According to the Organisation for Economic Co-operation and Development, total health spending accounted for 9.4% of GDP in Spain in 2011, slightly above the OECD average of 9.3%. The Spanish health care system is considered one of the best in the world, in 7th position in the ranking elaborated by the World Health Organization. Spain is the 1st country in the world in organ transplants. The public sector is the main source of health funding in nearly all countries. In Spain, 73% of health spending was funded by public sources in 2011, very close to the average of 72% in OECD countries. Since 2010, real term spending on healthcare has declined in Spain.
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Hospitals
In an emergency you can go straight to a hospital A&E. For any other type of hospital treatment you’ll need a referral from a doctor. There are public and private hospitals. Only the public hospitals provide free treatment. Some hospitals offer both private and state healthcare services, so make sure the staff knows which service you want. When you go to hospital you’ll need to show your social security card or proof of private insurance. If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don’t issue prescriptions.
In Spain patients have the right to read their own patient records, but there is evidence that this right is not well publicised.
Decentralization
In Spain, provision of health care services is decentralized in several autonomous communities. As of 2001, decentralization was present in the communities of Andalusia, the Canary Islands, Catalunya, Valencia, Navarra, Galicia, and Pais Vasco. In 1998, an analysis of the effects of higher autonomy on legislative performance and policy outcomes for health care observed a positive effect on legislative performance, but no effect on actual policy outcomes. The analysis noted that a possible explanation for this disconnect was that autonomous communities had only experienced higher autonomy in the policy area of health care for a short time, and positive effects on policy outcomes could take longer to manifest. In 2009, an analysis of data collected by the Spanish National Health Survey in 2001 showed that autonomous communities with decentralized health services tended to have better equity performance in their health care services. In 2014, an analysis of data collected by the Spanish Center on Sociological Research between 1996 and 2009 found that for twenty variables of public satisfaction with health care services, decentralized communities performed worse over time on three measures of primary or specialized care and one measure of hospital care. Decentralization had no effect over time on two measures of primary or specialized care and two measures of hospital care. No statistically significant trend was observed for twelve of the twenty measures of satisfaction. The authors of the analysis stressed that the data was limited due to the subjective nature of patient reported quality of health care, and the inability for many citizens to properly evaluate performance of health care services.
International comparisons
In a sample of 13 developed countries Spain was second in its population weighted usage of medication in 14 classes in both 2009 and 2013. The drugs studied were selected on the basis that the conditions treated had high incidence, prevalence and/or mortality, caused significant long-term morbidity and incurred high levels of expenditure and significant developments in prevention or treatment had been made in the last 10 years. The study noted considerable difficulties in cross border comparison of medication use.
The Euro health consumer index rated Spain 19th of 35 European countries in 2015, remarking that it relied a bit too much on seeking private care.