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Feature European Financial Crisis

Is Spanish public health sinking?

BMJ 2011; 343 doi: (Published 23 November 2011) Cite this as: BMJ 2011;343:d7445

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  1. Aser García Rada, physician and freelance journalist
  1. 1 Madrid, Spain
  1. alphaborealis{at}

The economic crisis threatens one of Europe’s best public health systems and creates opportunities for an expectant private sector. As Spain’s rightwing People’s Party prepares to form a government after its election victory at the weekend, Aser García Rada reports from Madrid

Despite the perception of it being chronically sick, the Spanish health service has a few things to shout about: it has a broad portfolio of services, achieves universal coverage (including for illegal immigrants), and provision is free of charge at the point of delivery (with the exception of drugs prescribed to people aged under 65, which entail a 40% copayment).1 The Spanish system was listed in 2000 as the seventh best healthcare system in the world by the World Health Organization2 and the third according to Newsweek in 2010.3

Spain has low infant mortality—3.3 per 1000 live births—and one of the highest life expectancies in the world—81.8 years.4 Moreover, Spain is an international benchmark in areas such as organ donation and transplantation.5 Though deceased organ donations are dropping in most countries that have been hit hard by the financial crisis—down 56% since 2008 in Greece—Spanish numbers remain on the rise.6

All that with only €70bn (£60.1bn; $94.9bn);7 about €1500 per person, 73.6% of total health expenditure, 6.5% of GDP.4 A low cost health service. This is not due to especially good management but to low wages; staff account for only 50% of the total health budget, the lowest proportion in western Europe. The Spanish National Service is the country’s biggest employer, generating 0.6 million direct jobs and up to 1.5 million indirect jobs.

It sounds unsinkable, but is the Spanish health service a new Titanic?


Spain is divided into 17 autonomous communities, and 13 held regional elections this May. …

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