Renewing Primary Care: Lessons Learned From The Spanish Health Care System

Abstract

From 1978 on, Spain rapidly expanded and strengthened its primary health care system, offering a lesson in how to improve health outcomes in a cost-effective manner. The nation moved to a tax-based system of universal access for the entire population and, at the local level, instituted primary care teams coordinating prevention, health promotion, treatment, and community care. Gains included increases in life expectancy and reductions in infant mortality, with outcomes superior to those in the United States. In 2007 Spain spent $2,671 per person, or 8.5 percent of its gross domestic product on health care, versus 16 percent in the United States. Despite concerns familiar to Americans-about future shortages of primary care physicians and relatively low status and pay for these physicians-the principles underlying the Spanish reforms offer lessons for the United States.

Effects of the economic crisis and social support on health-related quality of life: first wave of a longitudinal study in Spain

“…All salaries include a capitation component. 17 The GP:patient ratio is 1:1100. Appointment duration is approximately 8 minutes.…”

How to combine lean and safety management in health care processes: A case from Spain

“…The central government is responsible for several strategic areas (García-Armesto et al, 2010). Each autonomous community can define a different organization for its territory that can be distinguished into Health Areas and Basic Health Zones; the latter ones are the smallest unit of organizational healthcare (García-Armesto et al, 2010;Borkan et al, 2010). While regional health legislation, health insurance, health services planning, management and provision fall within the competence of Autonomous Communities, the local authorities are responsible for sanitation, collaboration in health services provision and public health and community services (García-Armesto et al, 2010).…”

“…Lopez-Casasnovas et al (2005) underline that this decentralized system has not generated inequalities; rather, it has increased quality improvements at least for what concerns patient satisfaction. Borkan et al (2010) report that in 2007 the NHS developed a Quality Plan: considering inputs from local authorities, twelve strategies were developed and executed at the national, regional, and local levels to reach quality and efficiency improvements and to reduce unnecessary costs and patient waiting times.…”

Pathways towards chronic care-focused healthcare systems: Evidence from Spain

“…Also, regarding support towards the care provided by informal caregivers and families, Spain Primary care is recognized internationally as one of the strengths of the Spanish NHS (Borkan et al, 2010). Primary care teams are assigned defined population groups, and work with established electronic health information systems, putting them in a good starting position for the development of active population management strategies.…”

“…By 2007, 97% of all consultations in primary care centers were supported by electronic health records, and 64% of centers had tools to support online patient referrals. In the next phase, an integrated electronic health record system is being developed throughout Spain using both centralized and decentralized platforms, to promote the exchange of information across levels of care and regional boundaries (Borkan et al, 2010). New regulation is supporting this effort (Royal Decree 9/2011 of 19 th August), which is fundamental for improving chronic care.…”