Spanish National Health System
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The Spanish National Health System (, SNS) is the agglomeration of public healthcare services that has existed in
Spain Spain, or the Kingdom of Spain, is a country in Southern Europe, Southern and Western Europe with territories in North Africa. Featuring the Punta de Tarifa, southernmost point of continental Europe, it is the largest country in Southern Eur ...
since it was established through and structured by the ''Ley General de Sanidad'' (the "Health General Law") of 1986. Management of these services has been progressively transferred to the distinct autonomous communities of Spain, while some continue to be operated by the National Institute of Health Management (''Instituto Nacional de Gestión Sanitaria'', INGESA), part of the Ministry of Health and Social Policy (which superseded the Ministry of Health and Consumer Affairs—''Ministerio de Sanidad y Consumo''—in 2009). The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service (''Consejo Interterritorial del Servicio Nacional de Salud de España'', CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain. Article 46 of the ''Ley General de Sanidad'' establishes the fundamental characteristics of the SNS: * a. Extension of services to the entire population. * b. Adequate organization to provide comprehensive health care, including promotion of health, prevention of disease, treatment and rehabilitation. * c. Coordination and, as needed, integration of all public health resources into a single system. * d. Financing of the obligations derived from this law will be met by resources of public administration, contributions and fees for the provision of certain services. * e. The provision of a comprehensive health care, seeking high standards, properly evaluated and controlled.


Antecedents to the SNS in Spain

Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of
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s through the establishment of naval
quarantine A quarantine is a restriction on the movement of people, animals, and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have bee ...
s, the closing of city walls and prohibitions on travel in times of plague, but also in terms of hygienic and palliative measures.
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-ruled medieval Spain—was distinguished by its level of medical knowledge relative to the rest of Europe, particularly among the physicians of the
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. In the years after the ''
Reconquista The ''Reconquista'' (Spanish language, Spanish and Portuguese language, Portuguese for ) or the fall of al-Andalus was a series of military and cultural campaigns that European Christian Reconquista#Northern Christian realms, kingdoms waged ag ...
'', the ''Real Tribunal del Protomedicato'' regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious; the systems of
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and
Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...
dominated medical practice during most of the era of the '' Antiguo Régimen''. Medicine was one of the principal fields of activity for the '' novatores'' of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the
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, such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in
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. At the beginning of the 19th century, the Balmis Expedition (1803) to administer the
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throughout the Spanish colonies was a
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...
undertaking of unprecedented geographical scope. The
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debated a sanitary code (the ''Código Sanitario de 1812''), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During the
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, the Law of 28 November 1855 established the basis for a General Health Directorate (''Dirección General de Sanidad''), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction (''Instrucción General de Sanidad''), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health (''Inspección General de Sanidad''). After the
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, the ''Ley de Bases de 1944'' perpetuated this . The Law of 14 December 1942 create a system of obligatory
health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...
under the already extant National Insurance Institute (''Instituto Nacional de Previsión'', INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security (''Ley General de la Seguridad Social'') in 1974, toward the end of the Franco regime. Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities. The General Health Law (''Ley General de Sanidad'') of 25 April 1986 and the creation of Health Councils (''Consejerías de Sanidad'') and a Ministry of Health, fulfilled the mandate of the
Spanish Constitution of 1978 The Spanish Constitution () is the supreme law of the Kingdom of Spain. It was enacted after its approval in 1978 in a constitutional referendum; it represents the culmination of the Spanish transition to democracy. The current version was a ...
, in particular Articles 43 and 49 which made protection of health a right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the
autonomous communities The autonomous communities () are the first-level administrative divisions of Spain, created in accordance with the Spanish Constitution of 1978, with the aim of guaranteeing limited autonomy to the nationalities and regions that make up Spa ...
.


Laws


The General Health Law of 1986

The General Health Law of 1986 (''Ley 14/1986 General de Sanidad'') was formulated on two bases. First, it carries out a mandate of the Spanish Constitution, whose articles 43 and 49 establish the right of all citizens to protection of their health. The law recognizes a right to health services for all citizens and for foreigners resident in Spain. Second, Title VIII of the Constitution confers upon the autonomous communities broad purview in matters of health and health care. The autonomous communities have first-order importance in this area, and the law permits devolution of these functions from the central government to the autonomous communities, in order to provide a health care system sufficient for the needs of their respective jurisdictions. Article 149.1.16 or the Constitution, a further basis for the present law, establishes substantive principles and criteria that allow general and common characteristics to be consistent throughout the new system, providing a common basis for health services throughout Spanish territory. The administrative device set up by the law is the National Health System. The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency. Thus, the various health services fall under the responsibility of the respective autonomous communities, but also under basic direction and coordination by the central state. The respective health services of the autonomous communities would gradually realize a transfer of health resources from the central government to the autonomous communities.


La Ley 15/97 “Nuevas Formas de Gestión”

The law of 1997 allowed private health care companies to enter the market. It has been argued to be the beginning of deregulation.


Law of Cohesion and Quality, 2003

The General Health Law was complemented in 2003 by the Law of Cohesion and Quality of the National Health System (''Ley 16/2003 de cohesión y calidad del Sistema Nacional de Salud''), which maintained the basic lines of the General Health Law, but modified and broadened the articulation of that law to reflect existent social and political reality. By 2003, all of the autonomous communities had gradually assumed purview in matters of health and had established stable models to finance the assumed purview. Meanwhile, in the 17 years since the original law, Spanish society had undergone many cultural, technological and socioeconomic changes that affected people's ways of life and affected the country's patterns of disease and illness. These posed new challenges to the National Health System. Therefore, the 2003 law establishes coordination and cooperation of public health authorities as a means to ensure citizens the right to health protection, with the common goal of ensuring equity, quality and social participation National Health System. The law defines a core set of functions common to all of the autonomous health services. Without interfering with the diversity of forms of organization, management and services inherent in a decentralized system, it attempts to establish certain basic, common safeguards throughout the country. This law attempts to establish collaboration of public health authorities with respect to benefits provided, pharmacy, health professionals, research, health information systems, and the overall quality of the health system. Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to the participation of the autonomous communities. Among these are the Agency of Evaluation of Technologies (''Agencia de Evaluación de Tecnologías'', Spanish Agency of Medicines and Medical Devices (''Agencia Española de Medicamentos y Productos Sanitarios''), the Human Resources Committee (''Comisión de Recursos Humanos''), the Committee to Assess Health Research (''Comisión Asesora de Investigación en Salud''), the Charles III Institute of Health (''Instituto de Salud Carlos III''), the Institute of Health Information (''Instituto de Información Sanitaria''), the Quality Agency of the National Health System (''Agencia de Calidad del Sistema Nacional de Salud'') and the Observatory of the National Health System (''Observatorio del Sistema Nacional de Salud''). The basic organ of cohesion is the Interterritorial Council of the Spanish National Health Service (''Consejo Interterritorial del Servicio Nacional de Salud de España''), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions. A system of inspection, the ''Alta Inspección'', assures that accords are followed.


