Spain’ national health care system operates on a highly decentralized basis, giving primary responsibility to the country’s 17 regions. The Spanish Constitution guarantees all citizens the “right” to health care- including equal access to preventative, curative, and rehabilitative services. Coverage under the Spanish system is nearly universal, estimated at 98.7% of the population. The federal government provides each region with a block grant. The money is not earmarked – the region decides how to use it.

Spanish patients cannot choose their physicians, either primary care or specialist. Rather, they are assigned a primary care doctor from a list of physicians in their community. If more specialized care is needed, the primary care physician refers patients to a network of specialists. One may not go “out of network” unless the patient has private health insurance. This has sparked an interesting phenomenon whereby sick Spaniards move in order to change physicians or find networks with shorter waiting list.

Waiting lists vary from region to region but are a significant problem everywhere. On average, Spaniards wait 65 days to see a specialist, 71 days to wait for a gynecologist, and 81 days for a neurologist. The mean waiting time for a prostectomy is 62 days and for hip replacement surgery is 123 days. Some health services that US citizens take for granted are almost totally unavailable. For example, rehabilitation, convalescence, and care for those with terminal illness are usually left to the patient’s relatives. There are few public nursing and retirement homes, and few hospices and convalescence homes.

As with most other national health care systems, the waiting lists and quality problems have led to the development of a growing private insurance alternative. About 12% of the population currently has private health insurance. Overall, private insurance payments amount for 21% of total health care expenditures. More commonly, Spaniards pay for care outside of the national health care system out of pocket. In fact, nearly 24% of health care spending in Spain is out of pocket – more than any European country except Greece and Switzerland, and even more than the United States. Here again, a two-tier system has developed, with the wealthy able to buy their way around the defects of the national health care system, and the poor consigned to substandard services. Good Neighbor Insurance brokerage firm, at www.gninsurance.com, provides private health insurance coverage in Spain for US and non US citizens via international health insurance plans like BUPA, IMG, HTH, HCC, and other overseas health insurance companies.

There are also shortages of modern medical technologies. Spain has one-third as many MRI units per million people as the US and just over one-third as many CT units, and fewer lithotripters. Some regions, like Ceuta and Melilla do not have a single MRI unit. All hospital-based physicians and approximately 75% of all other physicians are considered quasi-civil servants and are paid a salary rather than receiving payment based on services provided. As a result Spain has fewer physicians and fewer nurses per capita than most European countries and the US.

Even so, Spaniards are generally happy with their system where nearly 60% describe their system as good, the second highest favorability rating in Europe. However, Spaniards do want more choice of doctors and hospitals, and they want the government to do a better job of dealing with the waiting lists.

Quick facts:

• The biggest industry in Spain is tourism
• Madrid, Spain’s capital city, is located in the exact center of the country
• The low birthrate registered in Spain is the result of the high unemployment, coupled with steep housing cost. These factors make it difficult for most people in Spain to buy houses big enough to accommodate more than two children
• Spanish (Castilian Spanish) is not the only language spoken in Spain. There are at least four other major languages spoken plus other variations and dialects. The major other languages are Galician, Basque, and Catalan
• You won’t find corn or flour tortillas in Spanish food. In Spain, tortillas are a popular egg and potato dish
• Soccer is Spain’s most popular sport
• Around 40% of Spaniards between 17 and 24 are smokers
• Spain has one of Europe’s highest rates of AIDS
• Prescription medications can be acquired over the counter at medicine shops