Health Care in the U.S. And Spain
What Can the U.S. Learn About Health Care from Spain?
In 2009, Spain’s single-payer health care system was ranked the seventh best in the world by the World Health Organization (Socolovsky, 2009). By comparison, the U.S. health care system ranted at 37 (Satiroglou, 2009). The Spanish system offers coverage as a right of citizenship that is constitutionally guaranteed. Spanish residents pay no expenses out-of-pocket, with the exception of a few select services. They do pay for drug costs themselves and many complain about long waits to see specialists to get certain procedures. However, on average the Spanish health care system ranks better than that of the United States in many categories. Almost everyone is an agreement that the U.S. health care system is in need of serious reform. However, deciding exactly what these reform should be as a point of contention among providers, lawmakers, and average citizens. This research explores both the U.S. And Spanish health care systems. It will address the issue of whether a national health care system, such as that which is found in Spain is the solution for the ailing system in the United States.
The U.S. System
Health care economists in the United States assert that although health care spending per capita may be higher than in any other OECD nation, the long-term rates of spending have been similar. However, White (2007) demonstrates that long-term growth rates have been exceptionally high as well. The author surmised that institutional features were responsible for high long-term growth rates in health care spending. This trend has been occurring steadily for close to the past three decades. White considers several factors to be causal in this growth rate. They are an aging population, general economic growth patterns, expansion of technological capabilities in medicine, and other factors such as expansions in health insurance coverage and financing options within the delivery system (White, 2007).
Nearly 17.4% of the GDP in the United States was accounted for by health spending. This is 9.5% higher than the OECD average (OECD, 2011a). Several factors about the U.S. health care system draw the attention of researchers and critics. The U.S. has a higher number of MRI units and CT scanners per million at 34.3. The OECD average is 22.1. There are also 3.5 beds per million people, which compares to an average of 2.7 per million in other OECD nations in the world (OECD, 2011a). The United States is one of the wealthiest nations in the world and has a high amount of technology and resources available to its citizens. Yet, it ranks considerably below Spain in terms of provision of that care. Japan, Switzerland, Italy, Spain and Australia have the highest life expectancies in the world (OECD, 2011a).
The United States has many resources available to its citizens, yet they have many health problems that could easily be resolved. For incidence, the U.S. has one of the highest obesity rates among OECD countries and these rates continue to climb (OECD, 2011a). One has to ask how a country that has the resources available that the United States does can rank so poorly in provision of health care to its citizens. The U.S. has one of the highest government spending rates for recipients of public aid among OECD countries (OECD, 2011a). Yet, it has some of the lowest standards of care among OECD nations.
Medicare is the primary delivery system for governments subsidized health care services. Currently, several sections of the Medicare System have been frozen due to inflationary increases in Social Security checks. Increases in Social Security offset small rises in Medicare premiums. The U.S. Health care system must continually make changes to adjust to gaps in coverage, such as the Affordable Care Act, which reduces prescription drug costs for people who fall into a gap in Medicare coverage (Sebelius, 2011). The government subsidized portion of the U.S. health care system must continually adjust to prop up portions of the system and to provide coverage for those who need it. However, the focus remains on only one portion of the system at a time, rather than taking a holistic approach to facing the problems that plague the entire system. This is a different approach than that taken by countries who have a national health care system in place. The U.S.treatment of the health-care system makes it seem as if the government is continually running around trying to fix portions that are falling apart, rather than providing the entire system with a solid base of operation. One of the key differences between the health care system in the United States and that of Spain is the viewpoint and approach that is taken by each of these countries. The United States can be seen as trying to micromanage the system, rather than providing a solid base for the system as a whole. The national health care approach can be seen as taking a holistic viewpoint of national health care problems.
