Spanish National Health System
Encyclopedia
The Spanish National Health System is the agglomeration of public health services that has existed in Spain
since it was established through and structured by the Ley General de Sanidad (the "General Health Law") of 1986. Management of these services has been progressively transferred to the distinct autonomous communities of Spain
, while some continue to be operated by the National Institute of Health Management (Instituto Nacional de Gestión Sanitaria, INGESA), part of the Ministry of Health and Social Policy (which superseded the Ministry of Health and Consumer Affairs—Ministerio de Sanidad y Consumo—in 2009). The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España, CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain.
Article 46 of the Ley General de Sanidad establishes the fundamental characteristics of the SNS:
s through the establishment of naval quarantine
s, the closing of city walls and prohibitions on travel in times of plague, but also in terms of hygienic and palliative measures. Al-Andalus
—Muslim
-ruled medieval Spain—was distinguished by its level of medical knowledge relative to the rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain. In the years after the Reconquista
, the Real Tribunal del Protomedicato regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious; the systems of Galen
and Hippocrates
dominated medical practice during most of the era of the Antiguo Régimen.
Medicine was one of the principle fields of activity for the novatores of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment
, such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid
. At the beginning of the 19th century, the Balmis Expedition
(1803) to administer the smallpox vaccine
throughout the Spanish colonies was a public health
undertaking of unprecedented geographical scope.
The Cádiz Cortes
debated a sanitary code (the Código Sanitario de 1812), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During the bienio progresista
, the Law of 28 November 1855 established the basis for a General Health Directorate (Dirección General de Sanidad), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction (Instrucción General de Sanidad), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health (Inspección General de Sanidad).
After the Spanish Civil War
, the Ley de Bases de 1944 perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance
under the already extant National Insurance Institute (Instituto Nacional de Previsión, INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security (Ley General de la Seguridad Social) in 1974, toward the end of the Franco
regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities.
The General Health Law (Ley General de Sanidad) of 25 April 1986 and the creation of Health Councils (Consejerías de Sanidad) and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978
, in particular Articles 43 and 49 which made protection of health a right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities
.
Second, Title VIII of the Constitution confers upon the autonomous communities broad purview in matters of health and health care. The autonomous communities have first-order importance in this area, and the law permits devolution of these functions from the central government to the autonomous communities, in order to provide a health care system sufficient for the needs of their respective jurisdictions. Article 149.1.16 or the Constitution, a further basis for the present law, establishes substantive principles and criteria that allow general and common characteristics to be consistent throughout the new system, providing a common basis for health services throughout Spanish territory.
The administrative device set up by the law is the National Health System. The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency.
Thus, the various health services fall under the responsibility of the respective autonomous communities, but also under basic direction and coordination by the central state. The respective health services of the autonomous communities would gradually realize a transfer of health resources from the central government to the autonomous communities.
Therefore, the 2003 law establishes coordination and cooperation of public health authorities as a means to ensure citizens the right to health protection, with the common goal of ensuring equity, quality and social participation National Health System. The law defines a core set of functions common to all of the autonomous health services. Without interfering with the diversity of forms of organization, management and services inherent in a decentralized system, it attempts to establish certain basic, common safeguards throughout the country. This law attempts to establish collaboration of public health authorities with respect to benefits provided, pharmacy, health professionals, research, health information systems, and the overall quality of the health system.
Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to the participation of the autonomous communities. Among these are the Agency of Evaluation of Technologies (Agencia de Evaluación de Tecnologías, Spanish Agency of Medicines and Medical Products (Agencia Española de Medicamentos y Productos Sanitarios), the Human Resources Committee (Comisión de Recursos Humanos), the Committee to Assess Health Research (Comisión Asesora de Investigación en Salud), the Charles III Institute of Health (Instituto de Salud Carlos III), the Institute of Health Information (Instituto de Información Sanitaria), the Quality Agency of the National Health System (Agencia de Calidad del Sistema Nacional de Salud) and the Observatory of the National Health System (Observatorio del Sistema Nacional de Salud).
The basic organ of cohesion is the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions. A system of inspection, the Alta Inspección, assures that accords are followed.
in Madrid
, across the street from the Museo del Prado
.
The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy. From the date of that decree, the new ministry assumed the functions of, and superseded the former Ministry of Health and Consumption (Ministerio de Sanidad y Consumo) and Secretary of State for Social Policy, Family, and Attention to Dependency and Disability (Secretaría de Estado de Política Social, Familia y Atención a la Dependencia y a la Discapacidad).
The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System (Agencia de Calidad del Sistema Nacional de Salud) and the General Directorate of Advanced Therapies and Transplants (Dirección General de Terapias Avanzadas y Trasplantes).
The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS. Under this law, the CISNS functions variously as a plenary body, by delegated committees, through technical commissions, and through work groups. It meets as a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. To some extent, this is a formality: resolutions from CISNS commissions are typically adopted by consensus. Cooperation agreements to conduct joint health actions are formalized in CISNS agreements.
Under the Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region.
Presentations, committees, and working groups have been very important, some more than others. Important committees include:
Articles 69, 70 and 71 of the Law of Cohesion regulate the principal functions of the Interterritorial Council of the SNS. The principal aspects of the Interterritorial Council are:
The Interterritorial Council is constituted by the Minister of Health and Consumer Affairs [now of Health and Social Policy], who holds its presidency, and by the Councilors with purview over matters of health of the autonomous communities. The vicepresidency of the body will be fulfilled by one of the Councilors with purview over matters of health of the autonomous communities, elected by all of the Councilors who make up the body.
The CISNS will come to know, debate among other things, and, as appropriate, make recommendations on the following matters:
The prior functions shall be exercised without prejudice to the legislative purview of the Cortes Generales
and, as appropriate, the norms of the General Administration of the State; likewise the normal developmental, executive and organizational purview of the autonomous communities.
The State finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. This tax is shared among the several autonomous communities according to various sharing criteria now that the communities are responsible for health in their respective territories.
Each year the CISNS, after deliberation, establishes the portfolio of services covered by the National Health System, which is published by a Royal Decree of the Ministry of Health. Each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the National Health System.
Article 42 of the General Health Law sets out that ayuntamiento
s—municipal governments—have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies:
In the autonomous cities of Ceuta
and Melilla
the corresponding health services are provided by the National Institute of Health Management, INGESA.
Further, the Organic Law 4/2000 (Ley Orgánica 4/2000) establishes the rights and liberties of foreigners resident in Spain. Its effect on the healthcare provision can be seen in the following articles:
Inclusion of a new service in the catalog of services of the National Health System is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. This memo is brought up to the Council of Fiscal Policy and Finance for analysis and approval as to whether to proceed.
In order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. In particular, the cards incorporate a digital form of this information; health facilities throughout Spain have appropriate equipment to read the digital information from the cards. A cardholder should thereby be able to access all the services of all relevant health professionals throughout the country.
, district, department, or other territorial unit used in that autonomous community.
and specialists' center.
(Spain's National Institute of Statistics) counts 616,232 individuals credentialed by a professional association as health care professionals. The largest number of these are nursing professionals; that is also the profession with the highest percentage of women. The following table is a breakdown of some of the INE statistics. No exact breakdown is available to indicate what number of these might be related to mental health
and psychotherapy
or clinical psychology
.
"surgery" or American English
"doctor's office." These are offices that, while not full-fledged health centers (centros de salud), nonetheless provide care beyond primary care. Some terms used are consultorios rurales, consultorios locales, abd consultorios periféricos (respectively, rural, local and "peripheral"; that last means a center located in a community other than the main settlement of a municipality
), but other terms may exist, analogous to those that refer to various types of health centers.
According to the 2008 National Catalog of Hospitals (Catálogo Nacional de Hospitales 2008), Spain in 2007 had a total of 10,178 consultorios that allowed health professionals to provide more local services than the health centers in their respective zones, with the purpose of bringing basic services closer to people who reside in nuclei dispersed through rural areas that tend to have an older than average population.
Health centers basically practice the general medicine or family medicine
, providing a unity of care in which a specialist in community and family medicine is responsible to provide preventive care, health promotion, diagnosis and basic treatment on an outpatient basis. According to the 2008 National Catalog of Hospitals (Catálogo Nacional de Hospitales), in 2007 Spain had 2,913 health centers.
Dental clinics: Focused on care of the teeth and mouth.
Centers for assisted human reproduction: Biomedical teams focused on assisted reproductive technology
.
Centers for voluntary interruption of pregnancy: Provide abortion
services in legally permitted cases.
Centers for major outpatient surgery: Provide surgery and subsidiary services including general, local
and regional anesthesia
and sedation
. For surgeries that require only brief post-operative care and therefore do not require overnight hospitalization.
Dialysis
centers: For patients with failed kidney
s.
Diagnostic centers: Dedicated to diagnostic, analytic and imaging services.
Mobile health care centers: Carry human and technical means for the purpose of health care activities.
Transfusion
centers: Carry out all activities related to the extraction and verification of human blood and its components, and of treatment, storage, and distribution.
Tissue bank
s: Conserve and guarantee the quality of tissues after they are obtained and until they are used as allografts or autografts.