Royal Decree-Law of 2012

The Royal Decree-Law 16/2012 was introduced on April 20, 2012. It puts into law severe cuts in the Spanish National Health System, including the following: * Refusal to give assistance to unregistered foreigners (in effect from September 1, 2012). This hasn't been applied by all the comunidades autónomas. * Increase of the percentage of medicines paid by the user: ** Senior citizens didn't pay for medicines before the reform, but now they pay 10% (limited to €8/month if their income is ≤€18,000 a year, €18/month if their income is >€18,000 and ≤€100,000 a year, or €60/month if their income is >€100,000 a year). ** Workers now pay 40% if their income is ≤€18,000 a year, 50% if their income is >€18,000 and ≤€100,000 a year, or 60% if their income is >€100,000 a year.


Governing agencies


Ministry of Health and Social Policy

The Ministry of Health and Social Policy develops the policies of the
Government of Spain The government of Spain () is the central government which leads the executive branch and the General State Administration of the Kingdom of Spain. The Government consists of the Prime Minister and the Ministers; the prime minister has the ...
in matters of health, in planning and delivery of services, as well as exercising the purview of the General Administration of the State to assure citizens the right to protection of their health. The ministry has its headquarters on the
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in
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, across the street from the
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. The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy. From the date of that decree, the new ministry assumed the functions of, and superseded the former Ministry of Health and Consumption (''Ministerio de Sanidad y Consumo'') and Secretary of State for Social Policy, Family, and Attention to Dependency and Disability (''Secretaría de Estado de Política Social, Familia y Atención a la Dependencia y a la Discapacidad''). The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System (''Agencia de Calidad del Sistema Nacional de Salud'') and the General Directorate of Advanced Therapies and Transplants (''Dirección General de Terapias Avanzadas y Trasplantes'').


Interterritorial Council

The General Health Law of 1986 created the Interterritorial Council of the Spanish National Health Service (''Consejo Interterritorial del Servicio Nacional de Salud'', CISNS) as the organ of general coordination in matters related to health between the central State and the autonomous communities who were given authority in health matters under that law. It is jointly composed, and coordinates the basic lines of health policy in matters affecting contracts; acquisition of health and pharmaceutical products, as well as other related goods and services; as well as basic health personnel policies. The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS. Under this law, the CISNS functions variously as a plenary body, by delegated committees, through technical commissions, and through work groups. It meets as a plenary body at the initiative of its president or at the initiative of one-third of its members; plenary meetings occur at least four times a year. To some extent, this is a formality: resolutions from CISNS commissions are typically adopted by consensus. Cooperation agreements to conduct joint health actions are formalized in CISNS agreements. Under the Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region. Presentations, committees, and working groups have been very important, some more than others. Important committees include: * Public Health Committee (''Comisión de Salud Pública'') * Permanent pharmacy committee (''Comisión permanente de farmacia'') * Scientific-technical committee of the National Health System (''Comisión científico-técnica del sistema Nacional de Salud'') * Committee to monitor the health cohesion fund (''Comisión de seguimiento del fondo de cohesión sanitaria'') * Permanent committee on insurance, funding, and benefits (''Comisión permanente de aseguramiento, financiación y prestaciones'') * Committee against gender violence (''Comisión contra la violencia de género'') * Transplant committee (''Comisión de trasplantes'') Articles 69, 70 and 71 of the Law of Cohesion regulate the principal functions of the Interterritorial Council of the SNS. The principal aspects of the Interterritorial Council are: The Interterritorial Council is constituted by the Minister of Health and Consumer Affairs ow of Health and Social Policy who holds its presidency, and by the Councilors with purview over matters of health of the autonomous communities. The vicepresidency of the body will be fulfilled by one of the Councilors with purview over matters of health of the autonomous communities, elected by all of the Councilors who make up the body. The CISNS will come to know, debate among other things, and, as appropriate, make recommendations on the following matters: * a) The development of the portfolio of services corresponding to the Catalog of Services of the National Health System, as well as its actualization. * b) The establishment of health services complementary to the basic services of the National Health System on the part of the autonomous communities. * c) Minimal guarantees of safety and quality for the authorization of the opening and placing into function of the health centers, services and establishments. * d) The general and common criteria for the development of collaboration between pharmacy offices. * e) The basic criteria and conditions of the convocations of professionals to assure their mobility throughout the State. * f) Declaration of the necessity to realize coordinated actions in matters of public health to which this law refers. * g) General criteria for the public financing of medicines, medical products and their variables. * h) Establishment of criteria and mechanisms in order to guarantee at all times the financial sufficiency of the system. The prior functions shall be exercised without prejudice to the legislative purview of the
Cortes Generales The (; ) are the Bicameralism, bicameral legislative chambers of Spain, consisting of the Congress of Deputies (the lower house) and the Senate of Spain, Senate (the upper house). The Congress of Deputies meets in the Palacio de las Cortes, ...
and, as appropriate, the norms of the General Administration of the State; likewise the normal developmental, executive and organizational purview of the autonomous communities.


