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EuropeSpain’s health system more likely to protect people from financial hardship than...

Spain’s health system more likely to protect people from financial hardship than others in Europe

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Spain’s health system more likely to protect people from financial hardship than health systems in most other European countries, new WHO report finds

A new report by WHO/Europe finds that people in Spain are less likely to suffer financial hardship because of health-care costs than people in most other European countries.

Despite a worsening economic situation during and after the 2008 financial crisis, only a small share of households currently experience financial hardship when using health services in Spain. This, the report shows, is thanks to the protective design of health coverage in the country’s National Health System (NHS).

“Health care is a fundamental right and should never leave people out of pocket. I am pleased to see that Spain is leading the way in our region. These are positive and encouraging findings, showing that limiting the use of co-payments, and practical measures such as reducing co-payments for medicines for chronic conditions, exempting disadvantaged groups and introducing income-based caps, go a long way in protecting Spanish households from financial hardship,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe, during a virtual press conference launching the report.

The report is authored by a group of Spanish experts with various affiliations, including the Aragon Health Sciences Institute (IACS).

What protects people from financial hardship in Spain?

The financial crisis in Spain had a significant effect on people’s ability to pay for health services, the report finds. Between 2008 and 2014, catastrophic health spending (out-of-pocket payments that are large in relation to a household’s capacity to pay for health care) increased.

The report has found that the following aspects of NHS coverage policy are most likely to protect people from financial hardship:

  • The basis for people’s entitlement to NHS coverage is residence.
  • The NHS benefits package covers a relatively wide range of health services, with very little regional variation in benefits and an even distribution of health centres across the country.
  • Many health services are free at the point of use: there are no co-payments for consultations, diagnostic tests or inpatient care.
  • When co-payments are applied, there are many protective measures, such as: reduced co-payments and a cap of €4.24 per item for most prescriptions for chronic conditions; exemptions from co-payments for disadvantaged groups of people, which have been expanded since 2020; and an income-based cap on co-payments for prescriptions for most pensioners.

Existing gaps and WHO recommendations

Despite the strengths of NHS coverage policy, the new report finds that there are important gaps in coverage. NHS coverage of dental and optical care is limited, which leads to financial hardship for some people and explains the relatively high level of unmet need for dental and optical care in Spain.

Waiting times for secondary care consultations and surgery are another long-standing and growing challenge.

“There is room for improvement,” the report’s authors said. “Better access and financial protection will involve expanding NHS coverage of dental and optical care, extending caps on co-payments to working-age people, renewed efforts to reduce waiting times and steps to mitigate administrative barriers to access for undocumented migrants and asylum seekers.”

In the report, a series of policy recommendations outline ways to improve access and financial protection in Spain.

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