Medical inspection centers: (Centros de reconocimiento médico), where examinations and other tests of ability are carried out for applicants or holders of medical and other health care permits or licenses.
Mental health centers: Diagnose and treat mental illness on an outpatient basis.
. These establishments are grouped by specialty and, on that account, must have accredited or certified technical personnel. Among these establishments are:
Pharmacies
: Private establishments operated in the public interest, subject to health care planning established by the autonomous communities, which provide the public with basic services recognized in Article 1 of Law 16/1997, of 25 April, that regulates pharmacy services (Ley 16/1997, de 25 de abril, de regulación de los servicios de las oficinas de farmacia).
Botiquines: (singular: Botiquín) are authorized to hold, conserve and dispense medicines and health care products in places where there would be special difficulties of accessibility of a pharmacy.
Optometric offices (Ópticas): Evaluate visual capacity using optometric
techniques; crafting, sale, verification and control of adequate means for the prevention, detection, protection, and improvement of visual acuity
.
Orthopedia centers: Dispense orthopedic health care products such as prostheses
and orthotics
, technical devices to alleviate loss of autonomy, functionality, or physical capacity.
Audioprosthesis centers: Dispense health care products, intended for the correction of auditory deficiencies, such as hearing aid
s, with adaptation individualized to each patient.
is a health care establishment that provides inpatient care
and specialized (and other) care, providing such services as are needed in its geographical area. A hospital can be a single structure or a hospital complex, even including branch buildings off of its main campus; it can also integrate any number of specialized centers.
A similar concept to a hospital is a clinic. In Spain, a clinic (clínica) is a health center, typically a private one, where patients can receive health coverage in a broad range of specialties. Some of these clinics include very up-to-date operating theaters capable of providing minimally invasive surgery, and "hospitalization zones" where patients can recuperate on an inpatient basis. In large Spanish cities, there are numerous clinics. These are the facilities that are normally used by health care professionals whose medical societies cover it: ASISA, Adeslas, etc.
The General Health Law of 1986 establishes that the level of specialized care provided in hospitals and their dependent specialty centers will focus care on complex health problems. Hospital centers will develop, besides their functions strictly related to health care, functions of health promotion, prevention of illnesses and investigation and teaching, in accord with the programs of each area of health, with the object of complementing their activities with those developed by the primary care network.
As elsewhere in the world, the size of hospitals in Spain is often gauged by the number of "installed beds" (camas instaladas). This is the number of hospital beds with fixed locations; at any given time, some beds may be out of commission.
there are also centers integrated into the Network of Hospitals for Public Use (Red de Hospitales de Utilización Pública, XHUP) as outlined in the supplement to Decree 124/2008 of the Department of Health of the Autonomous Government of Catalonia (Anexo del Decreto 124/2008 del Departamento de Salud de la Generalitat de Catalunya).
The 2009 National Catalog of Hospitals contains information about the patrimonial dependency of hospitals, summarized as follows; hospital complexes are each counted here as a single hospital:
40 percent of stays in private hospitals are arranged and paid for by the public system.
The 2008 National Catalog of Hospitals gives the following breakdown of types of hospitals.
Health care centers, principally hospitals and specialty centers, have high technology capabilities used primarily to perform better patient diagnoses. The following breakdown of such facilities is based on the 2008 National Catalog of Hospitals.
Article 11 of the law establishes the basic lines of public health services:
The following catalog demonstrates preventive activities, health promotion and education, family care and community care as performed in primary care centers.
At times, patients will require specialized health care services. These may be provided in external consultations, day hospitals, or on an inpatient basis.
Examples of specialized services are intensive and critical care, anesthesia
, defibrillation
, but also some forms of hemotherapy
, rehabilitation, and even nutrition, diet, post-partum treatment, and family planning, especially assisted reproductive technology
. Specialized treatment can also be involved in detecation, prescription and implementation of diagnostic and therapeutic procedures, especially those related to prenatal diagnosis
in risk groups, diagnosis by imaging, interventionist radiology
, hemodynamics
, nuclear medicine
, neurophysiology
, endoscopy
, lab tests, biopsies
, radiotherapy, radiosurgery
, renal
lithotripsy
, dialysis
, techniques of respiratory therapy
, organ transplant
s and other tissue and cell transplants.
is health care provided in cases where emergency care is needed. Emergency medicine is practiced both in healthcare facilities and at the site of work accident
s, traffic accidents, etc. or in the home of a patient whose condition prevents them from getting to a healthcare facility. Emergency medicine is a 24-hour-a-day service provided, in particular, by physicians and other medical professionals in hospital emergency rooms, but also in ambulance
s, medical evacuation helicopter
s, etc. en route to such facilities.
.
Pharmaceutical services include medications and health products are provided to patient according to their clinical needs, in precise doses and over an adequate period at the least cost possible. Medications are dispensed by pharmacies, each of which is headed by a licensed pharmacist.
All medications to be prescribed to patients must either be authorized and registered by the Spanish Agency of Medications and Health Care Products (Agencia Española de Medicamentos y Productos Sanitarios), or must be formulations prepared by licensed pharmacists. Exceptions to this requirement are cosmetics, dietetic products, dental products and other sanitary products, as well as drugs classified as advertising, homeopathic
medicines, and articles and accessories advertised to the general public and where the purchaser pays the full price (that is, no money comes from SNS-related sources).
Spanish patients make a copayment
when they acquire pharmaceuticals. The distribution of the cost is as follows:
, external prostheses, special orthoses and prostheses including hearing aid
s and earmold
s for children up to age 16 suffering from bilateral hearing impairment
s.
"Complementary services" include complex dietary therapies, vehicles for invalids, and home oxygen therapy
.
s, as well as air ambulance
s: helicopters and airplanes whose interiors are specially modified for the purpose. For most purposes, of course, ground transport is preferred, but sometimes distances or the difficulty of reaching particular locations make air transport more practical.
(Instituto Nacional de Estadística, INE), as of January 1, 2009, Spain has a population of 46,754,807, of whom 23,116,988 (49,44%) are male and 23,628,919 (50.56%) female. In recent years, this population has been increasing slowly but progressively. In the last decade, the increase has been largely through immigration: 5,268,762 Spanish residents are foreigners.
These numbers count only citizens and legal immigrants. The health care system muc also provide services for thousands of illegal immigrants and for the many tourists who visit Spain each year.
This structure is typical of a modern demographic regimen
, with an evolution toward an aging population and a declining birth rate
. This means that Spain has to expect an increase in use of the services that are targeted at older adults. This effect is further exacerbated by a steadily increasing life expectancy
.
Spain
Spain , officially the Kingdom of Spain languages]] under the European Charter for Regional or Minority Languages. In each of these, Spain's official name is as follows:;;;;;;), is a country and member state of the European Union located in southwestern Europe on the Iberian Peninsula...
since it was established through and structured by the Ley General de Sanidad (the "General Health Law") of 1986. Management of these services has been progressively transferred to the distinct autonomous communities of Spain
Autonomous communities of Spain
An autonomous community In other languages of Spain:*Catalan/Valencian .*Galician .*Basque . The second article of the constitution recognizes the rights of "nationalities and regions" to self-government and declares the "indissoluble unity of the Spanish nation".Political power in Spain is...
, while some continue to be operated by the National Institute of Health Management (Instituto Nacional de Gestión Sanitaria, INGESA), part of the Ministry of Health and Social Policy (which superseded the Ministry of Health and Consumer Affairs—Ministerio de Sanidad y Consumo—in 2009). The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España, CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain.
Article 46 of the Ley General de Sanidad establishes the fundamental characteristics of the SNS:
- a. Extension of services to the entire population.
- b. Adequate organization to provide comprehensive health care, including promotion of health, prevention of disease, treatment and rehabilitation.
- c. Coordination and, as needed, integration of all public health resources into a single system.
- d. Financing of the obligations derived from this law will be met by resources of public administration, contributions and fees for the provision of certain services.
- e. The provision of a comprehensive health care, seeking high standards, properly evaluated and controlled.
Antecedents to the SNS in Spain
Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of epidemicEpidemic
In epidemiology, an epidemic , occurs when new cases of a certain disease, in a given human population, and during a given period, substantially exceed what is expected based on recent experience...
s through the establishment of naval quarantine
Quarantine
Quarantine is compulsory isolation, typically to contain the spread of something considered dangerous, often but not always disease. The word comes from the Italian quarantena, meaning forty-day period....
s, the closing of city walls and prohibitions on travel in times of plague, but also in terms of hygienic and palliative measures. Al-Andalus
Al-Andalus
Al-Andalus was the Arabic name given to a nation and territorial region also commonly referred to as Moorish Iberia. The name describes parts of the Iberian Peninsula and Septimania governed by Muslims , at various times in the period between 711 and 1492, although the territorial boundaries...
—Muslim
Muslim
A Muslim, also spelled Moslem, is an adherent of Islam, a monotheistic, Abrahamic religion based on the Quran, which Muslims consider the verbatim word of God as revealed to prophet Muhammad. "Muslim" is the Arabic term for "submitter" .Muslims believe that God is one and incomparable...
-ruled medieval Spain—was distinguished by its level of medical knowledge relative to the rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain. In the years after the Reconquista
Reconquista
The Reconquista was a period of almost 800 years in the Middle Ages during which several Christian kingdoms succeeded in retaking the Muslim-controlled areas of the Iberian Peninsula broadly known as Al-Andalus...
