Health insurance models vary from country to country. As highlighted in our first series of articles on international health markets, governments often dictate the role of private and public health insurance within any country. Milliman has produced a new series of blogs focused on the medical underwriting and risk adjustment practices of eight countries: Australia, Ghana, Ireland, New Zealand, Saudi Arabia, South Africa, Spain, and United Arab Emirates. This is the second article in our series.
The Spanish National Health System (NHS) follows an integrated model in which the financing (through general taxes), purchasing, and provision of health services are mainly public. It offers universal coverage and, in accordance with the Spanish Ministry of Health and Social Policy, 95.8% of the total population was covered in 2011.
Since 2002, the organization of the NHS has been decentralized across the 17 autonomous communities in which the territory is divided. The central government is responsible for ensuring equitable access to health services across the territory and keeps its authority over areas such as regulation of pharmaceutical products.
Patients are required to visit the general practitioner assigned to their specific geographic health areas, who in turn refers patients to corresponding specialists as needed.
In April 2012, a health reform introduced different measures to control the public health expenditure, such as the regulation of the conditions to provide health services to undocumented immigrants and the extension of selective copayments on pharmaceutical products. The copayment is established taking into account the level of income and whether the person is retired or actively working. Copayments are not applied in only a few cases, for example the long-term unemployed and low-income groups.