Demand for health care services in the United States has continued to increase at a rate of approximately 11% since 1960 (Klees, Wolfe, & Curtis, 2010). Health care in the United States is funded through a number of different sources, rather than a single source. These sources include individuals’ out-of-pocket expenses, private health insurance, philanthropy and charitable donations, non-patient revenues such as revenues from gift shops or parking lots, private insurance, individual employers and federal funds (Klees, Wolfe, & Curtis, 2010). This funding model is complicated and inefficient. As private payers become less able to pay for services public funds must pick up the tab. This places an even greater strain on the system, leading to more need to prop it up in some manner.
Government subsidized programs in the United States such as CHIP, Medicare, and Medicaid are only available to certain segments of the society. They are not available to every citizen, as they are in countries that have national health care programs. Government funded programs in the United States are only available to those who are older, disabled, significantly below the Federal poverty line, and uninsured children (InsureKidsNow.gov, 2011). The U.S. Census Bureau found that health insurance coverage was linked to family income for all demographic groups. This survey linked a lack of health insurance coverage to poverty (DeNavas, Proctor and Smith, 2011). Those that are very poor were eligible for government subsidies such as Medicaid. However, those that did not qualify for government programs and who could not afford health insurance were uninsured at the time of the survey (DeNavas, Proctor and Smith, 2011). This means that it is not the very poor who do not have health insurance in the United States, but rather those that fall into an income level just above the eligibility limits. There is a segment of the population that is unrepresented by the current health care system in the United States.
The United States differs in health- care growth compared to other OECD countries. One explanation for this may be how health care is financed in the United States as compared to other OECD nations. Three approaches to Health Care financing have been identified. They are:
1. public-integrated — this is where the government acts as both insurer and provider of services
2. public-contract — this is where the government or a centralized social insurer purchases services from private providers
3. private insurance/provider — In this structure private insurers purchase services from private providers (White, 2007).
Nearly all high income OECD countries use the public-integrated mode or the public-contract model. The United States stands out in its resistance to these other models. The United States relies almost entirely on private insurance/provider model (White, 2007). Both the public-integrated and public-contract models give the government or another oversight agency considerable leverage over medical providers. They can use this leverage to place limits on medical spending. In some cases, this has led to a different mix of services than is seen in the United States. These models are an excellent cost limiting tool (White, 2007).
The United States has resisted staunchly to the adoption of the health care models used in a majority of OECD nations. As result, the insurance providers and medical service providers have almost complete control over their pricing structures and expenditures. These differences have contributed to the health care finance crisis in the United States. The net result of unbridled spending limits has led to per capita spending that is more than double that in other OECD nations (Anderson & Frogner, 2006). This growth rate has serious implications for the U.S. economy. Anderson & Frogner suggests that the United States is not getting a high return for its expenditure, based on life expectancy, quality of life, and pother factors that indicate a healthy health care system. The U.S. is spending a lot of money on health care, but they are not providing the level of care that could be expected for the amount of money being spent (Anderson & Frogner, 2006).
The Spanish System
The health care system in Spain is still reeling from the recent global recession. High unemployment rates are expected to continue, which places a strain on the ability to support the national health care system (OECD, 2011b). The ability of the national health care system in Spain to provide services depends on an inflow of taxes from the people. Anything that harms the economy also harms the national health care system. The same is true in the United States, only the impact is not as great, because the system is not entirely dependent upon government funds.
The national health care system and Spain is known as the SNS. It is operated by the National Ministry of Health and Social Policy. It is structured as a hierarchy that has a central governing agency at the top that manages strategic areas such as policymaking and equitable functioning of the system across the nation. It is then broken down into 17 regional ministries who must report to the central governing body (Garcia-Armesto, Abadia-Taira, & Duran et al., 2010). The National Health System Interterritorial Council has final decision-making authority in the adoption of policies regarding the SNS (ISPOR, 2009). However, individual regions do have decision-making authority to fill the needs of their own citizens.
The reimbursement process for pharmaceuticals is governed by the Spanish Medicine Agency. They will only reimburse for pharmaceuticals that are approved and that meet certain site criteria in terms of safety and effectiveness. This is similar to the role of the Food and Drug Administration (FDA) in the United States (ISPOR, 2009). Reimbursement depends on the severity of the disease, the therapeutic value and efficacy of the product, the price of the product, and the budget impact on the SNS compared to other similar products.
