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Introduction

Public health services are considered to be an important part of any country’s human development index, as the availability and quality of medical services influence greatly the life conditions of every human being. However, the approaches to public health services that are used by different countries vary significantly, and depend on various factors, from economic conditions to legal framework, and administrative organization. The aim of this paper is to highlight similarities and differences between the approaches towards healthcare systems in Spain and the United States. The efficiency of each country’s approach towards public healthcare will be assessed basing on the quantitative data of the World Health Organization, as well as qualitative analysis provided by scholars and experts.

Population and Health Status

Demographic Profiles

1) According to the WHO demographic profiles of the United States and Spain, their populations equal to 310 million and 46 million people, respectively (WHO, 2012).

2) Urbanization and gross national income rates are higher in the USA comparing to Spain. 77% of Spaniards live in the cities, whereas this parameter for the USA is 82%.

3) Moreover, Spain is characterized by comparatively high life expectancy (82 years for both sexes), while the same parameter for the USA is considerably lower and is only 79 years (WHS, 2012).

4) Mortality rates of the two countries differ significantly. In the USA, adult mortality rate for both sexes is almost twice as high as in Spain (106 versus 58). What is more, maternal mortality ratio in the USA (21 maternal deaths per 100 000 births) exceeds this parameter of Spain (6 maternal deaths) in almost three times.

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Health Indicators

1) Adult risk factors are important to all spheres of country’s economic life, since they are directly linked to the quality and quantity of workforce. On the one hand, comparing to the US, Spain has lower raised blood glucose and obesity average. On the other hand, the US citizens tend to suffer from raised blood pressure less than their Spanish counterparts (17 and 14.2 for the US males, and females versus 27.7 and 18.6 for the Spanish ones).

2) Both countries have rather high levels of tobacco use, and for the US, this rate exceeds the regional average for American continent (WHS, 2012).

3) Spain and the US provide access to improved water and sanitation to 100% of their citizens (WHS, 2012).

4) The quantity of adults with HIV in Spain and the US is almost equal, although in Spain it is slightly lower (4 versus 6). However, Spain has much higher prevalence of tuberculosis, which differs from the US in almost five times (WHS, 2012).

Availability of Services

Territorial Organization of Healthcare Systems

1) The US is a federation; therefore, all the decisions regarding healthcare are taken on the level of states. The state governments are entitled to maintain the state health departmets. Local governments have their own health departments in their disposal. In Spain, the structure of healthcare system is even more complex, since it involves coordination between the central State and the autonomous communities. These communities are the main element of public health system, since they create Health Services on their respective territories.

2) As a result of decentralization, the citizens of both countries have access to medical care wherever they live. In the US, there are no territorial restrictions as to where a citizen can receive medical care. As for Spain, each region in this country is divided into several areas of 200-250,000 people. Such health areas are further divided into zones of 5-25,000 people which are located generally within a maximum of 35 miles from the closest health center. All citizens must receive health care in the particular health zone, and they are restricted from leaving their zone in order to see other doctors (Duran, 2006).

Access to healthcare system

1) Spanish Constitution guarantees equal access to healthcare system to all the foreign and native citizens, regardless of their financial status or insurance. What is more, the equity is enhanced through the view of citizens as beneficiaries of public healthcare system (Ley Organica).

2) The United States’ approach towards public health services is different, since all the citizens do not have access to public health services. The insurance issues, inequality regarding citizenship, race, and income constitute the major problems of the contemporary US healthcare system.

Public Health Expenditures

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Financing of Health Care Systems

1) Gross national income per capita of the two countries exceeds the global average significantly. However, the US has one of the largest national incomes in the world ($47 310), whereas Spain’s indicator is only $31 800.

2) The US is one of the countries that spend the large amounts of money on public health expenditures. Its healthcare spending per capita is more than $8.000, and has been growing constantly since 2005.

3) Spain ranks a little below the average of the OECD in health spending per capita. Its spending in 2009 was $3076, which is lower compared to that in 2010, which was  $3268 USD. However, its spending has been constantly decreasing since 2008 (OECD, 2012).

Public Health Spending

1) An annual series of Commonwealth OECD health data has highlighted such elements of public health expenditures as: administrative complexity, the aging of population, chronic disease burden, health care supply and utilization rates, access to care, resource allocation, and the use of technologically advanced equipment and procedures (Anderson, 2010).

2) Experts admit that, although population of the US is relatively young, it has below-average or average rates of chronic conditions, and also hospitalizations and comparatively few doctor visits compared to other industrialized countries. The USA still has to spend unjustifiably high amount of money on public health. Major reasons for higher spending, according to these studies, include substantiallly higher prices and more fragmented care delivery that leads to duplication of resources and extensive use of poorly coordinated specialists (Muennig, 2010).

3) Unlike in the United States, public sector is the main source of health funding in Spain. According to OECD data, 73.6% of health spending was funded by public sources in 2009, slightly more than the OECD average of 72.2% (OECD, 2012). However, the drawback of this system is that, according to The Economist, health spending makes up 30-40% of regional governments' budgets. As a result, increase of prices on pharmaceutics, ageing of Spain’s population, and reduced tax revenues are likely to double the health costs to 2018 (The Economist).

Health Care Resources

Medical Personnel and Training

1) Spain is characterized by sufficient quantity of medical personnel, including both physicians and nurses. The quantity of physicians per 10 000 population is higher than the respective indicator of the Unites States (39.6 and 24.2). On the contrary, the quantity of nurses in Spain is lower than Western European average, and comprises only 51.1 per 10 000, whereas in the US, 98.2 nurses are available. (WHS, 2012).

2) The discrepancy between the two countries’ results may be explained by the lack of qualified medical personnel in the United States; in order to compensate the under-supply of doctors, the country tends to ensure proper access to care through the increasing roles of nurses. In Spain, though, the situation is the opposite, and the over-supply of doctors leads to inefficient use of resources (OECD, 2011).

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Hospitals

1) The National Health Service of Spain has a wide network of hospitals and health centers located throughout the country. The health centers provide the primary healthcare services that include GP and family services, pediatrics and nursing, physiotherapists and social workers. Hospital beds density in Spain as of 2011 is 32 (U.S. Global Health Policy).

2) Much like Spain, the USA has sufficient quantity of hospital beds per 10 000 population. However, the structure of hospital system differs from the Spanish one, due to the fact most health facilities are operated by private businesses.

Conclusion

The major similarities and differences between the healthcare systems in the United States of America and Spain are caused mostly by differences in the approaches towards these systems rather than economic, administrative, or geographical reasons. Both countries have been able to ensure due life conditions, access medical care and qualified personnel to their citizens. However, recent debates about medical reform in the USA, as well as country’s lagging behind other developed nations of the world in terms of life expectancy and infant mortality rate, make the achievements of Spain a valuable subject for future research. While in the US, the state does not guarantee equality in terms of healthcare, the right of Spaniards to protection of their health is recognized by the Constitution, and all the citizens are beneficiaries of public health services. The example of Spain can prove to be useful in further reforms of healthcare system in the US.

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