Web-economic-crisis-health-systems-and-health-web

Spain
Enrique Bernal-Delgado, Sandra García-Armesto and José Ramón Repullo
Economic trends
• Spain's real per capita GDP contracted in 2009 and 2010, and although
positive, its 2011 growth remained in the bottom quintile of the European
region. The budget deficit increased in 2009 and remained high through
2011.
• The unemployment rate, which was previously above the European mean,
increased sharply after 2008 and reached 21.6% by 2011.
• While 10-year bond rates were close to the European average until 2011,
the gap increased substantially in the following years.
• Health spending as a share of government expenditure remained fairly
stable through 2011, although per capita public spending on health
did decrease in 2010 and 2011 by 2.0% and 1.3%, respectively. OOP
expenditure per capita had slightly positive growth in 2010 and 2011
(Spain: Figs 1 and 2).
Policy responses
Changes to public funding for the health system
• Regional health budgets grew between 2007 and 2010 and declined in
2011 (by 3.9% on average).
• The regions (autonomous communities), which are responsible for
setting health budgets, have come under increasing pressure to cut
spending, especially since 2011 when the government introduced a
constitutional commitment to stick to EU deficit targets and enforced
the repayment of sovereign debt as a priority over other areas of
government spending.
• The Ministry of Finance introduced a cap on deficits for the regions
(1.5% in 2012 and 0.7% in 2013; in 2011 the average deficit was
3.3%) (2011).
• To help the regions, the central government created a bailout fund to
provide them with support conditional on the submission of a plan
to reduce spending (including health), increase revenue and achieve
deficit targets.