, the Real Tribunal del Protomedicato regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious; the systems of Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
and Hippocrates
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
dominated medical practice during most of the era of the Antiguo Régimen.
Medicine was one of the principle fields of activity for the novatores of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment
Age of Enlightenment
The Age of Enlightenment was an elite cultural movement of intellectuals in 18th century Europe that sought to mobilize the power of reason in order to reform society and advance knowledge. It promoted intellectual interchange and opposed intolerance and abuses in church and state...
, such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid
Madrid
Madrid is the capital and largest city of Spain. The population of the city is roughly 3.3 million and the entire population of the Madrid metropolitan area is calculated to be 6.271 million. It is the third largest city in the European Union, after London and Berlin, and its metropolitan...
. At the beginning of the 19th century, the Balmis Expedition
Balmis Expedition
The Balmis Expedition was a three year mission to the Americas led by Dr Francisco Javier de Balmis with the aim of giving thousands the smallpox vaccine. He set off from La Coruña on 30 November 1803...
(1803) to administer the smallpox vaccine
Smallpox vaccine
The smallpox vaccine was the first successful vaccine to be developed. The process of vaccination was discovered by Edward Jenner in 1796, who acted upon his observation that milkmaids who caught the cowpox virus did not catch smallpox...
throughout the Spanish colonies was a public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
undertaking of unprecedented geographical scope.
Cádiz Cortes
The Cádiz Cortes were sessions of the national legislative body which met in the safe haven of Cádiz during the French occupation of Spain during the Napoleonic Wars...
debated a sanitary code (the Código Sanitario de 1812), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During the bienio progresista
Bienio progresista
In the history of Spain, the Bienio progresista was the two-year period from July 1854 to July 1856, during which the Progressive Party attempted to reform the political system of the reign of Isabella II, which had been dominated by the Moderate Party since 1843 in the so-called Década moderada...
, the Law of 28 November 1855 established the basis for a General Health Directorate (Dirección General de Sanidad), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction (Instrucción General de Sanidad), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health (Inspección General de Sanidad).
After the Spanish Civil War
Spanish Civil War
The Spanish Civil WarAlso known as The Crusade among Nationalists, the Fourth Carlist War among Carlists, and The Rebellion or Uprising among Republicans. was a major conflict fought in Spain from 17 July 1936 to 1 April 1939...
, the Ley de Bases de 1944 perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance
Health insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
under the already extant National Insurance Institute (Instituto Nacional de Previsión, INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security (Ley General de la Seguridad Social) in 1974, toward the end of the Franco
Francisco Franco
Francisco Franco y Bahamonde was a Spanish general, dictator and head of state of Spain from October 1936 , and de facto regent of the nominally restored Kingdom of Spain from 1947 until his death in November, 1975...
regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities.
The General Health Law (Ley General de Sanidad) of 25 April 1986 and the creation of Health Councils (Consejerías de Sanidad) and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978
Spanish Constitution of 1978
-Structure of the State:The Constitution recognizes the existence of nationalities and regions . Preliminary Title As a result, Spain is now composed entirely of 17 Autonomous Communities and two autonomous cities with varying degrees of autonomy, to the extent that, even though the Constitution...
, in particular Articles 43 and 49 which made protection of health a right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities
Autonomous communities of Spain
An autonomous community In other languages of Spain:*Catalan/Valencian .*Galician .*Basque . The second article of the constitution recognizes the rights of "nationalities and regions" to self-government and declares the "indissoluble unity of the Spanish nation".Political power in Spain is...
.
The General Health Law of 1986
The General Health Law of 1986 (Ley 14/1986 General de Sanidad) was formulated on two bases. First, it carries out a mandate of the Spanish Constitution, whose articles 43 and 49 establish the right of all citizens to protection of their health. The law recognizes a right to health services for all citizens and for foreigners resident in Spain.Second, Title VIII of the Constitution confers upon the autonomous communities broad purview in matters of health and health care. The autonomous communities have first-order importance in this area, and the law permits devolution of these functions from the central government to the autonomous communities, in order to provide a health care system sufficient for the needs of their respective jurisdictions. Article 149.1.16 or the Constitution, a further basis for the present law, establishes substantive principles and criteria that allow general and common characteristics to be consistent throughout the new system, providing a common basis for health services throughout Spanish territory.
The administrative device set up by the law is the National Health System. The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency.
Thus, the various health services fall under the responsibility of the respective autonomous communities, but also under basic direction and coordination by the central state. The respective health services of the autonomous communities would gradually realize a transfer of health resources from the central government to the autonomous communities.
Law of Cohesion and Quality (2003)
The General Health Law was complemented in 2003 by the Law of Cohesion and Quality of the National Health System (Ley 16/2003 de cohesión y calidad del Sistema Nacional de Salud), which maintained the basic lines of the General Health Law, but modified and broadened the articulation of that law to reflect existent social and political reality. By 2003, all of the autonomous communities had gradually assumed purview in matters of health and had established stable models to finance the assumed purview. Meanwhile, in the 17 years since the original law, Spanish society had undergone many cultural, technological and socioeconomic changes that affected people's ways of life and affected the country's patterns of disease and illness. These posed new challenges to the National Health System.Therefore, the 2003 law establishes coordination and cooperation of public health authorities as a means to ensure citizens the right to health protection, with the common goal of ensuring equity, quality and social participation National Health System. The law defines a core set of functions common to all of the autonomous health services. Without interfering with the diversity of forms of organization, management and services inherent in a decentralized system, it attempts to establish certain basic, common safeguards throughout the country. This law attempts to establish collaboration of public health authorities with respect to benefits provided, pharmacy, health professionals, research, health information systems, and the overall quality of the health system.
Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to the participation of the autonomous communities. Among these are the Agency of Evaluation of Technologies (Agencia de Evaluación de Tecnologías, Spanish Agency of Medicines and Medical Products (Agencia Española de Medicamentos y Productos Sanitarios), the Human Resources Committee (Comisión de Recursos Humanos), the Committee to Assess Health Research (Comisión Asesora de Investigación en Salud), the Charles III Institute of Health (Instituto de Salud Carlos III), the Institute of Health Information (Instituto de Información Sanitaria), the Quality Agency of the National Health System (Agencia de Calidad del Sistema Nacional de Salud) and the Observatory of the National Health System (Observatorio del Sistema Nacional de Salud).
The basic organ of cohesion is the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions. A system of inspection, the Alta Inspección, assures that accords are followed.
Ministry of Health and Social Policy
The Ministry of Health and Social Policy develops the policies of the Government of Spain in matters of health, in planning and delivery of services, as well as exercising the purview of the General Administration of the State to assure citizens the right to protection of their health. The ministry has its headquarters on the Paseo del PradoPaseo del Prado
The Paseo del Prado is one of the main boulevards in Madrid, Spain. It runs north-south between the Plaza de Cibeles and the Plaza del Emperador Carlos V , with the Plaza de Cánovas del Castillo lying approximately in the middle...
in Madrid
Madrid
Madrid is the capital and largest city of Spain. The population of the city is roughly 3.3 million and the entire population of the Madrid metropolitan area is calculated to be 6.271 million. It is the third largest city in the European Union, after London and Berlin, and its metropolitan...
, across the street from the Museo del Prado
Museo del Prado
The Museo del Prado is the main Spanish national art museum, located in central Madrid. It features one of the world's finest collections of European art, from the 12th century to the early 19th century, based on the former Spanish Royal Collection, and unquestionably the best single collection of...
.
The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy. From the date of that decree, the new ministry assumed the functions of, and superseded the former Ministry of Health and Consumption (Ministerio de Sanidad y Consumo) and Secretary of State for Social Policy, Family, and Attention to Dependency and Disability (Secretaría de Estado de Política Social, Familia y Atención a la Dependencia y a la Discapacidad).
The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System (Agencia de Calidad del Sistema Nacional de Salud) and the General Directorate of Advanced Therapies and Transplants (Dirección General de Terapias Avanzadas y Trasplantes).
Interterritorial Council of the Spanish National Health Service
The General Health Law of 1986 created the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud, CISNS) as the organ of general coordination in matters related to health between the central State and the autonomous communities who were given authority in health matters under that law. It is jointly composed, and coordinates the basic lines of health policy in matters affecting contracts; acquisition of health and pharmaceutical products, as well as other related goods and services; as well as basic health personnel policies.The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS. Under this law, the CISNS functions variously as a plenary body, by delegated committees, through technical commissions, and through work groups. It meets as a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. To some extent, this is a formality: resolutions from CISNS commissions are typically adopted by consensus. Cooperation agreements to conduct joint health actions are formalized in CISNS agreements.
Under the Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region.