Purview of the autonomous communities

Article 41 of the General Health Law establishes that: * The autonomous communities exercise the purview assumed in their statutes /nowiki>of autonomy/nowiki> and those that the state transfers to them or, as appropriate, delegates to them. * The public policies and actions foreseen in this Act which are not expressly reserved for the state will be deemed to have been delegated to the autonomous communities. The State finances, through general taxes, all health benefits and a percentage of pharmaceutical benefits. This tax is shared among the several autonomous communities according to various sharing criteria now that the communities are responsible for health in their respective territories. Each year the CISNS, after deliberation, establishes the portfolio of services covered by the National Health System, which is published by a Royal Decree of the Ministry of Health. Each autonomous community then establishes its respective portfolio of services, which includes at least the service portfolio of the National Health System.


Purview of local governments

Article 42 of the General Health Law sets out that ''
ayuntamiento ''Ayuntamiento'' ()In other languages of Spain: * (). * (). * (). is the general term for the town council, or ''cabildo'', of a municipality or, sometimes, as is often the case in Spain and Latin America, for the municipality itself. is mai ...
s''—
municipal government A municipality is usually a single administrative division having corporate status and powers of self-government or jurisdiction as granted by national and regional laws to which it is subordinate. The term ''municipality'' may also mean the go ...
s—have the following responsibilities with respect to health, without prejudice to the purview of other public administrative bodies: * a) Health control of the environment:
air pollution Air pollution is the presence of substances in the Atmosphere of Earth, air that are harmful to humans, other living beings or the environment. Pollutants can be Gas, gases like Ground-level ozone, ozone or nitrogen oxides or small particles li ...
,
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, urban and industrial residue. * b) Health control of industries, activities and services, transport, waste">urban and industrial residue. * b) Health control of industries, activities and services, transport, noise and vibration">noise">waste">urban and industrial residue. * b) Health control of industries, activities and services, transport, noise and vibrations. * c) Health control of buildings and places of human residence or gathering, especially of food centers, hairdressers, saunas and centers of personal hygiene, hotels and residential centers, schools, tourist campsites and areas of physical activity for sports and recreation. * d) Health control of perishable food distribution and supply, beverages and other products directly or indirectly related to human use or consumption, such as means of transport. * e) Health control of cemeteries and mortuary health policy.


Territorial organization

As a consequence of the decentralization contemplated by the Spanish Constitution, each autonomous community has received adequate transfers to create a health service, the administrative structure that manages all of the centers, services and establishments of the community itself, as well as its deputations, municipal governments, and whatever other territorial administrations fall within that community. The Law of Cohesion establishes the Interterritorial Council (CISNS) as the organ of coordination and cooperation of the SNS. In the autonomous cities of
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and
Melilla Melilla (, ; ) is an autonomous city of Spain on the North African coast. It lies on the eastern side of the Cape Three Forks, bordering Morocco and facing the Mediterranean Sea. It has an area of . It was part of the Province of Málaga un ...
the corresponding health services are provided by the National Institute of Health Management, INGESA.


Health coverage in Spain

Under Chapter III of the 1978 Spanish Constitution, all Spanish citizens are beneficiaries of public health services. Concretely, it establishes that: * Article 39: The public powers assure social, economic and juridical protection of the family. * Article 43: The right to health protection is recognized. It is the responsibility of public authorities to organize and act as guardian over public health through preventive measures and the provision of necessary services. The Law will establish the rights and duties of all in this respect. The public powers will promote health education, physical education and sports. * Article 49. The public powers will bring into existence a policy of prevention, treatment, rehabilitation and integration of those with physical, sensory or psychological disabilities. Further, the Organic Law 4/2000 (''Ley Orgánica 4/2000'') establishes the rights and liberties of foreigners resident in Spain. Its effect on the healthcare provision can be seen in the following articles: * Article 3. Foreigners will enjoy in Spain, in equal conditions with the Spanish, the rights and liberties recognized in Title I of the Constitution and in the laws that develop it, in terms established in this Organic Law. * Article 10. Foreigners will have the right to engage in remunerated activity in self-employment or working for others, such as access to the Social Security System, in terms foreseen in this Organic Law and in the dispositions that develop it. * Article 12. Foreigners who are registered in Spain in the municipality in which they are habitually resident have the right to health services on the same conditions as the Spanish. Foreigners who are in Spain have the right to urgent health services in the event of contracting severe illness or having an accident, whatever may be the cause, and the continuity of this care until the time of discharge. Foreign minors of less than 18 years who are in Spain have the
right to health care The right to health is the economic, social, and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the U ...
on the same conditions as the Spanish. Pregnant foreigners who are in Spain have the right to health care during the pregnancy, while giving birth, and ''post partum''.


Financing

Article 10 of the Law of Cohesion establishes that the financing of the Spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay. Sufficient financing of services is determined by the resources assigned to the autonomous communities in conformity to what is established in the laws of autonomic financing. Inclusion of a new service in the catalog of services of the National Health System is accompanied by an economic memo that contains the positive or negative financial impact it is expected to imply. This memo is brought up to the Council of Fiscal Policy and Finance for analysis and approval as to whether to proceed.


Fairness in financing

Prior to 1986, public financing of health care occurred mostly through highly regressive payroll taxes. In 1986, the law that established the Spanish National Health System also shifted financing toward progressive general taxes and away from payroll taxes. In a 2000 report, the World Health Organization ranked Spain 26th of 191 countries in its fairness in financing. In 1999, reform to income tax deductions allowed high income earners to deduct more for private insurance. Although this reform was intended to decrease
overconsumption Overconsumption describes a situation where consumers overuse their available goods and services to where they can't, or don't want to, replenish or reuse them. In microeconomics, this is the point where the marginal cost of a consumer is greater ...
of health care services, it had the side effect of more regressive financing of public health services. Nevertheless, that same year payroll taxes were completely phased out while higher indirect taxes (on excise goods such as alcohol and tobacco) were earmarked for health care.


Functional organization


Individual health card

Article 57 of the Law of Cohesion establishes that citizens' access to health services will be facilitated by use of an individual health card (''tarjeta sanitaria individual''), as the administrative document that accredits its holder and provides certain basic data. In order to best facilitate collaboration, quality, and continuity of services, the each card includes a standardized form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. In particular, the cards incorporate a digital form of this information; health facilities throughout Spain have appropriate equipment to read the digital information from the cards. A cardholder should thereby be able to access all the services of all relevant health professionals throughout the country.


