Essay on Universal Healthcare in Spain

The Spanish healthcare system covers 99.7 percent of its citizens, however, the American healthcare system leaves around 9 percent of its citizens uninsured (“Key Facts About the Uninsured” 9). Both the United States and Spain's healthcare industry differs greatly. Spanish health care known as Spanish National Health System (SNS), is state-funded and covers all citizens. However, Spanish citizens have the option to take advantage of private healthcare insurance to help pay for private clinics. The United States healthcare industry is a private sector, where United States citizens pay a large premium to allow them to be insured. However, for the majority who cannot provide for themselves the government offers social welfare programs. There are positives and negatives to both the Spanish and United States healthcare programs. This paper will discuss both the United States and Spanish healthcare platforms, the advantages and consequences of the systems, and finally the future of both healthcare sectors.

The Spanish constitution requires that the state provide medical care it all of its citizens, therefore the public healthcare system is fairly permanent in its current state. By living and working in Spain, Spanish citizens contribute to social security which grants them access to state-funded healthcare. Through the Spanish National Healthcare System, basic medical services can be viewed as ‘free’. If a citizen requires a complicated service such as surgical procedure, overnight stay, or extensive prescriptions there is a charge, within a reasonable amount. However, unemployed noncitizens do not have access to this “free” healthcare and would be required to pay a monthly premium for a private plan. “Around 90 percent of Spaniards use the public healthcare system, with some 19 percent signed up for some sort of private healthcare scheme in order to combine the best of both systems”(“The Healthcare System In Spain” 3). Many Spaniards choose to have a small private insurance plan to avoid long wait times that are a result of the universal healthcare system. There is a belief that a universal healthcare system can result in inaccurate diagnostics and unsatisfactory service. However, the public Spanish healthcare system often employs graduates from Spain’s top medical schools. Having some of the best doctors in the nation practicing in public facilities speaks to the true merit of the universal healthcare system in Spain. With Spain’s tourism, there should be options for those who are visiting. Spain allows for those not covered by the Spanish National Healthcare System to be treated in public facilities for a generally low cost. Privatized hospitals have been known to charge an exuberant fee if either the patient’s state or private insurance does not match up with the hospital’s insurance providers. While many healthcare centers, both public and private, in metropolitan areas have English-speaking staff, many will charge for an interpreter. Beyond insurance coverage in the Spanish healthcare system, the cost of prescriptions in Spain depends on the insurance type. With a Spanish National Healthcare System insurance plan, the amount a citizen pays for prescriptions depends on income, working age, or state pensioner. According to Expatica, “If a citizen is of working age and has an annual income that is less than €18,000, 40 percent of the cost of the medication would be charged. If income is between €18,000 and €100,000 payment is 50 percent, and if it’s over €100,000 then payment is 60 percent. State pensioners pay 10 percent unless their income is over €100,000, in which case they also pay 60 percent”. Privatized insurance does not have a definitive payment amount like the Spanish National Healthcare System insurance. Coverage of prescriptions depends on a variety of things such as private insurance provider, type of plan, and the prices of the prescription itself.

Health insurance in the United States can be classified under privately purchased insurance or social welfare programs which help the user pay for medical expenses. In regards to privately purchased insurance, the way it works is the user pays a premium to an insurance company and that premium allows one to share risk with other users who pay the premium (“How U.S. Health Insurance Works” 2). Since most users are healthy most days, the premium can be used to cover the bills of the other members on the plan. Other than monthly premiums, users are also subject to a deductible and copay. Depending on the plan, deductibles can range from hundreds to thousands of dollars that the user pays upfront before the insurance company begins to contribute. After the deductible is met, the user is just subject to a copayment, which is a certain amount that must be paid upfront when going to a doctor's appointment. Galan states, “Insurance providers will usually cover services considered necessary by doctors, but often will not cover services which are considered elective” (3). The plan that one chooses differs greatly in the amount one pays. However, a lot of services are standardized under the Affordable Care Act to offer United States citizens essential health benefits to help better regulate the industry. However, if an American citizen is older, disabled, or from a low-income household, they are subject to receiving social welfare insurance programs including Medicaid and Medicare. “Medicaid is a means-tested health and medical services program for certain individuals and low-income households with few resources” (Galan 7). Rather than the government giving funds to the users themselves, Medicaid directly reimburses providers. Medicaid provides for those who are unable to provide for themselves. “Medicare is a federal program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income” (Galan 11). Medicare has parts A, B, C, and D. Medicare Part A covers hospital insurance for those who are allowed coverage, Part B covers supplementary medical insurance, Part C covers dental, hearing, and vision, and finally, Part D covers pharmaceuticals for prescribed medication. Both Medicaid and Medicare are covered through Federal payroll taxes, tax revenues, and beneficiary premiums that are all contributed to by United States citizens. Although Medicare and Medicaid are in place, there are still millions of Americans who go uninsured every year and cannot qualify for either and are then subject to the financial burden of medical insurance.