Presentations, committees, and working groups have been very important, some more than others. Important committees include:
- Public Health Committee (Comisión de Salud Pública)
- Permanent pharmacy committee (Comisión permanente de farmacia)
- Scientific-technical committee of the National Health System (Comisión científico-técnica del sistema Nacional de Salud)
- Committee to monitor the health cohesion fund (Comisión de seguimiento del fondo de cohesión sanitaria)
- Permanent committee on insurance, funding, and benefits (Comisión permanente de aseguramiento, financiación y prestaciones)
- Committee against gender violence (Comisión contra la violencia de género)
- Transplant committee (Comisión de trasplantes)
Articles 69, 70 and 71 of the Law of Cohesion regulate the principal functions of the Interterritorial Council of the SNS. The principal aspects of the Interterritorial Council are:
The Interterritorial Council is constituted by the Minister of Health and Consumer Affairs [now of Health and Social Policy], who holds its presidency, and by the Councilors with purview over matters of health of the autonomous communities. The vicepresidency of the body will be fulfilled by one of the Councilors with purview over matters of health of the autonomous communities, elected by all of the Councilors who make up the body.
The CISNS will come to know, debate among other things, and, as appropriate, make recommendations on the following matters:
- a) The development of the portfolio of services corresponding to the Catalog of Services of the National Health System, as well as its actualization.
- b) The establishment of health services complementary to the basic services of the National Health System on the part of the autonomous communities.
- c) Minimal guarantees of safety and quality for the authorization of the opening and placing into function of the health centers, services and establishments.
- d) The general and common criteria for the development of collaboration between pharmacy offices.
- e) The basic criteria and conditions of the convocations of professionals to assure their mobility throughout the State.
- f) Declaration of the necessity to realize coordinated actions in matters of public health to which this law refers.
- g) General criteria for the public financing of medicines, medical products and their variables.
- h) Establishment of criteria and mechanisms in order to guarantee at all times the financial sufficiency of the system.
Cortes Generales
The Cortes Generales is the legislature of Spain. It is a bicameral parliament, composed of the Congress of Deputies and the Senate . The Cortes has power to enact any law and to amend the constitution...
and, as appropriate, the norms of the General Administration of the State; likewise the normal developmental, executive and organizational purview of the autonomous communities.
Purview of the autonomous communities in matters of health
Article 41 of the General Health Law establishes that:- The autonomous communities exercise the purview assumed in their statutes
[ of autonomy] Statute of AutonomyNominally, a Statute of Autonomy is a law hierarchically located under the constitution of a country, and over any other form of legislation...
and those that the state transfers to them or, as appropriate, delegates to them. - Las decisiones y actuaciones publicas previstas en esta ley que no se hayan reservado expresamente al estado se entenderán atribuidas a las comunidades autónomas.
The State finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. This tax is shared among the several autonomous communities according to various sharing criteria now that the communities are responsible for health in their respective territories.
Each year the CISNS, after deliberation, establishes the portfolio of services covered by the National Health System, which is published by a Royal Decree of the Ministry of Health. Each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the National Health System.
Purview of local governments in matters of health
Ayuntamiento
Ayuntamiento In other languages of Spain:*Catalan/Valencian .*Galician .*Basque . is the general term for the council of a municipality, or sometimes the municipality itself, in Spain and Latin America. Historically Ayuntamiento was often preceded by the word excelentísimo , when referring to...
s—municipal governments—have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies:
- a) Health control of the environment: air pollutionAir pollutionAir pollution is the introduction of chemicals, particulate matter, or biological materials that cause harm or discomfort to humans or other living organisms, or cause damage to the natural environment or built environment, into the atmosphere....
, water supplyWater supplyWater supply is the provision of water by public utilities, commercial organisations, community endeavours or by individuals, usually via a system of pumps and pipes...
[and water qualityWater qualityWater quality is the physical, chemical and biological characteristics of water. It is a measure of the condition of water relative to the requirements of one or more biotic species and or to any human need or purpose. It is most frequently used by reference to a set of standards against which...] , wastewater treatmentSewage treatmentSewage treatment, or domestic wastewater treatment, is the process of removing contaminants from wastewater and household sewage, both runoff and domestic. It includes physical, chemical, and biological processes to remove physical, chemical and biological contaminants...
, urban and industrial residueWasteWaste is unwanted or useless materials. In biology, waste is any of the many unwanted substances or toxins that are expelled from living organisms, metabolic waste; such as urea, sweat or feces. Litter is waste which has been disposed of improperly...
. - b) Health control of industries, activities and services, transport, noiseNoiseIn common use, the word noise means any unwanted sound. In both analog and digital electronics, noise is random unwanted perturbation to a wanted signal; it is called noise as a generalisation of the acoustic noise heard when listening to a weak radio transmission with significant electrical noise...
and vibrationVibrationVibration refers to mechanical oscillations about an equilibrium point. The oscillations may be periodic such as the motion of a pendulum or random such as the movement of a tire on a gravel road.Vibration is occasionally "desirable"...
s. - c) Health control of buildings and places of human residence or gathering, especially of food centers, hairdressers, saunas and centers of personal hygiene, hotels and residential centers, schools, tourist campsites and areas of physical activity for sports and recreation.
- d) Health control of perishable food distribution and supply, beverages and other products directly or indirectly related to human use or consumption, such as means of transport.
- e) Health control of cemeteries and mortuary health policy.
Territorial organization
As a consequence of the decentralization contemplated by the Spanish Constitution, each autonomous community has received adequate transfers to create a Health Service, the administrative structure that manages all of the centers, services and establishments of the community itself, as well as its deputations, municipal governments, and whatever other territorial administrations fall within that community. The Law of Cohesion establishes the Interterritorial Council (CISNS) as the organ of coordination and cooperation of the SNS.In the autonomous cities of Ceuta
Ceuta
Ceuta is an autonomous city of Spain and an exclave located on the north coast of North Africa surrounded by Morocco. Separated from the Iberian peninsula by the Strait of Gibraltar, Ceuta lies on the border of the Mediterranean Sea and the Atlantic Ocean. Ceuta along with the other Spanish...
and Melilla
Melilla
Melilla is a autonomous city of Spain and an exclave on the north coast of Morocco. Melilla, along with the Spanish exclave Ceuta, is one of the two Spanish territories located in mainland Africa...
the corresponding health services are provided by the National Institute of Health Management, INGESA.
| Autonomous community | Royal Decree constituting the Autonomic Health Service | Identification of the Autonomic Health Service | Population served |
|---|---|---|---|
 CataloniaCatalonia Catalonia is an autonomous community in northeastern Spain, with the official status of a "nationality" of Spain. Catalonia comprises four provinces: Barcelona, Girona, Lleida, and Tarragona. Its capital and largest city is Barcelona. Catalonia covers an area of 32,114 km² and has an... |
1517/1981, 8 July | Servei Català de Salut (CatSalut) | 7,467,423 |
 AndalusiaAndalusia Andalusia is the most populous and the second largest in area of the autonomous communities of Spain. The Andalusian autonomous community is officially recognised as a nationality of Spain. The territory is divided into eight provinces: Huelva, Seville, Cádiz, Córdoba, Málaga, Jaén, Granada and... |
400/1984, 22 February | Servicio Andaluz de Salud (SAS) | 8,285,692 |
 Basque CountryBasque Country (autonomous community) The Basque Country is an autonomous community of northern Spain. It includes the Basque provinces of Álava, Biscay and Gipuzkoa, also called Historical Territories.... |
1536/1987, 6 November | Osakidetza | 2,155,546 |
 Valencian Community |
1612/1987, 27 November | Agència Valenciana de Salut | 5,094,675 |
 Galicia |
1679/1990, 28 December | Servizo Galego de Saúde (SERGAS) | 2,794,796 |
 NavarreNavarre Navarre , officially the Chartered Community of Navarre is an autonomous community in northern Spain, bordering the Basque Country, La Rioja, and Aragon in Spain and Aquitaine in France... |
1680/1990, 28 December | Servicio Navarro de Salud-Osasunbidea | 629,569 |
 Canary IslandsCanary Islands The Canary Islands , also known as the Canaries , is a Spanish archipelago located just off the northwest coast of mainland Africa, 100 km west of the border between Morocco and the Western Sahara. The Canaries are a Spanish autonomous community and an outermost region of the European Union... |
446/1994, 11 March | Servicio Canario de la Salud (SCS) | 2,075,968 |
 AsturiasAsturias The Principality of Asturias is an autonomous community of the Kingdom of Spain, coextensive with the former Kingdom of Asturias in the Middle Ages... |
1471/2001, 27 December | Serviciu de Salú del Principáu d'Asturies (SESPA) | 1,085,289 |
 CantabriaCantabria Cantabria is a Spanish historical region and autonomous community with Santander as its capital city. It is bordered on the east by the Basque Autonomous Community , on the south by Castile and León , on the west by the Principality of Asturias, and on the north by the Cantabrian Sea.Cantabria... |
1471/2001, 27 December | Servicio Cántabro de Salud (SCS) | 582,138 |
 La Rioja |
1473/2001, 27 December | Servicio Riojano de Salud | 321,702 |
 Region of MurciaRegion of Murcia The Region of Murcia is an autonomous community of Spain located in the southeast of the country, between Andalusia and Valencian Community, on the Mediterranean coast.... |
1474/2001, 27 December | Servicio Murciano de Salud (SMS) | 436,870 |
 AragonAragon Aragon is a modern autonomous community in Spain, coextensive with the medieval Kingdom of Aragon. Located in northeastern Spain, the Aragonese autonomous community comprises three provinces : Huesca, Zaragoza, and Teruel. Its capital is Zaragoza... |
1475/2001, 27 December | Servicio Aragonés de Salud (SALUD) | 1,326,918 |
 Castile-La ManchaCastile-La Mancha Castile-La Mancha is an autonomous community of Spain. Castile-La Mancha is bordered by Castile and León, Madrid, Aragon, Valencia, Murcia, Andalusia, and Extremadura. It is one of the most sparsely populated of Spain's autonomous communities... |
1476/2001, 27 December | Servicio de Salud de Castilla-La Mancha (SESCAM) | 2,081,313 |
 ExtremaduraExtremadura Extremadura is an autonomous community of western Spain whose capital city is Mérida. Its component provinces are Cáceres and Badajoz. It is bordered by Portugal to the west... |
1477/2001, 27 December | Servicio Extremeño de Salud (SES) | 1,102,410 |
 Balearic IslandsBalearic Islands The Balearic Islands are an archipelago of Spain in the western Mediterranean Sea, near the eastern coast of the Iberian Peninsula.The four largest islands are: Majorca, Minorca, Ibiza and Formentera. The archipelago forms an autonomous community and a province of Spain with Palma as the capital... |
1478/2001, 27 December | Servei de Salut de les Illes Balears (IB-SALUT) | 1,071,221ae |
 Community of Madrid |
1479/2001, 27 December | Servicio Madrileño de Salud (SERMAS) | 6,271,638 |
 Castile and LeónCastile and León Castile and León is an autonomous community in north-western Spain. It was so constituted in 1983 and it comprises the historical regions of León and Old Castile... |
1480/2001, 27 December | Sanidad Castilla y León (SACYL) | 2,553,301 |
Health coverage in Spain
Under Chapter III of the 1978 Spanish Constitution, all Spanish citizens are beneficiaries of public health services. Concretely,it establishes that:- Article 39: The public powers assure social, economic and juridical protection of the family.
