My IEE in: Spain By Casey Freeman

¡Bienvenido a España! Pamplona is a city in northern Spain which is about the size of Overland Park. La Cuenca de Pamplona… the city is surrounded by mountains and hills. Pamplona’s claim to fame is the running of the bulls at the San Fermin Festival.

The Hospital Private hospital ACUNSA = insurance provider Anesthesia Standard operating room in the hospital Robotic surgery in the hospital

History of the Spanish National Healthcare System Founded by Spain’s General Healthcare Act of 1986 Universal coverage Free healthcare access In 2002, the national system was decentralized giving regional authorities more autonomy in improving infrastructure

Current System Central (Organizacion de la Administracion Central) Issuing health proposals, planning and implementing government health guidelines, and coordinating activities such as efforts to fight substance abuse Autonomous Community (Organizacion autonomica) Each of the 17 autonomous communities is responsible for providing integrated health services to the regional population Local (Areas de Salud) In charge of unitary management of health services offered at the level of the autonomous community Defined by factors of demography, geography, climate, socioeconomics, employment, epidemiology, and culture

Healthcare Spending System primarily funded by taxation Total healthcare expenditure accounts for about 9% of GDP (as compared to 17.4% in the US) $2,658 per capita spent annually (compared to $9,402 in the US)

Private insurance Used for treatment at private hospitals and clinics Not widespread! 10-20% of the population on average has private insurance Benefits and usage Quicker service (“Used mainly to avoid long waiting lists for specialists”) Value-added services Private rooms Express mailing of test results Quick access to information via email or text messaging

Estimated costs in Spain Mostly covered by public insurance, but patients may have a small co- payment depending on their level of coverage Average monthly medical premium for an individual – $61 One-day hospital stay – $246 Primary Care visit – $123 Specialist visit – $184 Prescriptions are where most patient’s $$ are spent 10-60% out of pocket depending on income https://transferwise.com/gb/blog/healthcare-system-in-spain

Primary Care and Specialist Care Primary Care - Maximum accessibility and equity Multidisciplinary teams with various health personnel based on community needs Primary Healthcare services are available within a 15-minute radius from any place of residency Home care available when necessary Specialty care – Continuous care under equitable conditions After treatment by specialists, primary care provider assumes responsibility for follow up care

Conclusions Spain has a fantastic healthcare system with the following characteristics: Universal system that covers 99% of the population Communities (regionally and locally) that are highly involved in healthcare decisions Similar quality of care provided by public and private institutions When patients have to pay out-of-pocket, costs are still relatively affordable Highly accessible and equitable primary care

Medical Education Most profound clinical/academic experience: 6 year program Classes and clinical experiences from beginning to end Non-malignant learning culture (minimal “pimping”) Student time and learning is respected and valued by physicians Rotate with students of various healthcare professions

Death and Dying Most profound cultural experience: Most older patients in the hospital were ambulatory and appeared to be in fairly good health Relatives are often primary caregivers for their aging family members If a person was actively dying, they would be kept comfortable at home Not many retirement communities/nursing homes in Spain Quality of life >>> quantity of years lived

References https://healthmanagement.org/c/hospital/issuearticle/overview-of- the-spanish-healthcare-system https://transferwise.com/gb/blog/healthcare-system-in-spain https://data.worldbank.org Interview with on-site attending Dr. Ricardo Calderon