SPAIN

The Spanish health system is characterized by three statutory subsystems that coexist: the universal national health system (Sistema Nacional de Salud, SNS); Mutual Funds catering for civil servants, the Armed Forces and the judiciary (MUFACE, MUGEJU and ISFAS); and the Mutualities focused on assistance for Accidents and Occupational Diseases, known as “Collaborating Mutualities with the Social Security”.

The SNS is a national health system based in the principles of universality, free access, equity and fairness of financing, and is mainly funded by taxes. It is organized at two levels – national and regional – mirroring the administrative division of the country. Health competences are transferred to the 17 Autonomous Communities (ACs), with the national level being responsible, under the governance of the Interterritorial Council for the SNS, for certain strategic areas as well as for the overall coordination of the health system, and the national monitoring of health system performance. Main actors in the ACs are the Departments of Health, playing the role of a Health Authority (that is, regulation, planning, budgeting and thirdparty payer) backed by specialized agencies, including a health technology assessment agency in some regions. Planning and regulation responsibilities lie essentially with the Ministry of Health when it comes to nationwide laws and plans, and with the Departments of Health of the 17 ACs when it comes to the local implementation of national regulation, or the development of regional regulation and policies.

The private sector of the Spanish health system is characterized by a series of private insurance companies which offer intermediated medical assistance by means of a list of doctors and clinics. Private insurance companies and private clinics consider the patient population as their own. They own so-called keys for each physician who wants to work for them. The determine also unilaterelly the amount of remuneration a physician receives for his services.

A small sector of the Spanish health system concerns the reimbursement of medical care in free practice by health insurance companies.

And an even smaller sector of the health system concerns out of pocket services.