Clinical history

A patient's clinical history is a medical-legal document that arises from the interactions between health professionals and their clients. From a medical and legal point of view, the clinical history is the only document valid to track this history of interactions. In primary care, where methods of health promotion are important, the clinical history document is sometimes known as a "health history" (''historia de salud'') or "life history" (''historia de vida'').


Clinical histories in the SNS

The Clinical History of the panishNational Health System (''Historia Clínica Digital del Sistema Nacional de Salud'', HCDSNS) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient. This history should be available at all authorized locations, but nowhere else: except as needed for treatment, the information is considered confidential and access is restricted.


Health Areas

The term "Health Area" (Área de Salud) refers to an administrative district that brings together a functional and organizational group of health centers and primary care professionals. A Health Area may be exclusively focused on primary care or may include specialists as well. Some autonomous communities use different term, such as Direction of a sector (''Dirección de sector''), or of a
comarca A ''comarca'' (, , , ) is a traditional region or local administrative division found in Portugal, Spain, and some of their former colonies, like Brazil, Nicaragua, and Panama. The term is derived from the term ''marca'', meaning a "march, mark ...
, district, department, or other territorial unit used in that autonomous community.


Basic Health Zones

Although the autonomous communities differ among themselves in layering subdivisions of their health areas, all eventually come down to a Health Zone (''Zona de Salud'') or Basic Health Zone (''Zona Básica de Salud'') as the unit for a primary health care team. In Andalusia, for example, each existing Basic Health Zone takes care of a population between 5,000 and 20,000 inhabitants. The Basic Health Zone is served by a single
general hospital ''General Hospital'' (often abbreviated as ''GH'') is an American daytime television soap opera created by Frank and Doris Hursley which has been broadcast on American Broadcasting Company, ABC since April 1, 1963. Originally a half-hour seria ...
and specialists' center.


Primary Care

Article 12 of the Law of Cohesion establishes the concept of "primary care," the basic level of patient care that guarantees the comprehensiveness and continuity of care throughout the patient's life, acting as manager and coordinator of cases and regulator of issues. Primary care includes health promotion, health education, prevention of illness, health care, maintenance and recuperation of health, as well as physical rehabilitation and social work. Primary health care includes service provided either on-demand, scheduled, or urgently, both in the clinic as well as in the patient's home.


Specialized care

Article 13 of the Law of Cohesion regulates characteristics of health care offered in Spain by
medical specialist A medical specialty is a branch of medical practice that is focused on a defined group of patients, diseases, skills, or philosophy. Examples include those branches of medicine that deal exclusively with children (pediatrics), cancer ( oncology), ...
s, which is provided at the request of primary care physicians. This may be in-patient hospital care or out-patient consultation at specialist centers or day hospitals. It includes care, diagnosis, therapy, rehabilitation and certain preventive care, as well as health promotion, health education and prevention of illness whose nature makes it appropriate to handle at this level. Specialized care guarantees the continuity of integrated patient care once the capabilities of primary care have been exhausted and until matters can be returned to that level. Insofar as patient condition allows, specialized care is offered in out-patient consultation and in day hospitals. As of 2010, Spain recognizes fifty distinct medical specialties.


Social-health care

Article 14 of the Law of Cohesion defines social-health care (''atención sociosanitaria'') as the combination of care for those patients, generally those with a
chronic illness A chronic condition (also known as chronic disease or chronic illness) is a health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term ''chronic'' is often applied when the ...
, whose would benefit from the simultaneous and synergistic provision of health services and
social services Social services are a range of public services intended to provide support and assistance towards particular groups, which commonly include the disadvantaged. Also available amachine-converted HTML They may be provided by individuals, private and i ...
to increase their personal autonomy, palliate their limitation or hardships, and facilitate their social reinsertion. This group includes: * a) Longterm health care. * b) Health care connected to convalescence. * c) Rehabilitation after illness


Registered health professionals

2000 data from the INE (Spain's National Institute of Statistics) counts 616,232 individuals credentialed by a
professional association A professional association (also called a professional body, professional organization, or professional society) is a group that usually seeks to advocacy, further a particular profession, the interests of individuals and organisations engaged in ...
as health care professionals. The largest number of these are nursing professionals; that is also the profession with the highest percentage of women. The following table is a breakdown of some of the INE statistics. No exact breakdown is available to indicate what number of these might be related to
mental health Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...
and
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
or
clinical psychology Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well ...
.


Health establishments


Healthcare centers

Royal Decree 1277/2003, of 10 October, establishes the general bases for authorization of health centers, services and establishments. It defines "healthcare center" (''centro sanitario'') as the organized combination of technical means and installations in which trained professionals, identified by their official certification or professional qualification, undertake basic health care activities with the purpose of improving people's health. These may be integrated into one or more health services, which constitute its healthcare portfolio.


''Consultorios''

Certain healthcare centers (''centros sanitarios'') are referred to as ''consultorios'', a term roughly equivalent to
British English British English is the set of Variety (linguistics), varieties of the English language native to the United Kingdom, especially Great Britain. More narrowly, it can refer specifically to the English language in England, or, more broadly, to ...
"surgery" or
American English American English, sometimes called United States English or U.S. English, is the set of variety (linguistics), varieties of the English language native to the United States. English is the Languages of the United States, most widely spoken lang ...
"doctor's office." These are offices that, while not full-fledged health centers (''centros de salud''), nonetheless provide care beyond primary care. Some terms used are ''consultorios rurales'', ''consultorios locales'', and ''consultorios periféricos'' (respectively, rural, local and "peripheral"; that last means a center located in a community other than the main settlement of a
municipality A municipality is usually a single administrative division having municipal corporation, corporate status and powers of self-government or jurisdiction as granted by national and regional laws to which it is subordinate. The term ''municipality' ...
), but other terms may exist, analogous to those that refer to various types of health centers. According to the 2008 National Catalog of Hospitals (''Catálogo Nacional de Hospitales 2008''), Spain in 2007 had a total of 10,178 ''consultorios'' that allowed health professionals to provide more local services than the health centers in their respective zones, with the purpose of bringing basic services closer to people who reside in nuclei dispersed through rural areas that tend to have an older than average population.