Because of the endless options in insurance coverage, the Spanish healthcare system has many advantages as well as several disadvantages that will now be discussed. The Spanish healthcare system is regularly rated among the world’s best and continues to have some of the best statistics for life expectancy (“The Healthcare System in Spain”). With high life expectancy rates comes a growing population in Spain, which can help strengthen Spain's identity by having generations of Spanish culture being passed down. However, when it comes to a universal healthcare system the result is a greater population that needs treatment and coverage. According to Oriol Guell, “Patients wait an average of 93 days for surgery at a public hospital in Spain, and one in every eight people wait over six months” (3). This is a shocking statistic considering most of these surgeries are treating serious conditions that would benefit from a quick treatment timeline. The issue is no longer below-average service, but the lack of doctors treating patients. According to research done in 2016, there were approximately 3.8 doctors for 1,000 patients. With the current state of the Spanish healthcare system, doctors are being worked to the bone because there are too many citizens who need to be treated and not enough doctors. Even with the lack of doctors, Spain hospitals continue to treat patients with accurate and quality services as much as they can. As stated before the Spanish healthcare system is split into two distinct sectors, public and private. Both of these sectors have benefits and drawbacks. The public sector is one of the strongest in the world with some of the top doctors in Spain and all citizens can have coverage. Unlike in the private sector, doctors aren't financially incentivized to push expensive prescriptions and treatments that may not be necessary. They are accustomed to recommending the cheapest course of action, which is beneficial for any patient using the Spanish National Healthcare System’s insurance. Doctors in both the public and private sectors provide quality treatment. While the private sector can be more expensive because of privatized insurance and the encouragement of expensive prescriptions and treatments, many believe it is worth the extra expenses. The Spanish National Healthcare System’s insurance is known not to cover every health expense, which is never a concern with private insurance plans. Most procedures, treatments, and prescriptions are covered by the private insurance provider depending on the coverage level. In addition to the comfort that full coverage provides as well as timely treatment times, many patients believe that the private healthcare system is the future of Spain. Whether the belief that the private sector is the future of Spanish healthcare is true or not, Spain’s healthcare efficiency ranks first in Europe, and third in the world (Rippin 1).

The United States health insurance industry consists of both privately and publicly funded insurance plans and has many advantages and disadvantages to its users. First of all, the United States has one of the best medical research systems in the world (Christ 2). With impressive institutions such as the Mayo Clinic, Harvard Medical School, and the Cleveland Clinic, these privately-funded institutions can make incredible advances in medicine due to the free-market healthcare insurance industry. This is because customers/users are willing to pay to acquire new procedures, drugs, and research. Those who succeed are rewarded with a profit, allowing top professionals and researchers to remain in the United States to be paid for their work and continue to evolve in the medical field. This can be alluded to as the reason why the United States has the highest rate for certain cancer survival and the best treatment for chronic diseases. Another advantage of the free-market industry is that taxpayers do not bear the expenses when providing insurance to every citizen of the country (“Key Facts About the Uninsured Population” 4). Because citizens are responsible for providing their care (other than Medicare and Medicaid recipients) they do not bear the burden of paying for others medical needs. Therefore, if they are healthy, they are paying the minimum amount to still be covered if an accident does occur. Another important advantage to address is that the user of the insurance can generally choose your provider (depending on your insurance plan). That being said, one can choose which doctor to attend based on reviews and experiences, rather than just going to an office and being assigned a doctor. Therefore, Americans tend to have more freedom when it comes to appointments and procedures because they are paying more money. Although there are many positives to this healthcare process, there are also many negatives that may come with a higher cost. The first is that “According to the United States Census Bureau, in 2012 there were 45.6 million people in the US (14.8 percent of the under 65 population) who were without health insurance” (“Key Facts About the Uninsured Population” 6). This is due to high insurance costs, and if they do not qualify for welfare programs they live uninsured. This is a large issue in itself due to the high cost of doctor appointments, emergency room, surgeries, etc.. An emergency room visit in the United States can range anywhere from $150-$3,000 (Christ 15). Therefore, for the nearly 15 percent of Americans who do not have insurance, health care is just simply not a viable option. These Americans do not have access to this top medicine that can be provided. It is estimated that the average out-of-pocket cost is $5,716 per year for insurance (Christ 19). This is an extremely high cost that most cannot provide every year. Uninsured Americans who face a health ailment can easily spiral into bankruptcy because they cannot afford the care they need to survive. Although there are positives to a free-market health insurance industry, citizens who cannot afford to pay high amounts for coverage are constantly struggling to receive the care they need.

