EXPLORING ON GLOBAL PUBLIC HEALTH: THE SPANISH HEALTH SYSTEM, WHAT NIGERIA CAN LEARN FROM IT
BY OLUSEYI ELIZABETH ODUDIMU
A recent report (World Health Organization 2016a) found that the total population in Spain is 46, 348, 000 and non-communicable diseases such as cardiovascular disease, Cancers and Chronic respiratory diseases have been the major health issues since the 1970s (WHO,2016b). WHO (2016a) data estimated 91% of all deaths rate of which the proportional mortality rate from cardiovascular disease is 28%, Cancers 26% and chronic respiratory disease 10%; this shows that the three diseases remain the top three causes of death in Spain. WHO (2016a) reported a total of 382, 700 untimely deaths from non-communicable diseases and shows a proportion of 191, 300 males and 191, 400 females.
Smoking takes the highest proportion among men while drug, and alcohol consumption, high blood pressure, Obesity and dietary disorders are also recorded as contributing factors. Women’s top risk factor is Obesity, even as high blood pressure, dietary disorders, high fasting blood sugar, smoking, and drug and alcohol consumption also contributed to it. Between the age of 30 to 70 years, 14 males and 6 females died untimely of NCD in 2016. However, this report shows gender dissimilarity in the risk factors (WHO, 2016a).
Delgado et el. (2018) claim that between 2009 and 2015, the GDP per capita decreased by 20% in Spain and reversed in 2016 with GDP per capita reaching US$ 26 530 as the unemployment rates rise, household incomes also reduced which causes an increase in the poverty rate to 28.6% in 2015 and increases the level of the citizen exposures to the risk factors. Delgado et el. (2018) state that decreased inequalities in healthcare services and increases in education and income alleviate the risk factors of cardiovascular in 2016.
There has been a reduction in the mortality rate since 2000, Spain’s life expectancy at birth increased to 83 years in 2015 and this is considered the highest among European Union countries (State of Health in the EU, 2017).
In terms of disability-adjusted life years (DALYs), cardiovascular disease is among the five top causes of morbidity and mortality in Spain and when data was compared with other neighbouring countries in Europe between 1990 and 2016, it has always been among the 10 main causes of death (Barcelona Institute for Global Health, 2018). Out of 1,000 live birth, only 3 have the Probability of dying (WHO, 2018).
To maintain sustainable improvement WHO (2018) establishes certain preventative measure and the Spanish government follow this course by responding to their health system frequently, considering that it is an essential component to deal with the NCD burden and recover the quality of life. They prioritize, and provide adequate resources and staff on regular basis to ensure that the system attends to NCDs with immediate effects and this scheme has helped prevent, control and provides all the citizen’s access to affordable quality medicines and technologies.
However, this Health care structure and its legal framework required ongoing financing, efficiency and health equity and that is the reason they increase the economic gap through an increase in tax revenues (WHO, 2018). NCD remain one of the causes of poverty, which is why a reduction of the prevalence of poverty is used to measure well-being and improvement. Global health indicators have been improving steadily in Spain and they have been able to meet life expectancy as one of the highest in the world mortality rates have been decreasing and able to meet a similar rate to the EU average rate (WHO, 2018).
Spain is a parliamentary monarchy and the political organization is made up of central states and 17 highly decentralised regions (Comunidades Autónomas autonomous communities) with their respective governments and parliaments. However, a Comprehensive health system was adopted as the management scheme used for public health care in 1885 (Malhotra, 2009). In the early centuries, vaccines and hygiene campaigns were used as the preventive measure to mobilize social and medical resources to control and manage infection in Spain and 1935 marked a turning point in medicine industrialization; Sulpha prontosil-drug was produced by the chemical research industry to fight infection in pests. The chemotherapeutical transformation from a natural product to industrially manufactured synthetics was authorized to be used during Great War (Santesmases, 2017).
