WIHI

Spain: #22 in the 2021 World Index of Healthcare Innovation

Spain’s single-payer system has rebounded from the financial crisis but continues to restrict access to new therapies.
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Introduction

Spain ranked 22nd overall in the 2021 WIHI Analysis — two spots ahead of its inaugural ranking at 24th in 2020. Notably, Spain ranked 22nd in the WIHI Dimension for Quality, 14th for Choice, 21st for Science & Technology, and 19th for Fiscal Sustainability.

The mid-2000’s global recession reduced Spain’s per capita GDP by 20 percent (from 2009 to 2015), but a gradual economic recovery lifted the country’s financial standing in the years since. Accordingly, Spain’s health expenditure is around nine percent of its GDP. Furthermore, Spain’s life expectancy is the highest in the European Union (E.U.) at 83.5 years — more than two years above the E.U. average. As a product of this longevity, Spain’s patient population experiences many long-standing disabilities and chronic conditions that come with old age.

Background

Spain’s national health system (Sistema Nacional de Salud, or SNS) is organized at two levels — the national and regional — with health competencies apportioned among Spain’s 17 Autonomous Communities. The national level is responsible for federal laws, regulations, and plans, and the Autonomous Communities oversee the local administration of health care services. Public expenditure — mainly through taxes — accounts for 71.1 percent of total health care financing. Moreover, private payment — such as out-of-pocket spending — sits above the E.U. average for Spanish citizens. Individual co-payments are correlated with household income.

Supplemental private health insurance is common in Spain. It serves as a way to pay for non-covered benefits and to gain faster access to medical care. Approximately a quarter of the Spanish population owns supplemental health insurance, including 80 percent of civil servants.

Quality

Spain ranked in the bottom third of countries in the WIHI Dimension for Quality at 22nd. It ranked below the median in WIHI Elements for “Patient-Centered Care” (24th) and “Infrastructure” (17th). Nonetheless, it ranked 12th in “Pandemic Preparedness and Response” and 16th in “Measures of Preventable Disease.”

Choice

Spain ranked around the median in the WIHI Dimension for Choice at 14th. Impressively, Spain achieves near-universal coverage, with 99.1 percent of the population receiving health insurance. The country placed 11th and 10th in the Elements “Access to New Treatments” and “Affordability of Health Insurance,” respectively.

This article is part of the FREOPP World Index of Healthcare Innovation, a first-of-its-kind ranking of 31 national health care systems on choice, quality, science & technology, and fiscal sustainability.

Science & Technology

Spain ranked 21st in the WIHI Dimension for Science & Technology. Spain scored slightly below the median in the Elements measuring its contribution to “Medical Advances” (18th) and “Scientific Discoveries” (21st). Alternatively, Spain’s adoption of EHRs and other health IT advances ranked it 17th in the Element “IT.”

Fiscal Sustainability

Spain ranked below the median in the WIHI Dimension for Fiscal Sustainability at 19th. Spain’s sizeable debt-to-GDP ratio (measured in the Element “National Solvency” at 23rd) is a reminder of the global recession’s long-term effects. Similarly, Spain’s public health spending per capita ranked slightly below the median (18th). However, Spain performed well in the Element “Growth of Public Health Spending” at 6th (which measured the cost of health care spending as a share of GDP over the last ten years).

ABOUT THE AUTHORS
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Resident Fellow, Health Care