (23rd) and in the element national solvency (27th). Similarly, Spain’s public health spending rank was slightly below the median (19th). Spain’s growth of public health spending dropped ten spots from to 2021 falling from 6th to 16th.