Health centers

A health center (''centro de salud'', distinct from the smaller "healthcare center" ''centro sanitario'') in Spain's SNS is main physical and functional structure devoted to coordinated global, integral, permanent and continuing primary care, based in a team of health care professionals and other professionals who work there as a team. Health centers basically practice the general medicine or
family medicine Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...
, providing a unity of care in which a specialist in community and family medicine is responsible to provide preventive care, health promotion, diagnosis and basic treatment on an outpatient basis. According to the 2008 National Catalog of Hospitals (''Catálogo Nacional de Hospitales''), in 2007 Spain had 2,913 health centers.


Specialized centers

Specialized centers are healthcare centers where different health care professionals provide services to particular group identified by common pathologies, age, or other common characteristics. Among these are: ; Dental clinics : Focused on care of the teeth and mouth. ; Centers for assisted human reproduction : Biomedical teams focused on
assisted reproductive technology Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and cryopreservation of ga ...
. ; Centers for voluntary interruption of pregnancy: Provide
abortion Abortion is the early termination of a pregnancy by removal or expulsion of an embryo or fetus. Abortions that occur without intervention are known as miscarriages or "spontaneous abortions", and occur in roughly 30–40% of all pregnan ...
services in legally permitted cases. ; Centers for major outpatient surgery : Provide surgery and subsidiary services including
general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...
,
local Local may refer to: Geography and transportation * Local (train), a train serving local traffic demand * Local, Missouri, a community in the United States Arts, entertainment, and media * ''Local'' (comics), a limited series comic book by Bria ...
and
regional In geography, regions, otherwise referred to as areas, zones, lands or territories, are portions of the Earth's surface that are broadly divided by physical characteristics (physical geography), human impact characteristics (human geography), and ...
anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...
and
sedation Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, ...
. For surgeries that require only brief post-operative care and therefore do not require overnight hospitalization. ; Dialysis centers : For patients with failed
kidney In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organ (anatomy), organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and rig ...
s. ; Diagnostic centers : Dedicated to diagnostic, analytic and imaging services. ; Mobile health care centers: Carry human and technical means for the purpose of health care activities. ; Transfusion centers : Carry out all activities related to the extraction and verification of human blood and its components, and of treatment, storage, and distribution. ;
Tissue bank A tissue bank is an establishment that collects and recovers human cadaver tissue for the purposes of medical research, education and allograft transplantation. A tissue bank may also refer to a location where biomedical tissue is stored under cry ...
s : Conserve and guarantee the quality of tissues after they are obtained and until they are used as
allograft Allotransplant (''allo-'' meaning "other" in Ancient Greek, Greek) is the Organ transplant, transplantation of cell (biology), cells, Biological tissue, tissues, or Organ (anatomy), organs to a recipient from a genetically non-identical donor of ...
s or
autograft Autotransplantation is the transplantation of organs, tissues, or even particular proteins from one part of the body to another in the same person ('' auto-'' meaning "self" in Greek). The autologous tissue (also called autogenous, autogen ...
s. ; Medical inspection centers : (''Centros de reconocimiento médico''), where examinations and other tests of ability are carried out for applicants or holders of medical and other health care permits or licenses. ; Mental health centers : Diagnose and treat mental illness on an outpatient basis.


Specialized health care establishments

Specialized health care establishments are private centers that provide a suite of health care products, ranging from medicines to sophisticated prostheses. These establishments are grouped by specialty and, on that account, must have accredited or certified technical personnel. Among these establishments are: ;
Pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medication, medicines. It is a miscellaneous science as it ...
: Private establishments operated in the public interest, subject to health care planning established by the autonomous communities, which provide the public with basic services recognized in Article 1 of Law 16/1997, of 25 April, that regulates pharmacy services (''Ley 16/1997, de 25 de abril, de regulación de los servicios de las oficinas de farmacia''). ; ''Botiquines'': (singular: ''Botiquín'') are authorized to hold, conserve and dispense medicines and health care products in places where there would be special difficulties of accessibility of a pharmacy. ; Optometric offices (Ópticas) : Evaluate visual capacity using optometric techniques; crafting, sale, verification and control of adequate means for the prevention, detection, protection, and improvement of
visual acuity Visual acuity (VA) commonly refers to the clarity of visual perception, vision, but technically rates an animal's ability to recognize small details with precision. Visual acuity depends on optical and neural factors. Optical factors of the eye ...
. ; Orthopedia centers : Dispense orthopedic health care products such as prostheses and
orthotics Orthotics () is a medical specialty that focuses on the design and application of orthoses, sometimes known as braces, calipers, or splints. An is "an externally applied device used to influence the structural and functional characteristics of ...
, technical devices to alleviate loss of autonomy, functionality, or physical capacity. ; Audioprosthesis centers : Dispense health care products, intended for the correction of auditory deficiencies, such as
hearing aid A hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aids are classified as medical devices in most countries, and regulated by the respective regulations. Small audio amplifiers ...
s, with adaptation individualized to each patient.


Hospitals

A
hospital A hospital is a healthcare institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...
is a health care establishment that provides
inpatient care Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremel ...
and specialized (and other) care, providing such services as are needed in its geographical area. A hospital can be a single structure or a hospital complex, even including branch buildings off of its main campus; it can also integrate any number of specialized centers. A similar concept to a hospital is a ''clinic''. In Spain, a clinic (''clínica'') is a health center, typically a private one, where patients can receive health coverage in a broad range of specialties. Some of these clinics include very up-to-date
operating theater An operating theater (also known as an Operating Room (OR), operating suite, operation suite, or Operation Theatre (OT)) is a facility within a hospital where Surgery, surgical operations are carried out in an asepsis, aseptic environment. Histo ...
s capable of providing
minimally invasive surgery Minimally invasive procedures (also known as minimally invasive surgeries) encompass surgical techniques that limit the size of incisions needed, thereby reducing wound healing time, associated pain, and risk of infection. Surgery by definition ...
, and "hospitalization zones" where patients can recuperate on an inpatient basis. In large Spanish cities, there are numerous clinics. These are the facilities that are normally used by health care professionals whose medical societies cover it: ASISA, Adeslas, etc. The General Health Law of 1986 establishes that the level of specialized care provided in hospitals and their dependent specialty centers will focus care on complex health problems. Hospital centers will develop, besides their functions strictly related to health care, functions of health promotion, prevention of illnesses and investigation and teaching, in accord with the programs of each area of health, with the object of complementing their activities with those developed by the primary care network. As elsewhere in the world, the size of hospitals in Spain is often gauged by the number of "installed beds" (''camas instaladas''). This is the number of hospital beds with fixed locations; at any given time, some beds may be out of commission.


