| Breadth: variations in population coverage |
|
|
|
| Changes in rules for inclusion |
No |
Changes entitlement to SNS card from citizenship
to Social Security membership. For non-members, registration in
special agreement via payment of quota. |
No |
| Changes in the proportion of the insured population |
No |
Excludes undocumented immigrants (150 thousand
persons); does not cover individuals > 26 years without prior
participation in the labor market. |
No |
| Depth: services covered |
|
|
|
| Changes in package of services – explicit exclusion and cuts in
services |
No |
Fragments common package of services in SNS: (i)
basic: clinical services, without copayment; (ii) supplementary:
medicines, orthoses/prostheses, dietetic products, non-urgent
health transportation, with copayments; (iii) accessories.
Excludes 417 medicines for minor symptoms. |
No CCGs may define which services they consider
necessary to meet health needs. Some PCTs/CCGs set
“priorities”. |
| Measures for rationing and prioritization of services (formal
and informal, implicit and explicit) |
Implicit in payment systems. |
Implicit in staff and investment cuts. |
Due to budget cuts, CCGs will be forced to ration
services; already practiced by PCTs, which have excluded
services with low cost- effectiveness, and have regulated
access. |
| Control of entry of new services in package |
Reinforced action by Joint Federal Commission of
the GKV in the definition of whether services will be
incorporated into the package |
Increased discretionary power by Ministry of
Health in cutting services; expanded control over the entry of
new services through creation of the Spanish Network for Health
Technology Assessment of the SNS. |
Expands the functions of the National Institute
for Health and Care Excellence (NICE): includes social care –
assesses whether the procedures are cost-effective and safe and
develops guidelines for priorities. |
| Increased waiting times |
No. There are no waiting lists for surgeries or
delay in specialized consultations regulated: maximum time four
weeks. |
Increase in waiting lists for elective surgeries:
number of patients on waiting line increased by 43% from June
2009 to June 2012, and the waiting time increased from 63 to 76
days (21%) 34. |
Increase is expected in waiting times (data not
available); decrease in user satisfaction. |
| Reduction in supply of health services (staff cuts, reduction
in investments) |
Merger of Sickness Funds |
Closing of out-of-hours services and local
medical offices in rural areas; closing of surgical centers;
reduction of investments by 16.5% in 2011 and 35.3% in 2012
26. |
Reduction in management positions –30 thousand
health care professionals displaced. |
| Privatization of health services and new management formats for
public establishments |
Merger and sale of some local hospitals under
budget pressure from national program for adjustment of public
spending. |
Plans for outsourcing management of public
hospitals; public-private partnerships for concession of
services (Madrid, Valencia, Castilla la Mancha) – strong
opposition – suspension of privatization 59. |
All hospitals transformed into Foundation Trusts;
CCGs must hire “any qualified provider” (public or private);
Commissioning support services to be outsourced. |
| Height: proportion of expenditures covered by public
resources |
|
|
|
| Proposals to reduce public expenditures in health |
Control GKV contribution rates; end of parity:
freeze employer’s contribution rate. |
Reduce public expenditures in health from 6.5% to
5.1% of GDP by 2015; per capita spending in SNS decreased from
1,343 to 1,203 Euros between 2010 and 2012 (-10.4%)
46. |
Reduce 20 billion pounds from 2010 to 2015. |
| Public expenditures as share of total health spending (%) |
|
|
|
| 2007 |
76.4 |
71.9 |
80.2 |
| 2011 |
76.5 |
73.0 |
82.8 |
| Annual variation in public expenditures in health (%) * |
|
|
|
| 2008-2009 |
4.6 |
6.0 |
8.3 |
| 2009-2010 |
2.3 |
-1.2 |
-0.7 |
| 2010-2011 |
0.7 |
-4.3 |
-1.2 |
| Changes in copayment |
In 2012, abolition of 10 Euros/quarter copayment
for outpatient medical consultations. |
Increase in rates and expansion of services
subject to copayment for health transportation,
ortheses/prostheses, and dietetic products; copayment of
medicines for pensioners. |
Implicit: providers offer NHS patients the
“option” of direct private payment (self-funding) of procedures
not approved by PCTs or with long waiting times (in vitro
fertilization, bone mineral densitometry) 58. |
