This four-page summary report from WHO gives a snapshot of financial protection in Spain. It provides facts and figures indicating a high burden from financial hardship when people in Spain use health services and pay out of pocket.
The document, titled “Can people afford to pay for health care? New evidence on financial protection in Spain: summary”, became available at WHO website on June 14, 2022. It utilizes data from annual household budget surveys (2006–2019) by Spain’s National Statistics Institute and data on unmet healthcare needs.
Key findings from this summary report by WHO include the following:
- Incidence of Catastrophic Health Spending:
- Catastrophic spending is most prevalent in the poorest fifth of the population across all years studied.
- Between 2006 and 2019, catastrophic spending shifted from older and retired households to households led by working-age individuals (35–50 years), including employed and unemployed people and families with children.
- In 2019, about 1.6% of households (300,000 households) experienced catastrophic health spending, up from 1.0% in 2006.
- Similarly, 0.8% of households (150,000 households) were impoverished or further impoverished after out-of-pocket payments, increasing from 0.2% in 2006.
- The rise in catastrophic health spending between 2008 and 2014 coincided with the global economic crisis, which reduced the financial capacity of households to pay for healthcare, especially among poorer groups.
- Healthcare Services Most Likely to Cause Catastrophic Spending:
- On average, dental care and medical products drive catastrophic health spending.
- Among the poorest quintile, outpatient medicines are significant contributors.
- Unmet Need for Dental Care:
- Unmet needs for dental care increased sharply during the economic crisis and remain substantially higher than the EU average, with pronounced socioeconomic inequalities.
- Waiting Times:
- The economic crisis exacerbated already significant issues with waiting times for secondary care and some surgeries.
Spain’s Comparative Standing in Europe:
Despite setbacks during the economic crisis, Spain maintains one of the lowest rates of catastrophic health spending in Europe, much lower than expected given its reliance on out-of-pocket payments. This is due to strengths in the Spanish National Health System (NHS):
- Entitlement: Access to the NHS is based on residence, including undocumented migrants.
- Benefits Package: The NHS offers a wide range of services with minimal regional variation, and health centers are evenly distributed.
- Protective Co-payment Policies:
- Exemptions for disadvantaged groups, expanded further in 2020.
- Income-based caps on co-payments for pensioners.
- Reduced co-payments and caps for chronic outpatient medicines (€4.24 per item).
Gaps in Financial Protection:Despite the NHS’s strengths, gaps in coverage remain significant:
- Dental Care and Medical Products:
- Dental care, optical care, and hearing aids are excluded from the benefits package, driving much of the financial hardship.
- Over time, outpatient medicines and diagnostic tests have contributed more to catastrophic spending.
- Co-payment Design:
- Co-payments, introduced in 2012, disproportionately impact poor households.
- There are no exemptions for children, no cap on co-payments for children or working-age individuals, and insufficient protections for vulnerable populations.
- Waiting Times:
- Persistent delays in secondary care and surgery undermine timely access to services.
WHO advises the following to improve financial protection in Spain:
- Expand Benefits Coverage:
- Include dental care, optical services, and hearing aids in the NHS benefits package to reduce out-of-pocket spending.
- Enhance Co-payment Protections:
- Introduce caps and exemptions for children and working-age individuals.
- Strengthen financial protections for the poorest households.
- Reduce Waiting Times:
- Invest in addressing systemic delays in secondary care and surgeries.
- Focus on Vulnerable Groups:
- Tailor policy changes to reduce the disproportionate burden on the poorest quintiles and working-age families.
Spain’s NHS exemplifies how robust public healthcare systems can mitigate financial hardship, but addressing persistent gaps will be crucial to strengthening financial protection for all.