- Article 43: The right to health protection is recognized. It is the responsibility of public authorities to organize and act as guardian over public health through preventive measures and the provision of necessary services. The Law will establish the rights and duties of all in this respect. The public powers will promote health education, physical education and sports.
- Article 49. The public powers will bring into existence a policy of prevention, treatment, rehabilitation and integration of those with physical, sensory or psychological disabilities.
Further, the Organic Law 4/2000 (Ley Orgánica 4/2000) establishes the rights and liberties of foreigners resident in Spain. Its effect on the healthcare provision can be seen in the following articles:
- Article 3. Foreigners will enjoy in Spain, in equal conditions with the Spanish, the rights and liberties recognized in Title I of the Constitution and in the laws that develop it, in terms established in this Organic Law.
- Article 10. Foreigners will have the right to engage in remunerated activity in self-employment or working for others, such as access to the Social Security System, in terms foreseen in this Organic Law and in the dispositions that develop it.
- Article 12. Foreigners who are registered in Spain in the municipality in which they are habitually resident have the right to health services on the same conditions as the Spanish. Foreigners who are in Spain have the right to urgent health services in the event of contracting severe illness or having an accident, whatever may be the cause, and the continuity of this care until the time of discharge. Foreign minors of less than 18 years who are in Spain have the right to health care on the same conditions as the Spanish. Pregnant foreigners who are in Spain have the right to health care during the pregnancy, while giving birth, and post partum.
Financing of the health system
Article 10 of the Law of Cohesion establishes that the financing of the Spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay. Sufficient financing of services is determined by the resources assigned to the autonomous communities in conformity to what is established in the laws of autonomic financing.Inclusion of a new service in the catalog of services of the National Health System is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. This memo is brought up to the Council of Fiscal Policy and Finance for analysis and approval as to whether to proceed.
Individual health card
Article 57 of the Law of Cohesion establishes that citizens' access to health services will be facilitated by use of an individual health card (tarjeta sanitaria individual), as the administrative document that accredits its holder and provides certain basic data.In order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. In particular, the cards incorporate a digital form of this information; health facilities throughout Spain have appropriate equipment to read the digital information from the cards. A cardholder should thereby be able to access all the services of all relevant health professionals throughout the country.
Clinical history
A patient's clinical history is a medical-legal document that arises from the interactions between health professionals and their clients. From a medical and legal point of view, the clinical history is the only document valid to track this history of interactions. In primary care, where methods of health promotion are important, the clinical history document is sometimes known as a "health history" (historia de salud) or "life history" (historia de vida).Clinical histories in the SNS
The Clinical History of the [Spanish] National Health System (Historia Clínica Digital del Sistema Nacional de Salud, HCDSNS) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient. This history should be available at all authorized locations, but nowhere else: except as needed for treatment, the information is considered confidential and access is restricted.Health Areas
The term "Health Area" (Área de Salud) refers to an administrative district that brings together a functional and organizational group of health centers and primary care professionals. A Health Area may be exclusively focused on primary care or may include specialists as well. Some autonomous communities use different term, such as Direction of a sector (Dirección de sector), or of a comarcaComarca
A comarca is a traditional region or local administrative division found in parts of Spain, Portugal, Panama, Nicaragua, and Brazil. The term is derived from the term marca, meaning a "march, mark", plus the prefix co- meaning "together, jointly".The comarca is known in Aragonese as redolada and...
, district, department, or other territorial unit used in that autonomous community.
Basic Health Zones
Although the autonomous communities differ among themselves in layering subdivisions of their health areas, all eventually come down to a Health Zone (Zona de Salud) or Basic Health Zone (Zona Básica de Salud) as the unit for a primary health care team. In Andalusia, for example, each existing Basic Health Zone takes care of a population between 5,000 and 20,000 inhabitants. The Basic Health Zone is served by a single general hospitalGeneral hospital
A general hospital is a type of medical facility which is set up to deal with many kinds of disease and injury.General hospital may also refer to:*General Hospital, an American soap opera broadcast since 1963...
and specialists' center.
Primary Care
Article 12 of the Law of Cohesion establishes the concept of "primary care," the basic level of patient care that guarantees the comprehensiveness and continuity of care throughout the patient's life, acting as manager and coordinator of cases and regulator of issues. Primary care includes health promotion, health education, prevention of illness, health care, maintenance and recuperation of health, as well as physical rehabilitation and social work. Primary health care includes service provided either on-demand, scheduled, or urgently, both in the clinic as well as in the patient's home.Specialized care
Article 13 of the Law of Cohesion regulates characteristics of health care offered in Spain by medical specialists, which is provided at the request of primary care physicians. This may be in-patient hospital care or out-patient consultation at specialist centers or day hospitals. It includes care, diagnosis, therapy, rehabilitation and certain preventive care, as well as health promotion, health education and prevention of illness whose nature makes it appropriate to handle at this level. Specialized care guarantees the continuity of integrated patient care once the capabilities of primary care have been exhausted and until matters can be returned to that level. Insofar as patient condition allows, specialized care is offered in out-patient consultation and in day hospitals. As of 2010, Spain recognizes fifty distinct medical specialties.Social-health care
Article 14 of the Law of Cohesion defines social-health care (atención sociosanitaria) as the combination of care for those patients, generally those with a chronic illness, whose would benefit from the simultaneous and synergistic provision of health services and social services to increase their personal autonomy, palliate their limitation or hardships, and facilitate their social reinsertion. This group includes:- a) Longterm health care.
- b) Health care connected to convalescenceConvalescenceConvalescence is the gradual recovery and of health and strength after illness. It refers to the later stage of an infectious disease or illness when the patient recovers and returns to normal, but may continue to be a source of infection even if feeling better...
. - c) Rehabilitation after illness
Registered health professionals
2000 data from the INEInstituto Nacional de Estadística (Spain)
The National Institute of Statistics is the official organisation in Spain that collects statistics about demography, economy, and Spanish society. Every 10 years, this organisation conducts a national census. The last census took place in 2001....
(Spain's National Institute of Statistics) counts 616,232 individuals credentialed by a professional association as health care professionals. The largest number of these are nursing professionals; that is also the profession with the highest percentage of women. The following table is a breakdown of some of the INE statistics. No exact breakdown is available to indicate what number of these might be related to mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
and psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
or clinical psychology
Clinical psychology
Clinical psychology is an integration of science, theory and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development...
.
| Type of association | Males | Females | Total |
|---|---|---|---|
| Physician Physician A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments... s |
119,018 | 94,959 | 213,977 |
| Dentist Dentist A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services... s |
14,575 | 11,122 | 25,697 |
| Podiatrists | 2,292 | 2,735 | 5,027 |
| Physiotherapists | 10,102 | 21,127 | 31,229 |
| Nursing Nursing Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death.... professionals |
41,719 | 208,420 | 250,139 |
| Veterinarian Veterinarian A veterinary physician, colloquially called a vet, shortened from veterinarian or veterinary surgeon , is a professional who treats disease, disorder and injury in animals.... s |
16,806 | 11,382 | 28,188 |
| Pharmacist Pharmacist Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use... s |
18,409 | 43,566 | 61,975 |
| Total | 222,922 | 413,321 | 616,232 |
Healthcare centers
Royal Decree 1277/2003, of 10 October, establishes the general bases for authorization of health centers, services and establishments. It defines "healthcare center" (centro sanitario) as the organized combination of technical means and installations in which trained professionals, identified by their official certification or professional qualification, undertake basic health care activities with the purpose of improving people's health. These may be integrated into one or more health services, which constitute its healthcare portfolio.Consultorios
Certain healthcare centers (centros sanitarios) are referred to as consultorios, a term roughly equivalent to British EnglishBritish English
British English, or English , is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere...