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The Spanish healthcare system has been under criticism on whether it is sustainable in today’s world. The state-funded system has been decentralized since 2002, giving each autonomy’s healthcare authorities the power to plan, alter, and improve the system. The idea behind autonomizing healthcare was to provide greater and more equal access to health centers around Spain. The plan of decentralizing worked extremely well in the beginning, however it did not last. As the population continues to grow, the constraints have tightened especially in highly populated, urban areas. While the idea of “free” healthcare is enticing to everyone, the state is required to fund these systems. The global economic crisis caused Spain to dive into a recession and caused the government to have to adjust budgets for all government-funded programs. Just in the past two years, the budget for healthcare has been reduced due to the country’s need to save money. Many regions were forced to implement unpopular spending cuts causing the installation of prescription copayments and the privatization of several hospitals. Currently, the issue of sustainability is overwhelming for Spain and all of its citizens and subsidiaries. According to the Alliance for Natural Health, a sustainable healthcare system is the following:

“A complex system of interacting approaches to the restoration, management, and optimization of human health that has an ecological base, that is environmentally, economically and socially viable indefinitely, that functions harmoniously both with the human body and the non-human environment, and which does not result in unfair or disproportionate impacts on any significant contributory element of the healthcare system.”

This description not only expresses concern for the people working or receiving services under the healthcare system but for contributors who fund it as well. For the issues in healthcare, sustainability is all about the distribution of money. Fiscal sustainability in the healthcare system means the government should be able to pay all costs without significant changes to taxes or debt (Sabeva 9). If Spain expects the current healthcare system to continue, there needs to be an evaluation of the necessary and unnecessary expenditures throughout the system. However, this evaluation will cause dissatisfaction among the Spanish population because there is truly no good way to assess the worth of someone’s health in society today. The largest issue with assessing and changing the current public healthcare system is there will be some type of change that is made to the operating system. People, not just Spanish, do not like change, therefore the mere idea of replacement or alterations to universal healthcare within Spain causes distress amongst the population. Many politicians have considered the option of collaborating with the privatized healthcare system, however, this partnership would be extremely difficult to manage in today's society. The public and private sectors are run in very different approaches, therefore joining the two sectors would be nearly impossible for the government. The future of the Spanish public healthcare system truly relies on the government to make intelligent decisions on how to distribute public funds properly over the next few years.

The future of the United States healthcare insurance industry can be addressed based on the facts on increased cost and availability. Even though for those who meet the requirements for Medicare or Medicaid, these sectors consume nearly 17 percent of the United States GDP (Bohigian & Klingele 1). The United States spends more of its total GDP on these healthcare sectors than any other country in the world, for only a small about of users. With the number of users rising, Medicare and Medicaid are not a viable option. There have been several attempts in recent years in which United States politicians are trying to move towards Medicare for all. One such program is Obamacare- it is a law enacted to ensure that all Americans gain access to affordable healthcare insurance. Obamacare offers consumers tax credits (known as discounts) on government-sponsored health care plans (Bohigian & Klingele 1). Obamacare users can pay anywhere from $100-$700 a month to allow health insurance coverage for their families. Obamacare also expands Medicaid assistance to more people who cannot afford these plans. Although the American government is attempting to gain healthcare for all, there are serious issues with a plan like Obamacare in the American government today. Some of the issues include skyrocketing premiums, increasing deductibles, and worsening America’s debt which the American public would have to deal with. America is faced with a large challenge when it comes to covering citizens' health care. Due to issues previously discussed and some of the most expensive medical practices, America will greatly struggle to separate from a free-market health insurance industry in the future. Rather, one will see more Americans forced to go uninsured while those who can afford it gain access to the best medical doctors, procedures, and researchers in the world.