General and specialized hospitals

General hospitals treat a broad range of pathologies and typically provide services including surgery, obstetrics and gynecology, and pediatrics. Other hospitals are more specialized. The following list includes most of the common types of specialized hospitals in Spain, but is not intended to be exhaustive. * Surgical hospitals * Medical-surgical hospitals * Maternity hospitals * Children's hospitals * Maternity and Children's hospitals (''materno-infantil'') * Psychiatric hospitals * Hospitals for illnesses of the
thorax The thorax (: thoraces or thoraxes) or chest is a part of the anatomy of mammals and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main di ...
* Oncological hospitals * Ophthalmic hospitals * Traumatological and rehabilitation hospitals * Psycho-physical rehabilitation hospitals *
Geriatric Geriatrics, or geriatric medicine, is a medical specialty focused on addressing the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' mean ...
and longterm care hospitals * Leprological and dermatological hospitals


Health care contracts

Spanish government-run healthcare administrations sign health care contracts (''conciertos sanitarios'') with privately run entities that provide health care services. They are regulated by the provisions of the General Health Law and the current rules of government contracting. There are some special cases where the relation between the hospital and the managing entity is regulated by a special arrangement called a ''Convenio de Vinculación'' or ''Convenio Singular'' ("Linkage Convention" or "Singluar Convention"). In
Catalonia Catalonia is an autonomous community of Spain, designated as a ''nationalities and regions of Spain, nationality'' by its Statute of Autonomy of Catalonia of 2006, Statute of Autonomy. Most of its territory (except the Val d'Aran) is situate ...
there are also centers integrated into the Network of Hospitals for Public Use (Red de Hospitales de Utilización Pública, XHUP) as outlined in the supplement to Decree 124/2008 of the Department of Health of the Autonomous Government of Catalonia (''Anexo del Decreto 124/2008 del Departamento de Salud de la Generalitat de Catalunya'').


Patrimonial dependency

The patrimonial dependency (''dependencia patrimonial'') of a hospital (or other health care facility) is the individual or other juridical entity that owns, at least, the building occupied by the facility. Hospitals that are under the dependency of Spanish Social Security belong primarily to the General Treasury of Social Security, although there is a special group within Social Security for the Mutuals of Accidents and Occupational Diseases (''Mutuas de Accidentes de Trabajo y Enfermedades Profesionales'', MATEP). There are also a few cases where patrimony is shared by two or more public entities on a consortium basis. The 2009 National Catalog of Hospitals contains information about the patrimonial dependency of hospitals, summarized as follows; hospital complexes are each counted here as a single hospital: 40 percent of stays in private hospitals are arranged and paid for by the public system. The 2008 National Catalog of Hospitals gives the following breakdown of types of hospitals.


High technology resources

Health care centers, principally hospitals and specialty centers, have high technology capabilities used primarily to perform better patient diagnoses. The following breakdown of such facilities is based on the 2008 National Catalog of Hospitals.


Services

Article 7 of the Law of Cohesion establishes the catalog of services of the National Health System, with the object of guaranteeing the basic and common conditions for an adequate level of integrated, continuous health care. Health care services include prevention, diagnosis, therapy and rehabilitation, as well as promotion and maintenance of citizens' health. Article 11 of the law establishes the basic lines of public health services: * 1. The public health service is the ensemble of initiatives organized by public administrations to preserve, protect and promote the health of the population. It is a combination of sciences, capabilities and attitudes directed to the maintenance and improvement of the health of all persons through collective and social acts. * 2. The services in this ambit include the following activities:
Epidemiological Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...
information and vigilance. Protection of health. Promotion of health. Vigilance and control of possible health risks derived from the importation, exportation and transit of merchandise and of international travel. Promotion and protection of environmental safety. Promotion and protection of health on the job. * 3. Public health services are to be exercised with an integral character, from public health structures to administrations and the infrastructure of primary care of the National Health System.


