Health Care in Spain in Comparison to the USA
Introduction
Spain covers an area of 505,955 km2. Due to its comparatively large size in Europe, it is the third largest country. However, the country exhibits one of the lowest fertility rates in Europe. In 2007, it stood at 1.4 children per woman, thus reflecting a slight increment in the fertility rate in comparison to rates witnessed in early 2000s. An influx of immigrant population has been responsible for the population increase. Spain has also registered one of the highest life expectancies in the region. For instance, the expectancy stood at 77.8 and 82.2 for men and women respectively in 2007. Respiratory diseases, cardiovascular diseases, and cancer have constantly been major causes of mortality in the country. This paper offers a comparison of the healthcare systems in the USA and Spain. It is valid to note that Spain manages its healthcare system in a more efficient way as compared to the USA. Proper management of its healthcare system is responsible for associated positive results.
Health Statistics and Costs: Comparison between the USA and Spain
On the one hand, Spain registers the lowest mortality rate from the three causes mentioned above in the entire European Union. Furthermore, there has been a tremendous improvement in child and maternal health indicators. The indicators encompass maternal, perinatal, and neonatal mortality rates. Scores of the indicators are below the average scores for the EU. On the other hand, the United States had a population of 295,734,000 individuals in 2005. 26%, 67%, and 12.4% of the population was comprised of citizens aged between 0-14, 15-64, and over 64 years respectively. The population growth rate was 0.93% with an associated birth rate of 14.14/1000. The country exhibited a death rate of 8.25 per 1,000 with the infant mortality rate of 6.5 per 1,000. Male and female life expectancy figures were 74.89 and 80.67 years respectively. The USA registered a birth rate of 2.08 children per woman with a net immigration rate of 3.31 immigrants per 1,000. Noted HIV prevalence was 0.6% per 950,000 individuals (Holtz, 2008).
Spain displays positive performance in terms of lifestyle factors that determine the individual’s health status. To be precise, there has been a constant reduction in the number of smokers (García-Armesto et al., 2010). The USA has also noted an overall improvement in the health condition of its citizens. Improvements originate from increased healthcare funding, health research, and programs devoted to public health and health education. The past 50 years have witnessed a period of disease eradication. Reduction in heart-related deaths is attributed to healthcare education pertaining healthy lifestyles. The education entails smoking cessation campaigns, proper diets and medication used to lower cholesterol levels, and modern technology for performing heart surgery and related procedures.
However, Spain’s performance in respect to alcohol consumption is dismal. Hazardous drinking has affected 7% and 3% of men and women respectively. Spain has also noted increasing cases of overweight and obese individuals, corresponding to 15.6%. The figure is twice the rate that was witnessed among adult individuals in 1987 (7.4%). In 2006, 37.8% of Spanish adult persons had the BMI of between 25 and 30 (30% women and 45% men). The percentage of individuals that were physically active during their leisure time was approximately 60%. 20% and 10% of children aged between 2 and 17 years were overweight and obese respectively. Observations are similar in the USA. Despite dedicated healthcare efforts aimed at promoting healthy lifestyles, 25% and 20% of American men and women respectively continue smoking. Antiretroviral medications have been responsible for a decline in the number of HIV/AIDS deaths. Safety work, as well as home and travel conditions have lowered the amount unintentional injuries and deaths. Immunizations have also reduced the number of deaths caused by infectious diseases such as mumps, rubella, and measles. Prevalent risk activities include obesity, physical inactivity, and excessive weight. Overall cancer rates have declined and stabilized for both males and females.
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There are two features that characterize the SNS: complete healthcare evolution in all regions of Spain and universal healthcare access for all Spaniards. Spain has displayed an upward trend in health expenditures. The public sector funds most of the expenditure. Private insurance caters for approximately 6% of the expenditure. The country spends 8.3% of its GDP on health care, which is a percentage below the EU15 average. The figure yields a corresponding per capita expenditure of $2,267 (García-Armesto et al., 2010). Looking at healthcare expenditure in the USA, it is evident that it leads other countries in terms of healthcare spending as a percentage of its GDP. For instance, the expenditure amounted to 15.3% in 2005.
Healthcare Financing: Comparison between the USA and Spain
Public sources are major funders of the Spain’s healthcare expenditure. However, in the USA funders of the healthcare system include healthcare purchasers such as the government, individuals, and employers. Other funders include medical insurance companies, the government through Medicaid and Medicare programs, insurers, and purchasers. Even though Spain noted a decline in funding from public sources between 1980 and 2000, the last decade has witnessed an expenditure of 71%. Private insurance funding stands at 6% with out-of-pocket-payment accounting for 21% of the total healthcare expenditure, reflecting a downward trend (García-Armesto et al., 2010). It suffices to state that Spain’s healthcare funding has been a collective responsibility funded by public funds, private insurance, and OOP payments.