Every patient must see a “gatekeeper” physician to be referred to a specialist.
One of the key complaints about the Spanish health care system is about long wait times to see a specialist. This can be especially traumatic for those that have been sent to specialists to see if they have a serious disease. The wait can seem to be extensive for some. Wait times of up to eight months have been reported to get the results of a simple gynecological test (Expatica, 2004). This argument is also used as one of the key points of contention on the topic of a national health care system is mentioned in the United States.
In a recent study, it was found that wait times varied from region to region. This study also found that wait times varied depending on the type of consultant that you went to see. An average wait time in Castilla, La Mancha is 23 days. Wait times for the same test results in Canary were up to 140 days. This is a dramatic difference. On average, the national wait time is around 65 days for most tests (Expatica, 2004). It seems to be more difficult to see an allergist than a neurologist. The difference is the patient load for the particular specialty. There are many more people who need to see allergists than neurologists (Expatica, 2004).
In 2009, the population of Spain was 40,525,002 with a GDP per capita in 2008 of $34,600. The average life expectancy for females was 84 and 78 for Males. Infant mortality rates were low (“International Health Systems,” n.d.). The national health care system covered 99.5% of primary care, inpatient surgery, outpatient surgery, long-term disease management, emergency care, and some drugs if they were deemed necessary (“International Health Systems,” n.d.). From this perspective, it would appear that Spanish national health care system was a success in promoting the health of its citizens. However, some services such as mental health, dental, and long-term care coverage did require some out-of-pocket expense or supplemental insurance. Care of the elderly is underdeveloped in Spain. Therefore, many children tend to care for their parents well into old age. The national health system is financed through taxation and funds allocated to the various regions in Spain (“International Health Systems,” n.d.).
The Spanish system of health care may rank among the best in the world, but that is not say that it does not have its problems as well. The Spanish system looks very different from the U.S. system not only on the outside and on the inside as well. For instance, many Americans are used to having a certain amount of “creature comforts” in the health care setting. For instance, they are used to padded chairs and soothing mood music in the waiting room. By comparison, one of the oldest and biggest hospitals in Spain has hard plastic chairs and no music (Socolovsky, 2009). The Spanish system is considered to focus more and function than comfort. This does not reduce the effectiveness of the treatment process is as one can see from the national health averages. Spanish citizens are not accustomed to having the same amenities in the public system that they have in private sector providers. They expect an efficient, but stark an appearance from the public Healthcare System. The difference between the U.S. And Spanish systems stems from the need to be competitive in the U.S. system, and the need to spend tax payer dollars wisely in the Spanish System.
It might be noted that in the private sector in Spain patients will find more amenities and comforts. The treatment procedures and medical care is the same in both the public and private sectors in Spain. The patient expect to pay considerably higher prices in the private sector but they also expect more amenities. It cost is a concern, many Spanish citizens will utilize the public health system, rather than to pay for the comforts provided by the private sector system. The private sector must compete with the public sector to attract patients who could get the same services from the public sector for free. Use of the private sector services in Spain is a sign that a person is more concerned about comfort than price. There is no difference in terms of delivery of service or quality of service in either the public or private sectors of the Spanish system.
U.S. health care providers must compete with other private health care providers to attract patients and remain profitable. This is not so in the Spanish system. The Spanish health care system is funded entirely by taxpayer dollars. They do not have to attract patients. Therefore, the focus in the Spanish system is on providing the best quality health care at the lowest cost to the government and consequently the Spanish citizens. The attitude in the Spanish health care system is different. Spanish health care providers are a government service provider just like any other government department. This gives them a different attitude towards what is important in their facilities. By comparison, U.S. health care providers must pay more attention to the marketing and business end. This does not mean that they do not.pay attention to the medical needs of the patient, it simply means that they must spend money on advertising.