"surgery" or American English
American English
American English is a set of dialects of the English language used mostly in the United States. Approximately two-thirds of the world's native speakers of English live in the United States....
"doctor's office." These are offices that, while not full-fledged health centers (centros de salud), nonetheless provide care beyond primary care. Some terms used are consultorios rurales, consultorios locales, abd consultorios periféricos (respectively, rural, local and "peripheral"; that last means a center located in a community other than the main settlement of a municipality
Municipality
A municipality is essentially an urban administrative division having corporate status and usually powers of self-government. It can also be used to mean the governing body of a municipality. A municipality is a general-purpose administrative subdivision, as opposed to a special-purpose district...
), but other terms may exist, analogous to those that refer to various types of health centers.
According to the 2008 National Catalog of Hospitals (Catálogo Nacional de Hospitales 2008), Spain in 2007 had a total of 10,178 consultorios that allowed health professionals to provide more local services than the health centers in their respective zones, with the purpose of bringing basic services closer to people who reside in nuclei dispersed through rural areas that tend to have an older than average population.
Health centers
A health center (centro de salud, distinct from the smaller "healthcare center" centro sanitario) in Spain's SNS is main physical and functional structure devoted to coordinated global, integral, permanent and continuing primary care, based in a team of health care professionals and other professionals who work there as a team.Health centers basically practice the general medicine or family medicine
Family medicine
Family medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
, providing a unity of care in which a specialist in community and family medicine is responsible to provide preventive care, health promotion, diagnosis and basic treatment on an outpatient basis. According to the 2008 National Catalog of Hospitals (Catálogo Nacional de Hospitales), in 2007 Spain had 2,913 health centers.
Specialized centers
Specialized centers are healthcare centers where different health care professionals provide services to particular group identified by common pathologies, age, or other common characteristics. Among these are:Dental clinics: Focused on care of the teeth and mouth.
Centers for assisted human reproduction: Biomedical teams focused on assisted reproductive technology
Assisted reproductive technology
Assisted reproductive technology is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons...
.
Centers for voluntary interruption of pregnancy: Provide abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
services in legally permitted cases.
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
and regional anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
and sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...
. For surgeries that require only brief post-operative care and therefore do not require overnight hospitalization.
Dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
centers: For patients with failed kidney
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
s.
Diagnostic centers: Dedicated to diagnostic, analytic and imaging services.
Mobile health care centers: Carry human and technical means for the purpose of health care activities.
Transfusion
Blood transfusion
Blood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
centers: Carry out all activities related to the extraction and verification of human blood and its components, and of treatment, storage, and distribution.
Tissue bank
Tissue bank
A Tissue Bank, as used in this article, is a term most commonly used to describe an establishment that collects and harvests human cadaver tissue for the purposes of medical research and education....
s: Conserve and guarantee the quality of tissues after they are obtained and until they are used as allografts or autografts.
Medical inspection centers: (Centros de reconocimiento médico), where examinations and other tests of ability are carried out for applicants or holders of medical and other health care permits or licenses.
Mental health centers: Diagnose and treat mental illness on an outpatient basis.
Specialized health care establishments
Specialized health care establishments are private centers that provide a suite of health care products, ranging from medicines to sophisticated prosthesesProsthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
. These establishments are grouped by specialty and, on that account, must have accredited or certified technical personnel. Among these establishments are:
Pharmacies
Pharmacy
Pharmacy is the health profession that links the health sciences with the chemical sciences and it is charged with ensuring the safe and effective use of pharmaceutical drugs...
: Private establishments operated in the public interest, subject to health care planning established by the autonomous communities, which provide the public with basic services recognized in Article 1 of Law 16/1997, of 25 April, that regulates pharmacy services (Ley 16/1997, de 25 de abril, de regulación de los servicios de las oficinas de farmacia).
Botiquines: (singular: Botiquín) are authorized to hold, conserve and dispense medicines and health care products in places where there would be special difficulties of accessibility of a pharmacy.
Optometric offices (Ópticas): Evaluate visual capacity using optometric
Optometry
Optometry is a health care profession concerned with eyes and related structures, as well as vision, visual systems, and vision information processing in humans. Optometrists, or Doctors of Optometry, are state licensed medical professionals trained to prescribe and fit lenses to improve vision,...
techniques; crafting, sale, verification and control of adequate means for the prevention, detection, protection, and improvement of visual acuity
Visual acuity
Visual acuity is acuteness or clearness of vision, which is dependent on the sharpness of the retinal focus within the eye and the sensitivity of the interpretative faculty of the brain....
.
Orthopedia centers: Dispense orthopedic health care products such as prostheses
Prosthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
and orthotics
Orthotics
Orthotics is a specialty within the medical field concerned with the design, manufacture and application of orthoses. An orthosis is an orthopedic device that supports or corrects the function of a limb or the torso...
, technical devices to alleviate loss of autonomy, functionality, or physical capacity.
Audioprosthesis centers: Dispense health care products, intended for the correction of auditory deficiencies, such as hearing aid
Hearing aid
A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer. Earlier devices, known as "ear trumpets" or "ear horns", were passive funnel-like amplification cones designed to gather sound energy and...
s, with adaptation individualized to each patient.
Hospitals
A hospitalHospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
is a health care establishment that provides inpatient care
Inpatient care
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or are have severe physical...
and specialized (and other) care, providing such services as are needed in its geographical area. A hospital can be a single structure or a hospital complex, even including branch buildings off of its main campus; it can also integrate any number of specialized centers.
A similar concept to a hospital is a clinic. In Spain, a clinic (clínica) is a health center, typically a private one, where patients can receive health coverage in a broad range of specialties. Some of these clinics include very up-to-date operating theaters capable of providing minimally invasive surgery, and "hospitalization zones" where patients can recuperate on an inpatient basis. In large Spanish cities, there are numerous clinics. These are the facilities that are normally used by health care professionals whose medical societies cover it: ASISA, Adeslas, etc.
The General Health Law of 1986 establishes that the level of specialized care provided in hospitals and their dependent specialty centers will focus care on complex health problems. Hospital centers will develop, besides their functions strictly related to health care, functions of health promotion, prevention of illnesses and investigation and teaching, in accord with the programs of each area of health, with the object of complementing their activities with those developed by the primary care network.
As elsewhere in the world, the size of hospitals in Spain is often gauged by the number of "installed beds" (camas instaladas). This is the number of hospital beds with fixed locations; at any given time, some beds may be out of commission.
General and specialized hospitals
General hospitals treat a broad range of pathologies and typically provide services including surgery, obstetrics and gynecology, and pediatrics. Other hospitals are more specialized. The following list includes most of the common types of specialized hospitals in Spain, but is not intended to be exhaustive.- Surgical hospitals
- Medical-surgical hospitals
- Maternity hospitals
- Children's hospitals
- Maternity and Children's hospitals (materno-infantil)
- Psychiatric hospitals
- Hospitals for illnesses of the thorax
- OncologicalOncologyOncology is a branch of medicine that deals with cancer...
hospitals - OphthalmicOphthalmologyOphthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
hospitals - TraumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
tological and rehabilitation hospitals - Psycho-physical rehabilitation hospitals
- GeriatricGeriatricsGeriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
and longterm care hospitals - LeprologicalLeprosyLeprosy or Hansen's disease is a chronic disease caused by the bacteria Mycobacterium leprae and Mycobacterium lepromatosis. Named after physician Gerhard Armauer Hansen, leprosy is primarily a granulomatous disease of the peripheral nerves and mucosa of the upper respiratory tract; skin lesions...
and dermatologicalDermatologyDermatology is the branch of medicine dealing with the skin and its diseases, a unique specialty with both medical and surgical aspects. A dermatologist takes care of diseases, in the widest sense, and some cosmetic problems of the skin, scalp, hair, and nails....
hospitals
Health care contracts
Spanish government-run healthcare administrations sign health care contracts (conciertos sanitarios) with privately run entities that provide health care services. They are regulated by the provisions of the General Health Law and the current rules of government contracting. There are some special cases where the relation between the hospital and the managing entity is regulated by a special arrangement called a Convenio de Vinculación or Convenio Singular ("Linkage Convention" or "Singluar Convention"). In CataloniaCatalonia
Catalonia is an autonomous community in northeastern Spain, with the official status of a "nationality" of Spain. Catalonia comprises four provinces: Barcelona, Girona, Lleida, and Tarragona. Its capital and largest city is Barcelona. Catalonia covers an area of 32,114 km² and has an...
there are also centers integrated into the Network of Hospitals for Public Use (Red de Hospitales de Utilización Pública, XHUP) as outlined in the supplement to Decree 124/2008 of the Department of Health of the Autonomous Government of Catalonia (Anexo del Decreto 124/2008 del Departamento de Salud de la Generalitat de Catalunya).
