Spain: #24 in the 2020 World Index of Healthcare Innovation

Introduction

Spain ranked 24th overall in the World Index of Healthcare Innovation, with a score of 43.11. Spain ranked Moderate on all four dimensions of Quality (49.06, #26), Choice (38.58, #19), Fiscal Sustainability (50.50, #18), and Science & Technology (35.10, #16).

The global economic recession reduced Spain’s per capita GDP from 2009–2015 by 20 percent, but the Spanish economy has gradually rebounded with seemingly little impact on the health status of the population. Health expenditure is an estimated 9.2% of GDP. Moreover, life expectancy in Spain is 83.3 years, the highest in the EU — and two years above the average of 81.0.

Background

Spain’s national health system (Sistema Nacional de Salud, or SNS) is organized at two levels — the national and regional — with health competences transferred to the 17 Autonomous Communities. The national level is responsible for the nationwide laws, regulations, and plans, and the Autonomous Communities administer the system locally. Public expenditure — mainly through taxes — account for 71.1% of total health financing. Private spending, such as out-of-pocket spending, is above the EU average. Co-pays are linked to household income.

Supplemental private health insurance is common in Spain as a way of paying for non-covered benefits and for gaining faster access to medical care. 23% of the Spanish population, including 80% of civil servants, own such a plan.

Quality

Life expectancy in Spain is 83.3 years, the highest in the EU — and over two years above the average of 81.0. Because of its aging population, Spain sees many long-standing disabilities and chronic conditions in its citizens. Within the WIHI analysis, Spain ranked in the bottom third of countries regarding measures of preventable disease (22nd). Likewise, it ranked 26th within patient-centered customer service and 20th for modern health system infrastructure. Overall, Spain ranked 26th in health system quality.

Choice

Spain ranked slightly below the median in overall choice at 19th. Impressively, Spain achieves near-universal coverage, with 99.1% of the population receiving health insurance. The country lagged in access to technological services (28 of 31) but fared better in offering patients the freedom to choose their health care services (13th) and providing affordable insurance options (13th).

Science & Technology

Spain ranked near the median for overall innovation at 16th. Spain scored above the median (13 of 31) in medical innovation and national EHR adoption (14 of 31). However, the country dipped with scientific innovation to 22nd.

Fiscal Sustainability

Spain ranked near the median for overall fiscal sustainability. Most notably, Spain maintains a high debt-to-GDP ratio (ranking 24 out of 31), largely due to the long-term effects of the global recession. Similarly, Spain’s public health spending per capita ranked slightly below the median (18 of 31). However, Spain performed well regarding the growth of health spending as a share of GDP over the last 10 years, ranking 4th overall. Fiscally, public expenditure — mainly through taxes — accounts for 71.1% of total health financing. Private spending, such as out-of-pocket spending, still remains above the EU average.