Health Care Systems – the Unites States and Spain

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Health Care Systems – the Unites States and Spain


The provision of health care services is a major issue in the modern world. Citizens of every nation have the rights to access proper health care. In this regard, every country has a health care system mandated to offer these services. It is important that the health care systems meet the required standards in terms of provision of the health care services. The World Health Organization presents some of the necessary requirements to monitor the operation of the systems. Despite the global provision of health care services, the health care systems differ slightly in their ways of operation, structures, funding of the services, accessibility, and costs incurred. The paper seeks to compare and contrast the health care systems of two prominent countries, the United States and Spain.

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Health Statistics and Costs: the United States and Spain

The United States is arguably the top developed country boasting to have a state-of-the-art health care delivery system. Despite this, the nation has shorter male and female life expectancy rates as compared to other top developed countries (Holtz, 2008). America maintains several separate systems for different classes of people. On the other hand, Spain works towards stabilizing its own integrated National Health System that aims to cover for almost 96% of the nation’s population (Mossialos, Wenzl, Osborn, & Anderson, 2015). From the national level, the idea has streamed down to regional levels. The decentralization of the health care system in Spain is instrumental in the advancement of new medical practices and technologies (Kringos, Boerma, van der Zee, & Groenewegen, 2013).

According to World Health reports (2014), America does not have a uniform health system and it does not offer universal health care coverage. In simple terms, the system present in the United States is hybrid with 50% of the health care spending coming from private funds (World Health Organization, 2014). The World Health Organization (2014) also indicates that America’s health spending the figure stands at 17% of the GDP. Provisions of the service does not heavily rely on the government as is the case with Spain. The total health spending accounted for 9.4% of GDP in Spain. The percent is slightly higher than the standard of 9.3%, while the 17% of the United States is the highest. Accordingly, the health care spending is a 50-50 costing between public and private health care providers (Kringos et al., 2013). Mossialos et al. (2015) highlight the rate of America’s life expectancy is about 78 years. The age seems to be stagnated for the last decade and this fact is accorded to the existing health insurance coverage gaps. The world health statistics has faulted America’s lifestyle that has a negative impact on Americans’ health.

Spain has a population of over 40 million as per the recent statistics, with an average age distribution. Notable, the overall health indicators remain relatively favorable with life expectancy at birth standing at 75 years (World Health Organization, 2014). The main health causes of death in the country arise from cardiovascular complications, accidents, and cancer. One striking factor is the high mortality rate for the population under the age of 35 years (Kringos et al., 2013). Another notable health factor is the obesity rates that have greatly increased in Spain. The obesity rate in Spain is at 16.6% in 2011, which is lower compared to the United States rate of 28.6%. The quality and cost of health care system for the two countries also vary in their ranking. According to the world ratings, Spain reports 74.54, eight times more than the United States, which is at 69.

Health Care Financing: Comparison between the United States and Spain

Earlier in the century, the main system of health care financing in Spain employed the Bismarck model. Currently, the country finances its health services through the Beveridge model. According to the model, the government takes almost 80% of healthcare financing for the Spaniards (Kringos et al., 2013). Work related contribution to insurance funds, which is usually shared between the employer and the employee, takes 18% of the funding (World Health Organization, 2014). However, the co-payments within the system apply to some medical devices and drugs. When it comes to health care financing in Spain, the publicly-funded insurance scheme covers an estimated 99% of the population. Out of this number, 93% fall under the compulsory insurance scheme, 1% benefit from government subsidies, and 4.5% are insured through a special scheme. The 4.5% of the population covers the civil servants (World Health Organization, 2014). In addition to the compulsory cover, approximately 18% of the population obtain additional private insurance with voluntary schemes.

The decentralization system applicable to the health care system also applies to the financing. Annual budgets are allocated to the independent regions estimate on a per capita basis. Just like other countries, Spain has both public and private hospitals that offer health care services. All hospital physicians in Spain are on a salary payroll, while the general practitioners receive payment through capitation. The country sets a national budget for health care expenses, which is not the case for the United States. Total health care expenditure in Spain has risen steadily from 2% to 8%. Public share of expenditure in Spain adds to approximately 80% (Mossialos et al., 2015).