Patrimonial dependency
The patrimonial dependency (dependencia patrimonial) of a hospital (or other health care facility) is the individual or other juridical entity that owns, at least, the building occupied by the facility. Hospitals that are under the dependency of Spanish Social Security belong primarily to the General Treasury of Social Security, although there is a special group within Social Security for the Mutuals of Accidents and Occupational Diseases (Mutuas de Accidentes de Trabajo y Enfermedades Profesionales, MATEP). There are also a few cases where patrimony is shared by two or more public entities on a consortium basis.The 2009 National Catalog of Hospitals contains information about the patrimonial dependency of hospitals, summarized as follows; hospital complexes are each counted here as a single hospital:
| Patrimonial Dependency | Number of centers | Number of beds |
|---|---|---|
| Civil, public (SNS) | 301 | 103,655 |
| Ministry of Defense | 8 | 1,458 |
| MATEP | 22 | 1,741 |
| Private, charitable | 120 | 19,980 |
| Private, non-charitable | 349 | 33,458 |
| TOTAL | 804 | 160,292 |
40 percent of stays in private hospitals are arranged and paid for by the public system.
The 2008 National Catalog of Hospitals gives the following breakdown of types of hospitals.
| Type of care | Number of hospitals | Number of beds | Beds per 100,000 population | Percent in the public system |
|---|---|---|---|---|
| Acute illness | 591 | 131,510 | 290.5 | 72.1% |
| Psychiatric | 90 | 16,028 | 35.5 | 37.5% |
| Geriatric | 119 | 12,945 | 28.7 | 34.2% |
High technology resources
| Type of equipment | Total | Rate per million inhabitants |
|---|---|---|
| X-ray computed tomography (CTC) | 654 | 14.4 |
| Magnetic resonance imaging Magnetic resonance imaging Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures... (MRI) |
417 | 9.2 |
| Gamma camera Gamma camera A gamma camera, also called a scintillation camera or Anger camera, is a device used to image gamma radiation emitting radioisotopes, a technique known as scintigraphy... (GAM) |
232 | 5.1 |
| Hemodynamics Hemodynamics Hemodynamics, meaning literally "blood movement" is the study of blood flow or the circulation.All animal cells require oxygen for the conversion of carbohydrates, fats and proteins into carbon dioxide , water and energy in a process known as aerobic respiration... (HEM) facility |
220 | 4.9 |
| Single photon emission computed tomography Single photon emission computed tomography Single-photon emission computed tomography is a nuclear medicine tomographic imaging technique using gamma rays. It is very similar to conventional nuclear medicine planar imaging using a gamma camera. However, it is able to provide true 3D information... (SPECT) |
46 | 1.0 |
| Digital subtraction angiography Digital subtraction angiography Digital subtraction angiography is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. Images are produced using contrast medium by subtracting a 'pre-contrast image' or the mask from later images, once... (DSA) |
194 | 4.3 |
| Extracorporeal shock wave lithotripsy (ESWL) | 91 | 2.0 |
| Radiation therapy Radiation therapy Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control... with cobalt Cobalt Cobalt is a chemical element with symbol Co and atomic number 27. It is found naturally only in chemically combined form. The free element, produced by reductive smelting, is a hard, lustrous, silver-gray metal.... |
40 | 0.9 |
| Medical linear particle accelerator Linear particle accelerator A linear particle accelerator is a type of particle accelerator that greatly increases the velocity of charged subatomic particles or ions by subjecting the charged particles to a series of oscillating electric potentials along a linear beamline; this method of particle acceleration was invented... (linac) |
160 | 3.5 |
| Positron emission tomography Positron emission tomography Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a... (PET) |
32 | 0.7 |
| Mammography Mammography Mammography is the process of using low-energy-X-rays to examine the human breast and is used as a diagnostic and a screening tool.... |
481 | 10.6 |
| Bone Densitometry Densitometry Densitometry is the quantitative measurement of optical density in light-sensitive materials, such as photographic paper or film, due to exposure to light... |
165 | 3.6 |
| Hemodialysis Hemodialysis In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy... equipment |
3,225 | 71.2 |
Services
Article 7 of the Law of Cohesion establishes the catalog of services of the National Health System, with the object of guaranteeing the basic and common conditions for an adequate level of integrated, continuous health care. Health care services include prevention, diagnosis, therapy and rehabilitation, as well as promotion and maintenance of citizens' health.Article 11 of the law establishes the basic lines of public health services:
- 1. The public health service is the ensemble of initiatives organized by public administrations to preserve, protect and promote the health of the population. It is a combination of sciences, capabilities and attitudes directed to the maintenance and improvement of the health of all persons through collective and social acts.
- 2. The services in this ambit include the following activities: EpidemiologicalEpidemiologyEpidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
information and vigilance. Protection of health. Promotion of health. Vigilance and control of possible health risks derived from the importation, exportation and transit of merchandise and of international travel. Promotion and protection of environmental safety. Promotion and protection of health on the job.
- 3. Public health services are to be exercised with an integral character, from public health structures to administrations and the infrastructure of primary care of the National Health System.
Primary care services
Primary care services constitute the majority of the services of the SNS; this is true of health promotion and education, prevention of illness, hands-on health care, health maintenance, recuperation, rehabilitation, and social work.The following catalog demonstrates preventive activities, health promotion and education, family care and community care as performed in primary care centers.
- Inculcate healthy life habits in adolescents with respect to the use of tobaccoTobaccoTobacco is an agricultural product processed from the leaves of plants in the genus Nicotiana. It can be consumed, used as a pesticide and, in the form of nicotine tartrate, used in some medicines...
, alcoholAlcoholIn chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....
and recreational drugs as well as harmful eating disorderEating disorderEating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. Bulimia nervosa, anorexia nervosa, and binge eating disorder are the most common specific...
s and healthy conduct with respect to sexualityHuman sexualityHuman sexuality is the awareness of gender differences, and the capacity to have erotic experiences and responses. Human sexuality can also be described as the way someone is sexually attracted to another person whether it is to opposite sexes , to the same sex , to either sexes , or not being...
. - Orientation of women during pregnancyPregnancyPregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
and birthBirthBirth is the act or process of bearing or bringing forth offspring. The offspring is brought forth from the mother. The time of human birth is defined as the time at which the fetus comes out of the mother's womb into the world...
, early diagnosis of gynecological cancers and breast cancerBreast cancerBreast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
, detection and care of problems related to menopauseMenopauseMenopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
. Family planningFamily planningFamily planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
. - PediatricsPediatricsPediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...
, including infant and child health care, nutrition, general counsel on child development, health education and childhood accidents. VaccinationVaccinationVaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
s. - Care for adults in risk groups or with chronic conditions. Counsel on healthy life styles and detection of health problems.
- GeriatricsGeriatricsGeriatrics is a sub-specialty of internal medicine and family medicine that focuses on health care of elderly people. It aims to promote health by preventing and treating diseases and disabilities in older adults. There is no set age at which patients may be under the care of a geriatrician, or...
: promotion of health and prevention of illness. Homecare for the housebound. - Detection of violence against womenViolence against womenViolence against women is a technical term used to collectively refer to violent acts that are primarily or exclusively committed against women...
and domestic abuse, as well as child abuseChild abuseChild abuse is the physical, sexual, emotional mistreatment, or neglect of a child. In the United States, the Centers for Disease Control and Prevention and the Department of Children And Families define child maltreatment as any act or series of acts of commission or omission by a parent or...
, elder abuseElder abuseElder abuse is a general term used to describe certain types of harm to older adults. Other terms commonly used include: "elder mistreatment," "senior abuse," "abuse in later life," "abuse of older adults," "abuse of older women," and "abuse of older men."...
, and abuse of the disabled. - Dentistry: Care, diagnosis and therapy, health promotion and education, and illness prevention related to the teeth and mouth.
- Care of terminal patient: integral, individual and continual care either in the home or at a health center.
- Mental healthMental healthMental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
care: prevention and promotion to maintain mental health, in coordination with specialists.
Specialized care
Examples of specialized services are intensive and critical care, anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, defibrillation
Defibrillation
Defibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, but also some forms of hemotherapy
Hemotherapy
Hemotherapy or hemotherapeutics is the treatment of disease by the use of blood or blood derivatives, as in transfusion.It includes various types of connected processes as, for example:*Blood partial transfusion;*Blood total transfusion;...
, rehabilitation, and even nutrition, diet, post-partum treatment, and family planning, especially assisted reproductive technology
Assisted reproductive technology
Assisted reproductive technology is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. It is reproductive technology used primarily in infertility treatments. Some forms of ART are also used in fertile couples for genetic reasons...
. Specialized treatment can also be involved in detecation, prescription and implementation of diagnostic and therapeutic procedures, especially those related to prenatal diagnosis
Prenatal diagnosis
Prenatal diagnosis or prenatal screening is testing for diseases or conditions in a fetus or embryo before it is born. The aim is to detect birth defects such as neural tube defects, Down syndrome, chromosome abnormalities, genetic diseases and other conditions, such as spina bifida, cleft palate,...
in risk groups, diagnosis by imaging, interventionist radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...
