health care

health care
   Spain has had a comprehensive health service only since 1986, when the PSOE government introduced the General Health Law. Previously, cover was provided under a compulsory health insurance introduced by the Franco regime in 1942, which by 1975 covered nearly 80 percent of the population. By the early 1990s, health care (except dental care and psychiatric treatment) was available free to 99 percent of the population, though anyone not receiving a state pension has to pay 40 percent of the cost of prescriptions. The overall administration of the health service at national level was entrusted to INSALUD (Instituto Nacional de la Salud—National Health Agency), which had been set up in 1978 in an attempt to co-ordinate health provision. In the years after the 1986 legislation, the seven autonomous communities with the largest measures of self-government (containing some 60 percent of the total population of the state) assumed responsibility not only for the administration of health care within their territories but also for policy and funding. With the setting up of a comprehensive public health service, and a vigorous hospital building programme undertaken in the 1980s, the relative importance of private health care has decreased. Private hospitals, however, still represent 30 percent of all hospitals, and provide 20 percent of the beds. Private hospitals can receive state funding, but only if they sign an agreement with the authorities, specifying the conditions under which they provide care. About 80 percent of state health funding goes to public health care, though at 6 percent of GDP, public health expenditure is low by EU standards. The massive increase in publicly funded health care from the mid-1980s was accompanied by a surge in demand. Hospital waiting lists increased threefold, there is a chronic shortage of hospital beds, especially long-stay beds, and there is no adequate system of aftercare. The problem is compounded by a shortage of qualified nurses and dentists, and by the inadequacy of medical training. By contrast, there is considerable overproduction of doctors, with consequent scarcity of permanent posts, a factor which has created serious unrest in the profession, reflected in a series of strikes in the first half of the 1990s. Though Spain has one of the highest ratios of doctors to population, geographical distribution is uneven, reflecting general resource imbalances in the system as a whole. The largest share of public funding is directed towards acute hospital and specialist care, with a consequent neglect of primary care, health education and preventive medicine. To some extent this is a legacy of the past, for disease prevention was regarded by the Franco regime as essentially a public order issue, and came under the control of the Interior Ministry. Fortunately, the general level of health in the population is good. Infant mortality rates stood at 7.8 per thousand in 1989, compared to 9.7 for the US and 8.4 for the UK. Life expectancy is 80 for women and 73 for men, the highest in the EU.
   Further reading
   - Hooper, J. (1995) The New Spaniards, Harmondsworth: Penguin (chapter 18 gives a good account of health care in the context of overall social security provision).
   - Ross, C.J. (1997) Contemporary Spain: A Handbook, London: Arnold (chapter 8.2 is a welldocumented and clear account of the problems faced by the health service).
   EAMONN RODGERS

Encyclopedia of contemporary Spanish culture. 2013.

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