Due to the need to include advertising and creature comforts into health care delivery, the U.S. health care system cannot operate as efficiently as the public system in Spain. This is one of the main differences between the government subsidized program and one that operates on the open market. The private system and Spain closely resembles that of the United States, only they cannot justify raising prices significantly above that offered by the public system, or no one would use their services. The private system and Spain faces many more challenges than that of the United States. They are and are far greater government control.
Thus far, we have surmised that the patient experience in the U.S. health care system and the one in Spain are different in terms of amenities and comforts. Spanish citizens have the option of paying extra to be treated in privately operated clinics. Many patients stated that the medical treatment is good in the public facilities, but the personal service is inconsistent (Socolovsky, 2009). Whether someone decides to use the public health care system or the private one is simply a matter of personal choice.
The most common complaint about the system in Spain is that there is a long wait to see specialists or to undergo certain procedures. However, in a recent survey it was found that Spain has one-third fewer deaths caused by a long wait to access health care than in the United States (Socolovsky, 2009). By comparison, Spain spends less and provides better quality service to its citizens than the United States. The life expectancy in Spain is one of Europe’s highest and the health care system is credited as one of the key factors (Socolovsky, 2009). Patients that choose to use Spain’s public health care system do not expect the amenities that they would receive at private health care facilities, but they expect for their medical treatment to be just as good. If someone loses a job or needs long-term care, they have no worries and know the system will look after them (Socolovsky, 2009). This is not the case in the United States where people have to often lose assets, even homes or their retirement savings, to pay for needed treatment. In the United States sometimes people have to choose between a roof over their head and lifesaving procedures. Such is not the case with the Spanish system.
The Spanish system may be more cost effective and more efficient than the U.S. system, but when it comes to health care, the bottom line is quality of service in terms of meeting the medical needs of the patient. In this respect, the Spanish system may seem a little more bare bones in the U.S. system. However, that does not mean that the quality of service is any less. There are no known cases were someone had to go to another country to receive a procedure that was not available in Spain.
The Spanish health care system does not turn away patients because of their inability to pay or because they have taken actions that led to their medical condition. For instance, if a patient comes into the Spanish system with diabetes and they do not take measures to control it, in the Spanish system that doctor still has an obligation to treat the patient (Socolovsky, 2009). In the U.S., a doctor does not have to treat a patient that is not compliant with the treatment plan and medical advice.
Spain faces many of the same problems as the United States and many other OECD countries. They have a growing elderly population that places a greater strain on the health care system. Coupled with this growing elderly population is a lack of young persons to fill health care jobs. This is a key contributing factor to growing waiting lists to see doctors in certain specialties (Expatica, 2004). As to which country has the longest wait to see a specialist, depends on the specialty and the part of the country. These factors apply to both the United States and Spain. Growing wait times to see a specialist are a problem with the health care system in both countries, along with many other OECD countries in the world.
Health systems are ranked according to eight criteria developed by the World Health Organization. These a criteria are overall health, which is divided into level and distribution. The next category is responsiveness, which is also divided into level and distribution. The next category is fairness in financial contribution. Next is goal attainment and health expenditure per capita in international dollars. The final criteria ranks health Systems in terms of level of overall health and overall health system performance (WHO, 1997).
This is a comparison criteria where the different countries are ranked in a numbered fashion for each of the criteria and overall. Japan continues to be ranked among the top of each category. France is also considered to have an excellent health system. Spain has been a top contender says the reform (WHO, 1997). Several other smaller countries are also in the top ranking, but in this research only larger countries are being considered for comparison. The United States is always ranked in the top third, but considering its per capita expenditure on health-care its performance has not been as spectacular as these other countries. If one were to comparison shop on a global basis for health care services, they would not be likely to choose the United States is their first pick.
Would the Spanish System Work in the United States?