, hemodynamics
Hemodynamics
Hemodynamics, meaning literally "blood movement" is the study of blood flow or the circulation.All animal cells require oxygen for the conversion of carbohydrates, fats and proteins into carbon dioxide , water and energy in a process known as aerobic respiration...
, nuclear medicine
Nuclear medicine
In nuclear medicine procedures, elemental radionuclides are combined with other elements to form chemical compounds, or else combined with existing pharmaceutical compounds, to form radiopharmaceuticals. These radiopharmaceuticals, once administered to the patient, can localize to specific organs...
, neurophysiology
Neurophysiology
Neurophysiology is a part of physiology. Neurophysiology is the study of nervous system function...
, endoscopy
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
, lab tests, biopsies
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
, radiotherapy, radiosurgery
Radiosurgery
Radiosurgery is a medical procedure that allows non-invasive treatment of benign and malignant tumors. It is also known as stereotactic radiotherapy, when used to target lesions in the brain, and stereotactic body radiotherapy when used to target lesions in the body...
, renal
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
lithotripsy
Lithotripsy
Lithotripsy refers to the physical destruction of gallstones or kidney stones. The term is derived from the Greek words meaning "breaking stones" .Forms include:* Extracorporeal shock wave lithotripsy...
, dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
, techniques of respiratory therapy
Respiratory therapy
Respiratory therapy is a healthcare profession in which specialists work with patients suffering from either acute or chronic respiratory problems. These specialists are termed Respiratory Therapists in most places internationally but may also be referred to as Respiratory Scientists or...
, organ transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
s and other tissue and cell transplants.
Urgent care
Emergency medicineEmergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
is health care provided in cases where emergency care is needed. Emergency medicine is practiced both in healthcare facilities and at the site of work accident
Work accident
A work accident is a "discrete occurrence in the course of work, which leads to physical or mental harm"...
s, traffic accidents, etc. or in the home of a patient whose condition prevents them from getting to a healthcare facility. Emergency medicine is a 24-hour-a-day service provided, in particular, by physicians and other medical professionals in hospital emergency rooms, but also in ambulance
Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
s, medical evacuation helicopter
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
s, etc. en route to such facilities.
Pharmaceutical services
Medications in Spain are regulated under Law 29/2006 of 26 July, of guarantees and rational use of medications and health care products (Ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios). Ono of the SNS's priorities with respect to pharmaceuticals is to teach patients to make rational use of medications and to avoid, insofar as possible, unsupervised self-medicationSelf-medication
Self-medication is a term used to describe the use of drugs or other self-soothing forms of behavior to treat untreated and often undiagnosed mental distress, stress and anxiety, including mental illnesses and/or psychological trauma...
.
Pharmaceutical services include medications and health products are provided to patient according to their clinical needs, in precise doses and over an adequate period at the least cost possible. Medications are dispensed by pharmacies, each of which is headed by a licensed pharmacist.
All medications to be prescribed to patients must either be authorized and registered by the Spanish Agency of Medications and Health Care Products (Agencia Española de Medicamentos y Productos Sanitarios), or must be formulations prepared by licensed pharmacists. Exceptions to this requirement are cosmetics, dietetic products, dental products and other sanitary products, as well as drugs classified as advertising, homeopathic
Homeopathy
Homeopathy is a form of alternative medicine in which practitioners claim to treat patients using highly diluted preparations that are believed to cause healthy people to exhibit symptoms that are similar to those exhibited by the patient...
medicines, and articles and accessories advertised to the general public and where the purchaser pays the full price (that is, no money comes from SNS-related sources).
Copayment
In the United States, the copayment or copay is a payment defined in the insurance policy and paid by the insured person each time a medical service is accessed. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after...
when they acquire pharmaceuticals. The distribution of the cost is as follows:
- Medications dispensed as part of hospitalization are free to the patient.
- Other prescriptions are financed as follows
- Most pensionerPensionerIn common parlance, a pensioner is a person who has retired, and now collects a pension. This is a term typically used in the United Kingdom and Australia where someone of pensionable age may also be referred to as an 'old age pensioner', or OAP. In the United States, the term retiree is more...
s and their beneficiaries receive their medicines for free. Pensioners who were public functionaries and are protected by MUFACE (Mutualidad General de Funcionarios Civiles del Estado) pay 30 percent of prescription cost. - Non-pensioners pay 40 percent of the price of prescription drugs. Active functionaries protecte by MUFACE pay 30 percent.
- Communities affected by toxic oil syndromeToxic oil syndromeToxic Oil Syndrome or simply Toxic Syndrome was the name given to a disease outbreak in Spain in 1981, which killed over 600 people. Its first appearance was as a lung disease, with unusual features: though the symptoms initially resembled a lung infection, antibiotics were ineffective...
and patients with AIDSAIDSAcquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
receive their prescriptions for free. - Individuals with toxic treatments pay 10 percent, up to a maximum of 2.64 euroEuroThe euro is the official currency of the eurozone: 17 of the 27 member states of the European Union. It is also the currency used by the Institutions of the European Union. The eurozone consists of Austria, Belgium, Cyprus, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg,...
s per prescription.
- Most pensioner
Orthoprosthetic and complementary services
Orthoprosthetic services can be permanent surgically implanted prosthesesProsthesis
In medicine, a prosthesis, prosthetic, or prosthetic limb is an artificial device extension that replaces a missing body part. It is part of the field of biomechatronics, the science of using mechanical devices with human muscle, skeleton, and nervous systems to assist or enhance motor control...
, external prostheses, special orthoses and prostheses including hearing aid
Hearing aid
A hearing aid is an electroacoustic device which typically fits in or behind the wearer's ear, and is designed to amplify and modulate sound for the wearer. Earlier devices, known as "ear trumpets" or "ear horns", were passive funnel-like amplification cones designed to gather sound energy and...
s and earmold
Earmold
An earmold is a device worn inserted into the ear for sound conduction or ear protection. Earmolds are anatomically shaped and can be produced in different sizes for general use or specially cast from particular ear forms. Some users specify how hard or soft they want their mould to be, an...
s for children up to age 16 suffering from bilateral hearing impairment
Hearing impairment
-Definition:Deafness is the inability for the ear to interpret certain or all frequencies of sound.-Environmental Situations:Deafness can be caused by environmental situations such as noise, trauma, or other ear defections...
s.
"Complementary services" include complex dietary therapies, vehicles for invalids, and home oxygen therapy
Oxygen therapy
Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care...
.
Health care transport
The health care transport infrastructure transports people who are ill, accident victims, or otherwise in need of medical attention. It includes ambulanceAmbulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient...
s, as well as air ambulance
Air ambulance
An air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
s: helicopters and airplanes whose interiors are specially modified for the purpose. For most purposes, of course, ground transport is preferred, but sometimes distances or the difficulty of reaching particular locations make air transport more practical.
Demographics of Spain
According to data from the National Institute of StatisticsInstituto Nacional de Estadística (Spain)
The National Institute of Statistics is the official organisation in Spain that collects statistics about demography, economy, and Spanish society. Every 10 years, this organisation conducts a national census. The last census took place in 2001....
(Instituto Nacional de Estadística, INE), as of January 1, 2009, Spain has a population of 46,754,807, of whom 23,116,988 (49,44%) are male and 23,628,919 (50.56%) female. In recent years, this population has been increasing slowly but progressively. In the last decade, the increase has been largely through immigration: 5,268,762 Spanish residents are foreigners.
These numbers count only citizens and legal immigrants. The health care system muc also provide services for thousands of illegal immigrants and for the many tourists who visit Spain each year.
Population pyramid
Analysis of the population pyramid shows that- 19 percent of the total population is under 20 years of age.
- 32 percent of the total population is 20 to 40 years of age.
- 28 percent of the total population is 40 to 60 years of age.
- 21 percent of the total population is at least 60 years old.
This structure is typical of a modern demographic regimen
Demographic transition
The demographic transition model is the transition from high birth and death rates to low birth and death rates as a country develops from a pre-industrial to an industrialized economic system. The theory is based on an interpretation of demographic history developed in 1929 by the American...
, with an evolution toward an aging population and a declining birth rate
Birth rate
Crude birth rate is the nativity or childbirths per 1,000 people per year . Another word used interchangeably with "birth rate" is "natality". When the crude birth rate is subtracted from the crude death rate, it reveals the rate of natural increase...
. This means that Spain has to expect an increase in use of the services that are targeted at older adults. This effect is further exacerbated by a steadily increasing life expectancy
Life expectancy
Life expectancy is the expected number of years of life remaining at a given age. It is denoted by ex, which means the average number of subsequent years of life for someone now aged x, according to a particular mortality experience...
.
| Graphic from the Spanish-language Wikipedia, based on 2009 data from the INE Instituto Nacional de Estadística (Spain) The National Institute of Statistics is the official organisation in Spain that collects statistics about demography, economy, and Spanish society. Every 10 years, this organisation conducts a national census. The last census took place in 2001.... |
See also
- National Transplant Organization achieved the highest rate of donors in the world in 2006.
- Social Security in SpainSocial Security in SpainThe Social Security system in Spain is its principal system of social protection. The concept of Social Security first appeared in Spain in 1883 under the Committee for Social Reform, it was expanded several times during the twentieth century and finally the right to social security was enshrined...