1. My IEE in:
Spain
By Casey Freeman

2. ¡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.

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

4. 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

5. 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

6. 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)

7. 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 or text messaging

8. 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

9. 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

10. 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

11. 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

12. 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

13. References
the-spanish-healthcare-system
Interview with on-site attending Dr. Ricardo Calderon