Currently, health care system reform is a hot issue in the U.S. government. The Affordable Care Act is a key point of contention, with some members of Congress claiming that it is unconstitutional. However, on November 8, 2011, the Supreme Court ruled that the act is constitutional and the Congress has the authority to devise national solutions to national problems (Cutter, 2011). The main issue regarding the Affordable Care Act is that it forces Americans who are able financially, to take care of their own insurance needs. It also has provisions to help make insurance affordable for middle class families. It was estimated that only 1% of Americans would pay a penalty for not having insurance if the plan went into place (Cutter, 2011). Opponents of the bill claim that Congress has exceeded its regulatory authority by telling people when and how they will pay for health insurance.
When all of these issues are taken at face value only a single issue remains. The issue is that many Americans are uninsured because they cannot afford health insurance. Nearly 83% of Americans already have some form of health insurance (Cutter, 2011). They pay either privately or they have insurance through their employer. It is the 17% that don’t have coverage that is the concern of the current debate in the U.S. This argument baffles Spanish government officials because to them it is unthinkable that anyone should pay taxes and be without health insurance. They consider health care to be a basic human right, as much a shelter, food, and clothing. Rhetoric by U.S. politicians makes the same claims about basic health care being a humanitarian right. Yet, they disagree that national health care is the answer. The current state of affairs in the U.S. Health care system leaves many gaps in coverage. As a result, there are some that do not receive the care that they need and they suffer unnecessarily because of it.
The proposed national health care system in the United States would not eliminate the ability to choose one’s own doctor, to have health insurance, or to pay for services if one was able. It would simply provide solutions for those who do not have these options. The system and Spain is not absolute either. People have the option to pay for private insurance, or to pay for services themselves if they have the means. For those that do not have the means, they can utilize the national system which will not deny them care for any reason or any condition.
The system and Spain did not eliminate many of the choices available, nor did it eliminate private health care. It simply fills the gap to make certain that none of its citizens must go without critical health care treatments. The system is there when the Spanish people need it, but they still have choices if they have the means to take advantage of them. The system and Spain is a parallel system: one private and the other government. This system works because it fills in the gaps, not because it replaces the private health care system.
In Spain, the private health care system still has room for competition among its private sector providers. They offer many more services and amenities than the publicly ran services. The public health care services do not offer the comfort and amenities of private providers, but they offer a solution when other options are not available to an individual. As we found in this study, sometimes even those that have health insurance work and pay for services themselves and will choose to use the public system to offset costs of a procedure. This has another affect on the health care market. Insurance companies and private providers must now compete with government providers in terms of cost and services offered. They must attract health care clients away from the government services. This has the effect of keeping costs down for insurance and private providers. It prevents the runaway fees and charges that are experienced in the United States.
The question is if the same type of system that works in Spain would also work in the United States. The answer is that this type of system would more than likely be successful in any scenario. Many people perceive the national health care system to mean the elimination of private health care providers and freedom of choice in which provider to use. However, this is a misconception and that there are few countries that use this all or nothing approach to national health care. The system utilized in Spain could be seen as more of a hybrid system that can bind public and market-based systems. The private and public systems run parallel to each other and must compete with each other. Spanish citizens can either choose the public for the private system as they see fit for their particular circumstance.
The adoption of a public health care system in the United States would not mean the elimination of the old one. People could access the care they needed when they need it using the existing private channels. Healthcare reform would simply mean the addition of another system into the mix that is already available to patients. This system would fill in the gaps for those that do not have coverage and that do not have access to any medical care at all under the current U.S. system.
Critics of the U.S. health care system are quick to point out the high expenditures in the United States vs. The quality of care compared to other OECD nations such as Spain. They use this simple deduction to suggest that the United States should adopt the government operated national health care system similar to those in other countries. However, analysts have examined these health care systems in other countries and have concluded that they suffer from the same problems that are experienced in the United States. They are still faced with rising costs and a lack of access to care (Tanner, 2008). It seems that there is no single perfect model for the provision of health care. Those that claim that the health care systems of other countries are nearly perfect fail to look below the surface, according to Tanner.
