Health system reforms during the economic
crisis: challenges and opportunities for
Spain
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
Pilar Farjas Abadia Secretary General for Health and Consumer Affairs
Ministry of Health, Social Services and Equality, S pain
Oslo, 18th April 2013
Spain
� Financed through national public budget
Features of the Spanish National Health System
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
� Universal coverage
� Health services free of charge
� Based in primary health care
� Decentralized model: 17 Regions
Evolution of public debt in the National Health System
8.555
15.699
8.000
10.000
12.000
14.000
16.000
173%
How was the situation? (1)
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
2.170 1.9302.745
4.685
6.369
3.0003.870
5.2305.745
8.555
0
2.000
4.000
6.000
8.000
2009 2010 2011
Mill. d
e €
Source: Data from Farmaindustria, Fenin, IDIS y FEFE
OthersPharmaceutical IndustryTotal
PharmaciesHealth Technology Industries
Evolution of GDP and public health care expenditure(million Euro), 2002-2012
How was the situation? (2)
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
Evolution of pharmaceutical expenditure and of the number of prescriptions, 2003-2012
How was the situation? (3)
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
Pharmaceutical expenditureNº Prescriptions
Health Insurance rights
Basket of benefits
What was done?: Health Reforms in 20121000 700
3550
600
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
PharmaceuticalPortfolio
Social-Health agreement
Health Professionals
Efficiency Measures
1442
500 500
1000
37 80
100
Estimated savings
Reached savings
In progress savings
(million Euro)
Results in pharmaceutical expenditurePharmaceutical expenditure per month, 2012 vs. 2011 (million Euro)
20112012
Savings
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
Providers’ payment
Plan
Evolution of hospital pharmaceutical debt, 2008-201 2 (million Euro )
Before Reform
After Reform
Self assessment of health status: good or very good
Performance of the National Health System
70,5 70,174,1 75,0 76,4
83,4 83,8 82,3
12,314,6
18,8 20,0 20,9
28,230,8
28,3
9,2 8,9
20
30
40
50
60
70
80
90
100
Use of health services National Health Survey 1987-2012
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
year
National Health Survey 2012
12,37,5 7,7 8,2 9,2 8,9 7,9
6,3 6,9
6,3 7,1
0
10
1987 1993 1995 1997 2001 2003 2006 2012año encuesta
92,8
7,2
98,2
11,1
98,2
10,6
98,7
10,1
99,5
11,9
98,3
14,6
99,0
13,4
0
10
20
30
40
50
60
70
80
90
100
1993 1995 1997 2001 2003 2006 2012año encuesta
doble cobertura (pública y privada) cobertura pública cobertura privada
Health CoverageNational Health Survey 1993-2012
2012: 12.5% double insurancepublic-private
75,3%
�Sustainability: The NHS reform has allowedaddressing the debt and obtaining savings withoutprecedent.�Equity and solidarity : Ensures the maintenance ofthe Universal health coverage and the protection of
Reforms Conclusions for Spain
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
9
the Universal health coverage and the protection ofthe most vulnerable ones.�Consensus: Among Regions in order to beadopted.�Acceptance: The NHS Reform has the support ofthe citizens.� Road Map: The NHS Reform creates the stabilityand the predictable frame needed and request by allthe stakeholders.
Thank you!
SECRETARÍA GENERAL DESANIDAD Y CONSUMO
Thank you!
http://www.msssi.gob.es/