The United States and Spanish healthcare systems greatly differ both financially and individually. As one can see, the future of both sectors is quickly evolving. Therefore, what changes are being made to help guide the future of these sectors? In the United States, the government is looking at replacing or revising the Affordable Care Act. However, this has led to many disagreements and discussions on the topic of healthcare. In the future, one can expect to see large changes in what health insurance companies cover, large advancements in digital health, and a large shift away from employer-sponsored health insurance. But for now, the United States healthcare industry will continue to be plagued by increasing prices, a rising number of uninsured citizens, etc.. In Spain, the healthcare system remains to be a topic of uncertainty. If the government continues to put off the proper delegation of funds, Spain will no longer be able to provide this ‘free’ healthcare. There is a great likelihood that the Spanish National Healthcare System will not be able to support itself, and private healthcare providers will take hold of the market. The future of Spanish healthcare is truly unknown and completely in the control of government politicians.

Both the United States and Spain have very different healthcare platforms, with many advantages and disadvantages that have been discussed. The United States has strong medical coverage and unparalleled doctors, procedures, and discoveries- but it comes with a large price tag for all citizens who need to privately purchase their insurance and leaves millions uninsured due to the cost. Spain allows coverage for all, but that comes with decreased benefits that can be seen daily by long wait times and lost services in hospitals all around the country. Both countries have interesting and evolving possibilities for the future, however, the future of both countries' healthcare systems is uncertain. With that being said, both the United States and Spain's health care plans have plenty of room for improvements and changes as times develop for all to be granted insurance with equal benefits. As for now, the systems will remain stagnant without large bills and laws being passed in both of their respective countries.

Works Cited

1. “Annual Report on the National Healthcare System of Spain 2016.” MSCBS, Ministry of Health, Social Services and Equality, 2017, www.mscbs.gob.es/estadEstudios/estadisticas/sisInfSanSNS/tablasEstadisticas/InfAnualSNS2016/Annual_Report_NHS_Spain_2016.pdf.
2. Avanzas, Pablo, et al. “The Great Challenge of the Public Health System in Spain.” Journal of Thoracic Disease, AME Publishing Company, May 2017, from www.ncbi.nlm.nih.gov/pmc/articles/PMC5462723/.
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4. Christ, S. (2019, January 10). Advantages & Disadvantages of American Health Care. Retrieved March 4, 2019, from https://pocketsense.com/advantages-disadvantages-of-american-heal th-care-12271358.html
5. Galan, N. (2018, November 30). Medicare and Medicaid: What do they do? Retrieved April 7, 2019, from https://www.medicalnewstoday.com/articles/323858.php
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7. Rippin, Tara. “Spain's Healthcare System Is 'Most Efficient in Europe'.” Euro Weekly News Spain, 30 Sept. 2018, from www.euroweeklynews.com/2018/09/30/spanish-healthcare-system-is-the-most-efficient-in-europe/#.XKjpSJgzbIU.
8. Rósenova Sábeva, Tanita. Sustainability and the Future of the Spanish Healthcare System. www.mscbs.gob.es/estadEstudios/estadisticas/sisInfSanSNS/tablasEstadisticas/InfAnualSNS2016/Annual_Report_NHS_Spain_2016.pdfhttps://cdn.ymaws.com/echalliance.com/resource/resmgr/Files/Sustainability_and_Future_of.pdf.
9. TransferWise. “Healthcare in Spain: A Guide to the Spanish Healthcare System.” TransferWise, TransferWise, 14 Nov. 2017, transferwise.com/gb/blog/healthcare-system-in-spain.