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Spain’s Health Care SystemMaria WilliamsSouthern New Hampshire University Purpose of The ArticleIt is paradoxical that one of the world’s leading powers is unable to guarantee quality health and is accessible to all its inhabitants. Furthermore, it is the country in the world that most of its GDP goes to the health sector. This guarantee of the service with universal coverage, which seems so evident to citizens of European countries, is not such in all healthcare systems. Perhaps, society is being somewhat unfair with the criticisms it is making of the quality and efficiency of the Spanish Health System (SNS). Furthermore, according to an OECD study, the Spanish National Health System ranks among the best in the world for its efficiency and quality. This study explores fundamental variables the life expectancy of citizens and the presence or not of universal coverage. Spanish inhabitants rank second in life expectancy, behind only Swiss citizens.Country DetailsThe current Spanish Health System, the National Institute of Provision (INP), was founded at the beginning of the 20th century. This body, together with the Ministry of Labor and Social Security, would be in charge of ensuring health benefits for the Spanish population throughout most of the 20th century. During that time, the provision of the service reached a minimum of 20% coverage in 1942 (Driessen et al., 2019). However, the end of the Franco regime and the preparation of the Spanish Constitution of 1978 was conducive to establishing the bases of the system. This Constitution embodies the right of all citizens to health protection, specifically in article 43.1. and the responsibility of the political powers to guarantee this right, set out in article 43.2. In 1986, the General Health Law finally defined the creation of what is now known as the National Health System (Angulo-Pueyo, Ridao-López & Martinez-Lizaga, 2019). This law included the fundamental principles of universal coverage, public financing through taxes, and the transfer of powers to the autonomous communities.The SNS stands out worldwide for the complexity of its structure. Since the creation of INSALUD in 1978, which managed the Social Security network, until 2002, there was a gradual transfer of powers from the central government to the regional governments (Mentzakis et al., 2019). The first autonomous communities to obtain the transfer of responsibilities were, in this order, Catalonia, Andalusia, the Basque Country, the Valencian Community, Navarra, and the Canary Islands. The other ten autonomous communities remained under the direct control of the central government until, in 2002, the jurisdiction over health issues was ceded (Driessen et al., 2019). This decentralization is the main distinctive feature that makes the SNS unique in the world.Healthcare issuesFinancingAccording to World Bank data, health spending over the country’s GDP expenditure amounts to 9.4% in 2019. Most of the health spending (71%) is paid with public funds collected mainly through taxes. The percentage of spending that corresponds to private insurance amounts to 5.5%, and the expenses are borne directly by citizens who have registered a slight decrease, reaching the current 22.4%, according to data from the Ministry of Health in 2019. The decentralization of the system is also reflected in the financing, managing 89.81% of the public health resources of the Autonomous Communities. In comparison, the central administration spends 3% of them, and the local authorities only manage the 1.25% of total expenditure (Aguilar, Bleda & Centelles, 2019). Health Care Service Provision in Spain  The provision of the service can be carried out by itself administration, even if it has an interposed legal personality. This way of providing the service is called direct management (Driessen et al., 2019). The most common direct forms of management, apart from the provision by the general health service through consortia or public foundations. A consortium is called an entity with legal personality and own capital created by a public administration and characterized by greater flexibility by being endowed under Private Law principles (Mentzakis et al., 2019). on the other hand, public foundations are entities with their legal personality managed by a council supervised by the health authorities (Angulo-Pueyo, Ridao-López & Martinez-Lizaga, 2019). two fundamental levels are distinguished: primary care and specialized care. The first of these makes a series of basic services available to the population, including preventive activities, health education, family care, and community care. The service is provided in those known as Health Centers or in the patient’s homes if necessary (Aguilar, Bleda & Centelles, 2019). Current StructureHealth care coverage currently is universal, or rather, quasi-universal since it is calculated that almost 99% of the population has access to the system (Aguilar, Bleda & Centelles, 2019). All Spaniards, citizens of a Member State of the European Union according to the criteria of Community law and nationals of States, not members of the Union who have the rights recognized by the signed agreements will have the right to enjoy the system (Angulo-Pueyo, Ridao-López & Martinez-Lizaga, 2019). Apart from the public service, it is calculated that 12% of the Spanish population has private coverage insurance, and this care may be complementary, substitute, or alternative to public provision (Mentzakis et al., 2019). The service of the service by the SNS is, in its entirety, free except for the pharmaceutical benefits for people under 65 years of age who must pay a payment with a participation of 40% on the estimated sale price for each medicine. Regarding what type of benefits the system covers, these were established in 1995 through a Royal Decree. The objective of this rule was not to frame a package of minimum services but to consolidate all the existing services as basic to expand the portfolio of services. Adult dental care (dental prosthetics, cleaning, and orthodontia) and partially socio-health care would be excluded from this primary care (Angulo-Pueyo, Ridao-López & Martinez-Lizaga, 2019).ReferencesAguilar, M. G., Bleda, J. G., & Centelles, C. G. (2019). Immigrants in the Spanish public healthcare system: participative and general healthcare matters. Revista espanola de salud publica, 93.Angulo-Pueyo, E., Ridao-López, M., & Martinez-Lizaga, N. (2019). Correction: Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system.Driessen, M. T., Whalen, J., Buguth, B. S., Vallejo-Aparicio, L. A., Naya, I. P., Asukai, Y., … & Risebrough, N. A. (2019). Correction to: Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: a Spanish National Healthcare System perspective. Respiratory research, 20(1), 18.Mentzakis, E., Garcia-Goñi, M., Sequeira, A. R., & Paolucci, F. (2019). Equity and efficiency priorities within the Spanish health system: A discrete choice experiment eliciting stakeholders’ preferences. Health Policy and Technology, 8(1), 30-41.