Tanner (2008) makes the following observations about trends in national health care systems around the world. The first observation is that health insurance does not necessarily mean access to health care. In countries that promise universal coverage, access to care is often limited by long waiting lists. The second observation is that rising health care costs are not a problem that only affects the United States. Some countries experience considerably lower rises, but costs are rising almost everywhere, even in countries where competition with the government drives prices down. The effects of rising costs are the same and include budget deficits, tax increases, and reductions in benefits. Tanner examined countries that are weighted towards tighter government control and found that the people are most likely to face waiting lists and rationing in those countries. However, the same could be found in countries that utilized more market-based systems. The problems were the same everywhere, and it is difficult to blame all of the problems with the health care system on one type of model or another. They all have the same problems, only they tend to resolve their problems differently.
Tanner (2008) found that the most successful models for the provision of health care were those that integrated some form of market mechanism, such as competition, cost sharing, market prices, and consumer choice rather than complete government control of the system. This is the type of system that Spain uses to administer its health care system. The government has considerable control, but private companies can still compete based on service and price. Tanner reports that this type of model is growing in popularity, as it seems to represent the best of both worlds. The citizens are guaranteed at least a minimum level of health care, but they still do not miss the amenities provided by the market-based system. It seems that the perfect system is not one extreme or another, but rather a system that integrates the best of both worlds.
The United States is in an intense battle over health care reform. A national system has been proposed, but has faced such intense opposition that other alternatives were quickly explored. The ideology behind the proposition of such a program is based on the success of national health care in other countries, such as Spain and Japan. Supporters of the system point to the various successes and see it as a panacea for the problems being faced in the United States. They point out that even though our system is one of the last “free market” health care systems, we still face many of the same problems as countries with a national health care system. The ideology behind the proposition is that if we are going to face the same problems, at least we could try to eliminate at least one of the problems. The national health care program would assure that the United States treats access to health care as a basic right, just as the other OECD countries do.
Opposition to the proposed national health care system in the United States point to the problems of higher taxes, long waits to see physicians and other problems that plague nationalized health care systems. However, they fail to recognize that even the market-based system in the United States still faces many of the same problems. Opponents of national health care recognize that solutions need to be found and they need to be found fast, but they do not agree as to the proper course of action. Thus far, the solutions proposed have been to prop up the existing system.
The problem that faces the United States as it tries to find resolutions to its current health care crisis is that neither the proponents or opponents of national health care have any real solutions. President Obama has met extensively with Prime Minister Jose Zapatero to discuss implementing solutions to the health care crisis that faces the United States. These meeting were the fuel behind President Obama’s institution of Obamacare, an idea that was destroyed before it could be fully understood by the public (Diehl, 2010). Discussions of Obamacare were a source of continual debate and it seemed that there were more rumors than fact about what it would or would not do if implemented. There was much confusion regarding the proposed health care package. At present, this confusion continues.
In the past, the Spanish Prime Minister Jose Zapatero has expressed confusion over the U.S. health care system. Zapatero is baffled by the debate over the reform of the U.S. health care system (Diehl, 2010). The main concern expressed by the Prime Minister is that the cost of care is so high compared to the GDP. He points to this as a basic problem and the system along with limited coverage (Diehl, 2010).
The Spanish health care system is so popular that some Americans go to Spain for procedures. This is referred to as “medical” tourism (Medical Tourism Corporation, 2011). Medical tourism in Spain is most popular for U.S. tourists and British tourists. According to a company that specializes in medical tourism, people come to Spain for a number of procedures including elective surgery, orthopedic surgery, dentistry, cosmetic surgery, eyesight surgery, and obesity surgery. The client can choose their doctor and facility. Medical tourism in Spain offers patients as much as a 70% savings over having the same surgery in their home country. Medical tourists can enjoy the following benefits from their stay:
Excellent environment and dietary conditions for recuperating patients
Low cost travel and hospital stay
30-70% cost savings adequately trained and experienced doctors and staff
English speaking professionals and interpretation services
Study placed Spain as 7th best health care system in Europe
Wide variety of treatment options (Medical Tourism Corporation, 2011).
