The Spanish health system offers almost universal coverage, a wide variety of services, and a high quality network of hospitals and primary care centres. Although it is a national system, financed with general tax revenue, the devolution of health services to the country’s 17 autonomous communities has led to a variety of management models.

Spain, like most countries in the European Union, has seen big increases in life expectancy over recent decades thanks to improved living conditions, public health interventions, and progress in medical care.1 2 Spanish citizens born in 2005 can expect to live to 80.4 years old, slightly more than the average in the 15 countries that were members of the EU before 2004 (79.7 years). Maternal and infant mortality as well as other main health indicators and trends are also better than the European average (table⇓).3 Virtually all citizens consider the social support mechanisms in place positively (96.6%) and believe that they have good family support (93.4%).4 The success has been achieved with comparatively low expenditure; despite the trend of increasing costs, a performance analysis shows the Spanish health system to be efficient compared with health systems of neighbouring countries.2 3

The system is not without its shortcomings, however. The sustainability of universal coverage is being tested as rising demands lead to rising costs (figs 1⇓ and 2⇓). As well as changes in demographics, patients are expecting more from health services and there are problems with professional satisfaction and resource management.