Primary care services

Primary care services constitute the majority of the services of the SNS; this is true of health promotion and education, prevention of illness, hands-on health care, health maintenance, recuperation, rehabilitation, and social work. The following catalog demonstrates preventive activities, health promotion and education, family care and community care as performed in primary care centers. * Inculcate healthy life habits in
adolescent Adolescence () is a transitional stage of human physical and psychological development that generally occurs during the period from puberty to adulthood (typically corresponding to the age of majority). Adolescence is usually associated w ...
s with respect to the use of
tobacco Tobacco is the common name of several plants in the genus '' Nicotiana'' of the family Solanaceae, and the general term for any product prepared from the cured leaves of these plants. More than 70 species of tobacco are known, but the ...
,
alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...
and
recreational drug Recreational drug use is the use of one or more psychoactive drugs to induce an altered state of consciousness, either for pleasure or for some other casual purpose or pastime. When a psychoactive drug enters the user's body, it induces an Sub ...
s as well as harmful
eating disorder An eating disorder is a mental disorder defined by abnormal eating behaviors that adversely affect a person's health, physical or mental health, mental health. These behaviors may include eating too much food or too little food. Types of eatin ...
s and healthy conduct with respect to
sexuality Human sexuality is the way people experience and express themselves sexually. This involves biological, psychological, physical, erotic, emotional, social, or spiritual feelings and behaviors. Because it is a broad term, which has varied ...
. * Orientation of women during
pregnancy Pregnancy is the time during which one or more offspring gestation, gestates inside a woman's uterus. A multiple birth, multiple pregnancy involves more than one offspring, such as with twins. Conception (biology), Conception usually occurs ...
and
birth Birth is the act or process of bearing or bringing forth offspring, also referred to in technical contexts as parturition. In mammals, the process is initiated by hormones which cause the muscular walls of the uterus to contract, expelling the f ...
, early diagnosis of gynecological cancers and
breast cancer Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a Breast lump, lump in the breast, a change in breast shape, dimpling of the skin, Milk-rejection sign, milk rejection, fluid coming from the nipp ...
, detection and care of problems related to
menopause Menopause, also known as the climacteric, is the time when Menstruation, menstrual periods permanently stop, marking the end of the Human reproduction, reproductive stage for the female human. It typically occurs between the ages of 45 and 5 ...
.
Family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marit ...
. *
Pediatrics Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, Adolescence, adolescents, and young adults. In the United Kingdom, pediatrics covers many o ...
, including infant and child health care, nutrition, general counsel on child development, health education and childhood accidents.
Vaccination Vaccination is the administration of a vaccine to help the immune system develop immunity from a disease. Vaccines contain a microorganism or virus in a weakened, live or killed state, or proteins or toxins from the organism. In stimulating ...
s. * Care for adults in risk groups or with chronic conditions. Counsel on healthy life styles and detection of health problems. *
Geriatrics Geriatrics, or geriatric medicine, is a medical specialty focused on addressing the unique health needs of older adults. The term ''geriatrics'' originates from the Greek γέρων ''geron'' meaning "old man", and ιατρός ''iatros'' mean ...
: promotion of health and prevention of illness. Homecare for the housebound. * Detection of
violence against women Violence against women (VAW), also known as gender-based violence (GBV) or sexual and gender-based violence (SGBV), violent, violence primarily committed by Man, men or boys against woman, women or girls. Such violence is often considered hat ...
and
domestic abuse Domestic violence is violence that occurs in a domestic setting, such as in a marriage or cohabitation. In a broader sense, abuse including nonphysical abuse in such settings is called domestic abuse. The term "domestic violence" is often use ...
, as well as
child abuse Child abuse (also called child endangerment or child maltreatment) is physical abuse, physical, child sexual abuse, sexual, emotional and/or psychological abuse, psychological maltreatment or Child neglect, neglect of a child, especially by a p ...
,
elder abuse Elder abuse (also called elder mistreatment, senior abuse, abuse in later life, abuse of older adults, abuse of older women, and abuse of older men) is a single or repeated act, or lack of appropriate action, occurring within any relationship where ...
, and abuse of disabled people. * Dentistry: Care, diagnosis and therapy, health promotion and education, and illness prevention related to the teeth and mouth. * Care of terminal patient: integral, individual and continual care either in the home or at a health center. *
Mental health Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...
care: prevention and promotion to maintain mental health, in coordination with specialists.


Specialized care

At times, patients will require specialized health care services. These may be provided in external consultations, day hospitals, or on an inpatient basis. Examples of specialized services are intensive and critical care,
anesthesia Anesthesia (American English) or anaesthesia (British English) is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prev ...
,
defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). Defibrillation delivers a dose of electric current (often called a ''count ...
, but also some forms of hemotherapy, rehabilitation, and even nutrition, diet, post-partum treatment, and family planning, especially
assisted reproductive technology Assisted reproductive technology (ART) includes medical procedures used primarily to address infertility. This subject involves procedures such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and cryopreservation of ga ...
. Specialized treatment can also be involved in detection, prescription and implementation of diagnostic and therapeutic procedures, especially those related to
prenatal diagnosis Prenatal testing is a tool that can be used to detect some birth defects at various stages prior to birth. Prenatal testing consists of prenatal screening and prenatal diagnosis, which are aspects of prenatal care that focus on detecting problem ...
in risk groups, diagnosis by imaging, interventionist
radiology Radiology ( ) is the medical specialty that uses medical imaging to diagnose diseases and guide treatment within the bodies of humans and other animals. It began with radiography (which is why its name has a root referring to radiation), but tod ...
,
hemodynamics Hemodynamics or haemodynamics are the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms of autoregulation, just as hydraulic circuits are controlled by control systems. The hemodynamic response continuously ...
,
nuclear medicine Nuclear medicine (nuclear radiology, nucleology), is a medical specialty involving the application of radioactivity, radioactive substances in the diagnosis and treatment of disease. Nuclear imaging is, in a sense, ''radiology done inside out'', ...
,
neurophysiology Neurophysiology is a branch of physiology and neuroscience concerned with the functions of the nervous system and their mechanisms. The term ''neurophysiology'' originates from the Greek word ''νεῦρον'' ("nerve") and ''physiology'' (whic ...
,
endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are insert ...
, lab tests, biopsies,
radiotherapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a treatment using ionizing radiation, generally provided as part of cancer therapy to either kill or control the growth of malignant cells. It is normally delivered by a linear particle ...
,
radiosurgery Radiosurgery is surgery using radiation, that is, the destruction of precisely selected areas of tissue using ionizing radiation rather than excision with a blade. Like other forms of radiation therapy (also called radiotherapy), it is usually us ...
,
renal In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and right in the retrop ...
lithotripsy, dialysis, techniques of
respiratory therapy A respiratory therapist is a specialized healthcare practitioner trained in critical care and cardio-pulmonary medicine in order to work therapeutically with people who have acute critical conditions, cardiac and pulmonary disease. Respirato ...
,
organ transplant Organ transplantation is a medical procedure in which an organ (anatomy), organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or org ...
s and other tissue and cell transplants.


Urgent care

Emergency medicine Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (or "ER doctors") specialize in providing care for unscheduled and undifferentiated pa ...
is health care provided in cases where emergency care is needed. Emergency medicine is practiced both in healthcare facilities and at the site of
work accident A work accident, workplace accident, occupational accident, or accident at work is a "discrete occurrence in the course of work" leading to physical or mental occupational injury. According to the International Labour Organization (ILO), more th ...
s,
traffic accident A traffic collision, also known as a motor vehicle collision, or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other moving or stationary obstruction, such as a tree, pole or building. Tr ...
s, etc. or in the home of a patient whose condition prevents them from getting to a healthcare facility. Emergency medicine is a 24-hour-a-day service provided, in particular, by physicians and other medical professionals in hospital
emergency room An emergency department (ED), also known as an accident and emergency department (A&E), emergency room (ER), emergency ward (EW) or casualty department, is a medical treatment facility specializing in emergency medicine, the acute care of pat ...
s, but also in
ambulance An ambulance is a medically-equipped vehicle used to transport patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to ...
s, medical evacuation
helicopter A helicopter is a type of rotorcraft in which Lift (force), lift and thrust are supplied by horizontally spinning Helicopter rotor, rotors. This allows the helicopter to VTOL, take off and land vertically, to hover (helicopter), hover, and ...
s, etc. ''en route'' to such facilities.