Spain is a family-oriented culture with some of the healthiest people in the world. While on holiday, the tourist can recuperate at Spain’s resorts and famous spas. While in Spain, the medical tourist can enjoy Spain’s many tourist attractions. They can enjoy wines, restaurants and historical attractions (Medical Tourism Corporation, 2011). The idea of taking a medical vacation in Spain might sound bizarre to the average U.S. citizen, but it is becoming more popular as people learn that they have a choice in health care and at a considerable savings to what is available in the United States.
The results of this research agree with the conclusions of the OECD. When one compares indicators and quality of care, the most expensive care is not always the best care. United States and Canada have some of the best cancer screening programs in the world. However, Japan has the highest survival rate (OECD, 2009). The United States spends more per capita on Health Care than any other country.
In 2007, U.S. spending on Health Care was more than double that of the OECD average. Yet, the country that spends less on Health Care per person placed higher in survivability and treatment success of chronic diseases and other life threatening conditions (OECD, 2009). This equates to inefficient spending of healthcare funds in the United States, supporting the claim by this research that more expensive health care is not always better health care.
It appears that the question of which system represents the best solution to the health care crisis, not only in the United States, but in the remainder of OECD nations is a matter of the grass is always greener on the other side. Both sides of the argument regarding a national health care program in the United States feel that their solution solves all of the problems facing the current system. This research demonstrates that no single solution is able to solve all of the problems facing the health care system. The system will still be facing rising costs and long waiting lists regardless of the solution that is chosen.
A system similar to that utilized by Spain would resolve the problem of solving access to health care due to a lack of payment options. This is the primary advantage of the Spanish system over the market system being used by the United States. The term “nationalized health care” causes confusion in many U.S. Citizens. Nationalized health care does not mean the end of choices in doctors and it does not mean the end of the market-based health care system. It simply means that a parallel system will be in place to serve those who cannot access the current market system. It would give others more choices in their health care options. They could either utilize the public or the private system.
The most significant finding in this research study is that there is no perfect solution to the health care crisis. National health care does not limit the choices available to the people, it increases them. It can help to control rising costs by introducing a low-cost alternative to private care. Private care will have to improve the quality and cost of its services if it wishes to remain competitive. A system such as that in Spain places greater constraints on health care providers, not by legislation and policy, but by the introduction of fierce competition into the market place.
Tanner (2008) found that there is no perfect health care system. The ones that were found to be the most successful were those that had both a market and public component to them. Market mechanisms are the key to success in the introduction of a national health care system. The system in Spain seems to represent the best of both models. Under a system such as this, all of the people are guaranteed at least a minimum level of care. However, they are not relegated to a stark, cold health care experience. They can choose a facility that offers more amenities than the public institution, but they will have to pay more for them. For those that have insurance that will cover the expenses, this is a viable option. However, those that do not have the means to pay will have to utilize the public health care system.
A healthcare system such as the one in Spain would offer many of the same advantages that are seen by the Spanish people. It would close the gap created by the uninsured and would introduce greater competition into the marketplace. It would be unrealistic to expect this system to fix all of the existing problems immediately, but it would solve some of the greatest concerns instantly. Those that do not have access to health care at all would be able to afford what they needed.
The introduction of a healthcare system similar to that in Spain would mean higher taxes, but the benefits must be considered as well. Americans tend to object to any rise in taxes without careful consideration of what they have to lose if they do not institute national health care. Perhaps what is needed is a term that reflects the true nature of the Spanish health care system. We have already explained that national health care is not the end of the system that we know and love. It is not the end of our choices in health care. Nationalized health care offers the possibility of guaranteed access to health care and all of the benefits of the free market system. To do nothing, or to spend too much time arguing the finer points is one of the greatest tragedies facing the nation. Every day that this problem goes unresolved, uninsured Americans suffer needlessly through the inability to access the health care system.
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