As earlier identified, financing of health care services in America takes a different approach from that of Spain. The major part of financing for the service is through private insurance and individual spending. In support of the two types of spending, Americans access health care services through Medicaid and Medicare programs. Medicaid and Medicare are an initiative of the national government and federal government to provide health care services to the low-income earners. According to the World Health Organization (2014), access to health care services in America is quite expensive, especially based on the fact that individuals remain responsible for the health care costs. Often, the self-spending on health care leads to bankruptcy of American citizens unlike in Spain, where the government oversees the health sector.

Health Care Administration: Comparison between the United States and Spain

Most of the health care providers in Spain are public dominated, which is not the case for America. Compared to the United States, Spain handles the health care issues from the national level and then delegates the roles to the regional level. The operations of the Spanish health care are under the social security system. The social security system is responsible for the management of public health institutions that provide health care services to nearly 40% of the country’s population. Out of the 17 Spanish regions, the public health facilities offer their services to 10 of them (Mossialos et al., 2015). Other institutions that help in the management of the public health facilities include National Institute of Social Services and National Institute for Social Insurance. For instance, outpatient care in Spain is done by designated outpatient centers. The centers also offer consultation services, problem-solving procedures, and minor surgical interventions (Mossialos et al., 2015). On the other hand, each region is equipped with one general hospital that offers simple clinical services and round the clock emergency services. The American health care systems operate under the key administration of the private practitioners and private health groups such as clinics and hospitals (Holtz, 2008). As earlier identified, the Spanish government has a much greater level of regulation of the system. The American government regulates the health care system through the management of health insurance market reforms and mandated benefits that must be covered by private insurance companies.

Health Care Personnel and Facilities: Comparison between the United States and Spain

Since a better part of the health care system in the United States is under the management of the private sector, the same applies to the health care personnel. Most of the medical practitioners and other health care professionals are in private practice. The practitioners work in small practices; hence, there is no overall body mandated with the business (Kringos et al., 2013). The payment method for the medical professionals is not standardized as salaried. There are different ways, through which they obtain their payments that comprise of capitation rate contracts, funds obtained from public programs, and discounted fees paid (Holtz, 2008).

Spain records a number of hospitals at about 900, with a number of hospital beds being 5 per 1000 population. The majority of the hospital beds belong to the public. This is a major difference as compared to the United States that has the private sector topping the list of health care services. According to the EU ratings, America reports low hospital beds per population. In addition, the industry has fewer physicians per person, 2.4 practicing physicians per 1,000 people (Kringos et al., 2013). As for personnel, Spain reports a number of practicing physicians, standing at 45 per 10,000 population. The number of nurses is adequate to the needs of the country, although the EU finds it below the required level. Just like the United States, Spain’s health care personnel comprise of practicing physicians, general practitioners, certified nurses, general practitioners, practicing pharmacists, practicing dentists, specialists, and consultants. World Health Organization (2014) indicates that the United States’ physicians per 1000 people is 2.3, being ranked the 31st in the world.

Access and Inequality Issues: Comparison between the United States and Spain

Spain faces key challenges in the provision of health care services. Reports indicate that Spain faces a major challenge in terms of the payment system for the professionals (Mossialos et al., 2015). Hospital physicians are salaried, which may not be an efficient system with the existing structures. The deficiency in the remuneration of physicians and practitioners leads to high cases of inefficiency in service provision, especially in the ambulatory care (Kringos et al, 2013). The country has a compulsory medical cover for all citizens’, hence minimal cases of inequality of health care services. The decentralized health care system in Spain helps in accessibility aspects of the services. The public provision of health care service also ensures equality is attained in Spain.

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The key challenges include access to the service and inequality issues (Holtz, 2008). America experiences major problems with accessibility and quality of health care along racial, income groups, ethnic, and other priority population. The different programs of financing were established to cover diverse populations. This implies that some programs suit people who are financially stable, others cover the less fortunate ones, while some programs are for the employed. Having such differences in the programs implies inequality in the public service. In addition, the differences in the program equate to the limited accessibility to proper health care services (World Health Organization, 2014).


The American and Spanish health care systems have features that bring out similarities and differences. From the above discussion, both systems combine public and private entities in the provision of insurance and health care services. As identified, both make use of employer and individual mandates, including insurance and health care services. Major differences are evident in terms of structure, administration, health providers, policymakers, and the insurance companies.