Organization of the Health Care System in Spain

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1 Organization of the Health Care System in Spain Patricia Santa Olalla Peralta Dirección General de Salud Pública Ministerio de Sanidad y Consumo Viral Hepatitis Prevention Board Meeting Madrid, November 23, 2006

2 Spain: Administrative Organization 1976: Parliamentary monarchy 1978: Spanish Constitution ADMINISTRATIVE ORGANIZATION : 50 PROVINCES 17 AUTONOMOUS COMUNITIES 2 AUTONOMOUS CITIES PARLAMENTS ELECTED BY DIRECT VOTE REGIONAL GOVERNMENTS

3 Background Spanish Constitution of 1978 Article 41 : Public regime of the Social Security Article 43 : Right to health protection and health care

4 Legal framework The main principles governing the exercise of this right are regulated by the General Health Act 14/1986, as follows: Public funding, with universal, free health services at the time of use Devolution of health affairs to the Autonomous Communities Provision of holistic health care, aiming to achieve high quality, with proper evaluation and control Inclusion of the different public health structures and services in a National Health System (NHS)

5 Spanish National Health System: Coordination General Health Act 14/1986 of 25 April: specifies the tools for collaboration creates the National Health System s Inter- Territorial Board as the coordinating body. Act 16/2003 of 28 May on Cohesion and Quality in the National Health System

6 Spanish National Health System: Coordination DECENTRALIZATION - COORDINATION State Administration Autonomous Communities Administration Government Government Inter- Territorial Board Presided by the Health Minister Commissions, Boards and Working Groups

7 Spanish National Health System National Health System (NHS): Made up of both the State and Autonomous Community Health Departments Covers all the health functions and services for which the public authorities are legally responsible.

8 Spanish National Health System Health care in Spain is a non-contributory benefit. paid through taxation included in the general budget for each Autonomous Community The services offered include: preventive care, diagnostic and therapeutic techniques, rehabilitation, health promotion and maintenance

9 Spanish National Health System Pharmaceutical services cover: drugs and health products. Unlike other services, pharmaceutical, orthopaedic prosthetic services co-financed by users

10 Ministry of Health and Consumer Affairs Body within the Central Administration proposes and implements the main government guidelines on: health policy, health planning, health care

11 State powers General organisation and coordination of health matters International health, and international health relations and agreements Legislation on pharmaceutical products

12 State powers General organisation and coordination of health matters: regulation of conditions and minimum requirements, aiming equal conditions of public health services creation of methods for the sharing of information, technical standardisation in specific areas joint action by State and Autonomous Community authorities International health, and international health relations and agreements: surveillance and control of health risks within import, export or traffic of goods international passenger traffic

13 State powers Legislation on pharmaceutical products: evaluation, authorisation and registration of drugs and health products for human and veterinarian use authorisation for public financing and pricing of drugs and health products guaranteeing the deposit of narcotics in accordance with international treaties imports of urgent, foreign medication maintenance of a strategic, State-run deposit of drugs and health products for emergencies and catastrophes purchase and distribution of drugs and health products for international cooperation programmes

14 Spanish National Health System Devolution of Health powers: decentralized management Public health: Health care: ISLAS CANARIAS (año 1994) ASTURIASCANTABRIA (año 1979) (año 1982) PAIS VASCO (año 1979) GALICIA (año 1980) CASTILLA Y LEÓN (año 1981) EXTREMADUR A (año 1979) MADRID (año 1984) CASTILLA - LA MANCHA (año 1982) ANDALUCIA (año 1981) ARAGO N (año 1982) LA RIOJA (año 1984) NAVARRA (año 1985) CATALUÑA (año 1979) COMUNIDAD VALENCIANA MURCIA (año 1980) (año 1980) ISLAS BALEARES (año 1980) CEUTA (año 1999) MELILLA

15 Powers of the Autonomous Communities Health Planning Public Health Health care functions and services, goods, rights and obligations relating to such powers, as well as the staff and budgets assigned to them.

16 Powers of the Autonomous Communities Regional Health Service: administrative and management body responsible for - centres, - services, - facilities in its own Community

17 Powers of the Public administrations on Health matters State Administration Autonomous Communities Basic principles and coordination of health International health matters Drug policy National Institute for Health management Health planing Public health Regional Health Services management National Health System Inter-Territorial Board Local Councils Health and hygiene Collaboration in the management of public services Sources: Distribution of powers according to the Spanish Constitution, the General Health Act and the Law for cohesion and quality in the National Health System

18 Technical Office Minister Health Advisory Council Under-Secretary for Health and Consumer General Technical Secretariat Directorate General for resources and Financial Services Spanish Agency for Food Safety Secretary General for Health National Centre for Transplants and Regenerative Medicine Directorate General for Public Health Directorate General for Pharmacy and Health Products Govermment Delegation for the National Drugs Plan Spanish Agency for Drugs and Health Products Directorate General NHS Quality Agency Directorate General for Consumer Affairs and Citizen Information National Institute for Consumer Carlos III Health Institute Directorate General NHS Cohesion and Senior Inspectorate National Institute for Health Management

19 Spanish NHS: Organization Primary Health Care: extensive accessibility sufficient technical resources Specialist Care: complex and costly diagnostic and therapeutic resources access by referral from Primary Health Care

20 Spanish NHS: Organization Primary Health Care Primary Care Centre Centr os de Salud Centros de Salud 15 minutes Average time from patient s home to Health centre Urban Centres Basic Health Zone Rural Centres

21 Spanish NHS: Organization HEALTH AREA Regional Health Service (Autonomous Community) Hospital H Basic Health Zone Basic Health Zone HEALTH AREA HEALTH AREA Primary Care Centre Primary Care Centre

22 Facilities and resources Health centers, 2005 Control Centers Beds Primary Care Centers (1) Hospitals Public Public Civil Hospitals Ministy of Defense Industrial Accident and Occupational Disease Mutual Funds Private, non-for-profit Private, profit 2, , , , , ,075 TOTAL ,926 (1) Year 2004 Sources: Ministry of Health and Consumer Affairs, Regional Departments of Health of the Autonomous Communities and the National Catalogue of hospitals

23 Human Resources

24 Thank you for your attention

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