In turn, 75% of American individuals aged below 65 years purchase medical insurance covers. Employers purchase private insurance covers. Medicare, a program that is funded by the federal government, covers disabled and old persons. Medicaid covers individuals and families that have a low income. The program obtains funding from both state and federal governments. In 2003, 15.2% of Americans did not have health insurance (Holtz, 2008).
It is evident that Spain uses public funds as the main source of financing for healthcare system whereas employers take the burden of healthcare financing in the United States. Individuals covered by Medicare and Medicaid programs and government employees represent the proportion of American citizens with a health insurance purchased by the government. The percentage is far below the one in Spain where most funding comes from public funds. In addition to high prices of drugs and medication in the USA as compared to Spain, it is appropriate to state that Spain’s healthcare system seems to be more efficient than the US one.
Healthcare Administration: Comparison between the USA and Spain
Spain’s healthcare administration has undergone a transformation from a centralized model of planning, provision, and legislation of healthcare services. The transformation of the SNS has yielded the devolution of healthcare competences to all Spanish regions. The devolution has led to emergence of 17 regional health departments or ministries. Regional ministries are responsible for organization and delivery of healthcare services within their territorial boundaries. As a result, regional administrators determine healthcare expenditure. In turn, both federal and state governments regulate the healthcare system in the USA. The federal government cedes the state government with the responsibility to regulate healthcare systems. Regulation entails licensing of providers of healthcare services and pharmaceuticals. The state government also regulates health insurance to ensure that insurance companies cover particular medical procedures.
In Spain, powers of the Ministry of Health and Social Policy are limited. The national ministry is responsible for the legislation of pharmaceuticals, as well as ensuring equity in the functionality of the country’s health services and defining devolved resources. It is responsible for guaranteeing quality and overall monitoring of the performance of regional ministries (García-Armesto et al., 2010). However, the mandate of the state is limited to healthcare services that are self-funded or funded mostly by employers in the USA. The Department of Health and Human Services oversees all healthcare agencies owned by the federal government. Governments of states also maintain their respective health departments (Holtz, 2013).
Healthcare Personnel and Facilities: Comparison between the USA and Spain
Spain’s network of primary health care is mainly comprised of salaried professionals employed in the public sector. In 2008, there were 804 hospitals in Spain. The SNS managed 40% of the facilities, while 60% were private health facilities. Variability is prevalent in the distribution of healthcare resources in Spain. Territorial size and population dispersion are factors that determine resource distribution. For instance, some areas contain up to 211 BHZ whereas others have only 1. There exist approximately 5,700 hospitals in the USA, 70% of which are non-profit facilities. Other regions also have government and for-profit hospitals that are owned by private individuals or organizations. The public can access public healthcare facilities. Permanent and field hospitals are also available for active military persons.
Spanish health centers and local medical offices are premises used in the provision of healthcare services. Health centers can perform surgeries due to existence of multi-professional teams consisting of family doctors, social workers, nurses, and pediatricians. Other surgical professionals and facilities may include dentists, physiotherapists, laboratory personnel, and diagnostics resources. A health center has at least two PCTs. Schedules for healthcare activities run from 8:00 to 21:00 during weekdays. Home and emergency visits are also available. LMOs are meant for rural areas to serve less-populated areas (García-Armesto et al., 2010). In the USA, hospitals are mainly meant to provide in-patient services though they sometimes offer out-patient services as well. Specialty clinics, hospice services, and prenatal clinics are intended to provide specialized healthcare services. The personnel system includes both international graduates and graduates of the medical education system (Holtz, 2013).
Access and Inequality Issues: Comparison between the USA and Spain
In 2009, the SNS achieved 99% coverage of the country. A high percentage implies that the majority of Spanish citizens have access to healthcare services. Inequalities have arisen from differences in per capita expenditure among regions. Disparities have led to unequal development of the system among territorial regions. However, due to an increase in healthcare costs, a good number of US citizens live without health insurance, thus escalating chances of having reduced healthcare access. Main factors influencing healthcare access are income and availability of healthcare providers.
In Spain, income differences do not yield differences in the healthcare access in the event of a similar need. However, horizontal equity differences in terms of specialist visits arise since purchase of a private insurance depends on income. In turn, in 2002 about 17% of US citizens below the age of 65 years could not afford health insurance. Socioeconomic factors, health practices, stress, discrimination, healthcare access, and environmental access lead to emergence of existing disparities in the USA.