In the 1930s, death caused by undernourishment and infection declined, within 1933 and 1944, penicillin reached Spain for healing and it was approved and used as a clinical miraculous capacity intervention to cure deadly infections and wounds (Santesmases, 2017). Infection increased again in the early 40s and declined as the primary cause of death in 1946. Health care and social security are shared areas of responsibility Since the 1970s, Gomez and Nicolas (2007) affirm that after the death of the dictatorship government, they returned to parliamentary, their health care system and principles changes to social security scheme paid by employers, employees and with additional support by a network of health care centres owns by the organization and this pre-dictatorship causes tough unfairness in-hospital care and democracy unleashed the latent demand for better health care system and this brought about changes in legislation and administration. In a modern hospital, primary and preventive in the public sector were underdeveloped, the medical practitioners use remote passages, without administrative or diagnostics support and they can only attend to patients for just two hours per day (Gomez and Nicolas 2007). Ministry of Health was created and the 1978 constitution guarantees widespread coverage and free healthcare access to all Spanish nationals this established the right to protection of health, provision of a comprehensive benefit, and public authority to organised safeguarding through the preventive measure. Spanish 1978 Constitution, Article 43 instituted the right to health safety for all citizens (State of Health in the EU 2017). I985 emerged with a comprehensive plan created by The Ministry of Health and Care Service, it was a national plan to tackle the complex phenomenon of drug addiction and they coordinated every activity of each department of the states, seventeen autonomous, regions, local administration, and non-governmental organization working with drug addicts (Gomez and Nicolas, 2007).
Spain’s General Healthcare Act of 1986 transforms social security networks into the Spanish National Healthcare System (“Instituto Nacional de la Salud”). Spanish established two arrangements to modify social-economic equality in access to health care services (Malhotra, 2009). The act was regulated and implemented by General Health Act in 1986 and facilitated the citizen right to healthcare services (State of Health in the EU 2017).
Richard et al (2004) say that during the year 1987, the Inter-territorial Care Policies of the National Health System (ICNPHS) was created to Harmonised and manage the Health care service of the administration of the state, seventeen autonomous communities, local corporations, hospital staff, privately contracted people and groups providing health care service.
According to Malhotra (2009) in January 2002, they implemented political delegation and health care management to the autonomous communities which provide the citizen with the right, equity and free access to health protection and their pursuit of health service sustainability, as well as the price control over pharmaceutical expenditure which is still effective till date. 2003 National Health System Act emerged with consistency and high standard quality (State of Health in the EU 2017). July 2004 establishes the European Health Card and the presentation of the card will give EU migrants access to medical care in Spain( Malhotra, 2009).2006 Act certified the Rational Use of Medicines(State of Health in the EU 2017). 2011 Public Health Act and Royal Decree-Law on Emergency Measures were created to assess the Sustainability of the National Health System. 2012 movement was put forward for the improvement of Quality and Safety (State of Health in the EU 2017).
Malhotra (2009) states that compared to every EU country, the Spanish enjoyed the longevity of life and a good health system and this is because of their template climate, Mediterranean diet, fish, olives, salad and red wine. Expenditure has grown steadily in Spain, the government are becoming increasingly concerned with achieving higher levels of efficiency matching financial sustainability with high quality of delivery and they set a maximum price for expenditure as a cost control mechanism (State of Health in the EU 2017). Spanish Health system performances have always been efficient, attentive to equity, responsive to the citizen’s expectations and ensuring financial protection. Furthermore, their first system benefited specialized outpatients and inpatients with financial support and zero co-payments for pensioners and the disabled, there is also a reduction of drugs for those with chronic diseases. (Gomez and Nicolas, 2007).