Pharmaceutical services

Medications in Spain are regulated under Law 29/2006 of 26 July, of guarantees and rational use of medications and health care products (''Ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios''). One of the SNS's priorities with respect to pharmaceuticals is to teach patients to make rational use of medications and to avoid, insofar as possible, unsupervised
self-medication Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or ...
. Pharmaceutical services include medications and health products are provided to patients according to their clinical needs, in precise doses and over an adequate period at the least cost possible. Medications are dispensed by pharmacies, each of which is headed by a licensed pharmacist. All medications to be prescribed to patients must either be authorized and registered by the Spanish Agency of Medicines and Medical Devices (''Agencia Española de Medicamentos y Productos Sanitarios''), or must be formulations prepared by licensed pharmacists. Exceptions to this requirement are cosmetics, dietetic products, dental products and other sanitary products, as well as drugs classified as advertising,
homeopathic Homeopathy or homoeopathy is a pseudoscientific system of alternative medicine. It was conceived in 1796 by the German physician Samuel Hahnemann. Its practitioners, called homeopaths or homeopathic physicians, believe that a substance tha ...
medicines, and articles and accessories advertised to the general public and where the purchaser pays the full price (that is, no money comes from SNS-related sources). Spanish patients make a
copayment A patient's copayment or copay is the patient's share of the cost for goods or services rendered, with the other share ("co" = with) paid by the patient's insurance company. The patient's co-payment is usually paid directly to the provider, but is ...
when they acquire pharmaceuticals. The distribution of the cost is as follows: * Medications dispensed as part of hospitalization are free to the patient. * Other prescriptions are financed as follows ** Most
pensioner A pensioner is a person who receives a pension, most commonly because of retirement from the workforce. This is a term typically used in the United Kingdom (along with OAP, initialism of old-age pensioner), Ireland and Australia where someone of p ...
s and their beneficiaries receive their medicines for free. Pensioners who were public functionaries and are protected by MUFACE (Mutualidad General de Funcionarios Civiles del Estado) pay 30 percent of prescription cost. ** Non-pensioners pay 40 percent of the price of prescription drugs. Active functionaries protected by MUFACE pay 30 percent. ** Communities affected by toxic oil syndrome and patients with
AIDS The HIV, human immunodeficiency virus (HIV) is a retrovirus that attacks the immune system. Without treatment, it can lead to a spectrum of conditions including acquired immunodeficiency syndrome (AIDS). It is a Preventive healthcare, pr ...
receive their prescriptions for free. ** Individuals with toxic treatments pay 10 percent, up to a maximum of 2.64
euro The euro (currency symbol, symbol: euro sign, €; ISO 4217, currency code: EUR) is the official currency of 20 of the Member state of the European Union, member states of the European Union. This group of states is officially known as the ...
s per prescription.


Orthoprosthetic and complementary services

Orthoprosthetic services can be permanent surgically implanted prostheses, external prostheses, special orthoses and prostheses including
hearing aid A hearing aid is a device designed to improve hearing by making sound audible to a person with hearing loss. Hearing aids are classified as medical devices in most countries, and regulated by the respective regulations. Small audio amplifiers ...
s and
earmold An earmold (also spelled; ear mold, ear mould or earmould) is a device worn inserted into the ear for sound conduction or Hearing protection device, hearing protection. Earmolds are anatomically shaped and can be produced in different sizes for ...
s for children up to age 16 with bilateral
hearing impairment Hearing loss is a partial or total inability to Hearing, hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to Lang ...
s. "Complementary services" include complex dietary therapies, vehicles for invalids, and home
oxygen therapy Oxygen therapy, also referred to as supplemental oxygen, is the use of oxygen as medical treatment. Supplemental oxygen can also refer to the use of oxygen enriched air at altitude. Acute indications for therapy include hypoxemia (low blood o ...
.


Health care transport

The health care transport infrastructure transports people who are ill, accident victims, or otherwise in need of medical attention. It includes
ambulance An ambulance is a medically-equipped vehicle used to transport patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to ...
s, as well as
air ambulance Air medical services are the use of aircraft, including both fixed-wing aircraft and helicopters to provide various kinds of urgent medical care, especially prehospital, emergency and critical care to patients during aeromedical evacuation an ...
s: helicopters and airplanes whose interiors are specially modified for the purpose. For most purposes, of course, ground transport is preferred, but sometimes distances or the difficulty of reaching particular locations make air transport more practical.


Demographics of Spain

According to data from the National Institute of Statistics (''Instituto Nacional de Estadística'', INE), as of January 1, 2018, Spain has a population of 46,659,302, of whom 22,882,286 (49,04%) are male and 23,777,015 (50.96%) female. In recent years, this population has been increasing slowly but progressively. In the last decade, the increase has been largely through immigration: 4,572,055 Spanish residents are foreigners. These numbers count only citizens and legal immigrants. The health care system must also provide services for thousands of illegal immigrants and for the many tourists who visit Spain each year.


Population pyramid

Analysis of the population pyramid shows that * 20 percent of the total population is under 20 years of age. * 24 percent of the total population is 20 to 40 years of age. * 31 percent of the total population is 40 to 60 years of age. * 25 percent of the total population is at least 60 years old. This structure is typical of a modern demographic regimen, with an evolution toward an aging population and a declining
birth rate Birth rate, also known as natality, is the total number of live childbirth, human births per 1,000 population for a given period divided by the length of the period in years. The number of live births is normally taken from a universal registr ...
. This means that Spain has to expect an increase in use of the services that are targeted at older adults. This effect is further exacerbated by a steadily increasing
life expectancy Human life expectancy is a statistical measure of the estimate of the average remaining years of life at a given age. The most commonly used measure is ''life expectancy at birth'' (LEB, or in demographic notation ''e''0, where '' ...
.


See also

* National Transplant Organization achieved the highest rate of donors in the world in 2006. * Miguel de Cervantes Health Care Centre * Social Security in Spain


Notes

{{Authority control * Universal health care Publicly funded health care