More than 30 years after becoming a constitutionally mandated right, Spain’s public health system struggles with increasing costs and maintaining a high level of care for all citizens.
By Kate Loftesness
Imagine finding out you have cancer, AIDS or another grave illness that could cost hundreds of thousands of dollars in medical treatment. Now imagine having the guarantee that you will receive all the treatment you need, completely free of charge.
This might be hard for Americans to envision, but for Spanish citizens, it is a reality.
Public healthcare has been the subject of much attention following United States President Barack Obama’s recent push for socialized healthcare, but for many Americans the idea of receiving expensive medical treatment completely free seems too good to be true. In Spain, the government has been providing universal health coverage for decades, but Spaniards still grapple with the same doubts. Spain’s public healthcare system has received attention for its wide reach and effectiveness as well as its shortcomings, including huge expenditures that continue to increase in the midst of an economic crisis.
In 1978, the Spanish Constitution afforded all citizens the right to universal healthcare. Today, the system administering this right is divided into 17 autonomous communities that function independently of each other, including the Andalusian Health Service (Servicio Andaluz de Salud, or SAS), which services the Andalusia region, in southern Spain. The SAS maintains 1,491 medical centers, where Andalusians can receive both primary and specialized medical attention.
Dr. Francisco Javier Conde García, a Doctor of Internal Medicine at the Virgen Macarena hospital and professor at the University of Seville, believes the public health system is successfully achieving the universal health coverage called for by the country’s constitution. “It’s the reality,” Conde says. “Here, no one is discriminated against.”
Mixed reviewsNot everyone is happy, though. Esther Menacho Dorado, part of the editing and production team for the Canal Sur Radio program El Público, hears many complaints about the system’s shortcomings.
“Every afternoon, we receive calls from listeners who tell us what’s happening to them, what they’re worried about, and one of the most frequent problems is the health system,” Menacho says. “Andalusians are upset because they spend months waiting for a specialist to see them, for lost medical forms, for a second medical opinion that never arrives, or about illnesses that the SAS doesn’t cover.”
Manuel Barragán García, a 21-year-old Huelva native, contacted El Público after the SAS denied him coverage for an expensive surgery he needed to keep from going blind. “What I had was an illness that deforms the cornea, and it got to the point where my cornea was going to open like a flower until I lost my vision completely,” Barragán says.
Though Barragán suffered from a very severe case of keratoconus, the same disease affecting his mother, the SAS told him it wasn’t a serious illness and they would not cover the surgical insertion of rings into his cornea that doctors said was necessary to save his vision. This surgery, which can cost between 4,000 and 6,000 euros per eye, was far too expensive for Barragán or his family to pay for independently.
After he spoke out against the SAS and publicized his case on the radio, a private doctor heard his plight and performed the surgery for Barragán and his mother for free last November.
The surgery, which is now covered by the SAS in part thanks to Barragán’s public protest, stopped the progression of Barragán’s keratoconus, but he still has trouble seeing. “I am angry with the health system,” he says. “If they had diagnosed my illness four years ago, now I would have glasses, but I would see a lot more than I see. Right now, I’m angry, very angry.”
Although Barragán’s case is far from alone, statistics speak more highly of the SAS’s services. According to one SAS survey, 88.2 percent of users report being “satisfied” or “very satisfied,” and 50 percent say the doctors are “very good.”
Yasameen Raissinia, a 21-year-old CIEE student from San Jose, California, currently studying with the International Business and Culture Program, learned about the Spanish health system her third day in Seville when she went to an emergency room in Triana with a broken foot. “There was absolutely no one there. We were in and out in half an hour,” Raissinia says.
The doctors gave Raissinia a cast and medicine, including a daily injection in her stomach to aid circulation in her foot. Because she is not a Spanish citizen, Raissinia had to pay about 180 euros in total and will be reimbursed by her private insurance once the paperwork is completed.
One week after the emergency room visit, Raissinia returned to see an orthopedic specialist, where she encountered an hour-long wait and many more people. This doctor told Raissinia that the x-rays were inconclusive and her foot may not have ever been broken in the first place. She no longer had to wear a cast or use crutches, but the pain lasted for a month and she still doesn’t have concrete answers.
“Overall, the service and the emergency room visit were great,” Raissinia says. “I just don’t really know what happened. The doctor might have been a little incompetent.”
Dr. Conde acknowledges that lack of motivation in medical personnel is a problem in the Spanish healthcare system. “People are burnt out,” he says. He also sees excessive bureaucratization, lack of communication, long waiting lists and increasing expenditures as other major problems.
Can Spain afford its healthcare system?In today’s economic crisis, the cost of Spain’s public health system has been the focus of increasing public scrutiny. Though Spain’s is one of the least expensive systems of all Westernized countries, costing less than those of the United States, Germany, Japan, and the United Kingdom, it still used 53,000 million euros in 2006, 5.9 percent of the country’s GDP. A current report by Fedea, the Fundación de Estudios de Economía Aplicada (Applied Economic Studies Foundation), shows that current expenditures are not sustainable. Between 2003 and 2007, the national health system deficit increased 11,000 million euros and the Fedea report estimates that if current trends continue, it could exceed 50,000 million euros by the year 2020.
Conde attributes much of this increase to an aging population and a greater number of chronic patients. According to a recent article in El País, in 10 years, one in every five Spaniards will be over the age of 65. “Age isn’t a limit now like it was before,” Conde says. “People are becoming chronic patients more often.”
He explains that more expensive medical technology, increasing numbers of immigrants, and changing user expectations are also burdening the current system. The average Spanish citizen goes to the doctor eight times every year, 40 percent more often than the average for the rest of the European Union. Conde advises that a major way to reduce the costs is to change the way people think. “You can’t go to the doctor for something silly,” he says. “It’s not a problem with the system; it’s a problem with the user.”
Even with its flaws and room for improvement, he has faith in the system’s fundamentals. “Despite being the critic that I am, I think the system works very well. I believe that here in Spain, it is a success and that isn’t going to change.”