Considering the logical development, performances and structure of the Spanish health system from historical perspectives, they are so different from other European countries like Australia, Belgium, France, Germany, Luxembourg, Netherlands and Switzerland that perceive Social Health Insurance as a preferred building block and advantageous policy, but Spanish policy look beyond country arrangements and focus more on long-term prospects (Richard et al, 2004). Richard et al (2004) state that Social Health Insurance, is private funding and delivery is self-regulated, managed by participants and was perceived as secure in financial terms that brought about extra-ordinary stability and longevity to Western Europe. Western Europe believes that SHI enhanced collective responsibility, improved social solidarity and help them produce appropriate policy responses and measurable results (Richard et al, 2004). On the other side, the Spanish taxation health system is considered a transparent contribution and income-related premium that automatically covered family members and this subsequently shapes the policies and programmes of the funding and project delivery of their health system from political crisis inbuilt in public budgeting; however, many people register with Private Health Insurance as personal insurance to avoid long waiting and this also leads to the difference in access to health care and causes inequality, as the rich are more favoured because of their high income (Malhotra, 2009).
by and large, Spanish health status (Sistema Nacional de Salud) keeps on developing, 71% of public disbursement comes through taxation and they have the highest life expectancy in the European Union that covers 99.1% of the population (Delgado et al, 2018). Although some structural reforms may be required to improve chronic care management and the reallocation of resources to high-value interventions, they need to implement gender‐specific interventions (World Health Organization, 2018). They should also reckon with other specific approaches to deal with the disproportionate morbidity among women and disproportionately high mortality among men, building on the growing knowledge provided by gender‐based medicine and research. Complementary medical services such as fertility treatments or sex reassignment surgery are paid with regional funds; however, this process can substantially affect the regional purse, and they should consider this package the patient’s responsibility (World Health Organization, 2018). Dental care is not classified as emergency case and preventive measures for children’s dental care differ across regions, they also need further improvement in the aspect of the health care plan (State of Health in the EU, 2017).
Delgado, B.E. et el. (2018) ‘Health Systems in Transition Spain: Health system review (20) 2 P22 Available at http://www.euro.who.int/__data/assets/pdf_file/0008/378620/hit-spain-eng.pdf?ua=1 ( Accessed: 6 November 2019)
Gomez, P.G. Nicolas, L.A. (2007)The Evolution of Inequity in Access to Health Care in Spain:1987-2001. 1st Edition. Spain: Fundacion BBVA Publisher.
Malhotra, U. ( 2009) Solving the American Health Care Crisis: Simply Common. 1st Edition. Bloomington, New York: iUniverse Sense Publisher. Available at: https://books.google.co.uk/books?id=HFhb8GiqTOsC&pg=PA79&dq=spanish+health+system&hl=en&sa=X&ved=0ahUKEwj2wurbgdnlAhXsSxUIHU8xCpgQ6AEIPzAD#v=onepage&q=spanish%20health%20system&f=false( Accessed: 7 November 2019)
Richard, B.S. et al (2004) Social Health Insurance Systems In Western Europe: European Observatory on Health Systems and Policies series. 1stEdition. United Kingdom: McGraw-Hill Education Publisher.
Santesmases, J.M. (2017). The Circulation of Penicillin in Spain: Health, Wealth and Authority: Medicine and Biomedical Sciences in Modern History. 2nd Edition. Spain: Springer Publisher
State of Health in the EU: (2017) Spain Country Health Profile. Available at: https://ec.europa.eu/health/sites/health/files/state/docs/chp_es_english.pdf (Accessed: 6 November 2019)
World Health Organization (2018) Health Systems Respond to NCDs: Experience in the European Region Sitges, Spain. Available at: http://www.euro.who.int/__data/assets/pdf_file/0020/370325/outcome-statement-sitges-eng.pdf
Access (06 November 2018)
World Health Organization (2016a) Spain NCD profile. Available at: https://www.who.int/nmh/countries/esp_en.pdf?ua=1 (Accessed: 7 November 2019)
World Health Organization (2016b) Spain profile. Available at: http://www.euro.who.int/en/countries/spain (Accessed: 7 November 2019)
World Health Organization (2018) Spain profile. Available at: https://www.who.int/countries/esp/en/
Barcelona Institute for Global Health (2018) Available at: https://www.isglobal.org/en/-/cardiopatia-isquemica-demencias-e-ictus-se-situan-como-las-principales-causas-de-muerte-en-espana(Accessed: 8 November 2019).