What Makes Spain's Health Care System The Best?

Spain's single-payer health care system is ranked seventh best in the world by the World Health Organization. The system offers universal coverage as a constitutionally-guaranteed right and no out-of-pocket expenses — aside from prescription drugs. Patients do complain, however, about the long wait to see specialists and undergo certain procedures.

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Americans debating health care can do comparison shopping with other nations. We heard this week about Britain's system, and this morning we go to Spain. Its health care system is being ranked as one of the best in the world by the World Health Organization. As Jerome Socolovsky reports, most taxpayers there don't seem to mind paying for it.

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JEROME SOCOLOVSKY: La Paz University Hospital in Northern Madrid is not known for its creature comforts. But most patients say they're not bothered by the hard plastic chairs or the absence of soothing music in the waiting rooms. La Paz might be one of the oldest and biggest hospitals in Spain, but it's considered one of the best.

Unidentified Woman: (Spanish spoken)

Unidentified Man: (Spanish spoken)

SOCOLOVSKY: Sali Avayeda(ph) has come for a follow-up appointment. She had a kidney transplant five months ago.

Ms. SALI AVAYEDA: (Spanish spoken)

SOCOLOVSKY: I feel like a new person, she tells her doctor. Before the operation, Avayeda said she hardly ever set foot in a public health facility. She was one of the minority, the 10 percent of people in this country who pay extra to be treated at privately-run clinics. But when symptoms of kidney disease developed a few years ago, Avayeda headed straight to this public hospital.

Ms. AVAYEDA: (Spanish spoken)

SOCOLOVSKY: The doctors are excellent. The nurses are very nice, and the service has been really good, she says.

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SOCOLOVSKY: Out in the waiting room, another kidney recipient, 32-year-old Jorge Ordiya(ph), is not quite as enthusiastic.

Mr. JORGE ORDIYA: (Spanish spoken)

SOCOLOVSKY: The care is good, technically speaking, but the personal service has its ups and downs, he says. The most common complaint of patients is the long wait to see specialists and undergo certain procedures. On the other hand, a study published last year in the U.S. journal Health Affairs found that in Spain, there are a third fewer deaths caused by delayed access to health care than in the United States.

Spain's constitution, drawn up in 1978 following the Franco dictatorship, not only guarantees the right to universal health care, it also requires the state to provide it. The World Health Organization's ranking system puts Spain's health care system seventh in the world, well ahead of America, even though it spends much less on health care.

Dr. Jimenez says the system covers virtually every medical need.

Dr. JIMENEZ (La Paz University Hospital): (Spanish spoken)

SOCOLOVSKY: I don't know of anyone who's had to go to another country for treatment that doesn't exist in Spain, he says. There are thousands of primary care clinics, even in small villages. Patients have a choice of doctors they can see as often as they like, and there are no co-payments and no claims forms. Even undocumented immigrants are treated.

In Spain, no one worries about their health coverage. If someone loses a job, is short of money or needs long-term care, the system will look after them. For those Americans who are used to private doctors offering a plethora of tests and the latest technologies, the Spanish system might seem a little basic, but no one is turned away.

Life expectancy in Spain is one of Europe's highest, and many of family practitioner Heronimo Fernandez Torente's(ph) patients in the northwestern city of Lugo are over 80 years old. He says there's no question of rationing.

Dr. HERONIMO FERNANDEZ TORENTE (Family Practitioner): (Spanish spoken)

SOCOLOVSKY: People come complaining of osteoarthritis or that they are 90 years old and their cholesterol is a bit too high, and you have to refer them for treatment, he says, because the system guarantees it.

Torente's also vice president of the main Spanish doctor's association, the OMC. He complains that physicians here are underpaid and overworked. Still, he defends Spain's medical service and insists it has nothing to do with socialism.

Dr. TORENTE: (Spanish spoken)

SOCOLOVSKY: It's the humanization of medicine, he says. As a citizen, it's my obligation to make sure that everyone has basic health coverage. But while health care costs are rising fast, Spanish politicians don't dare limit coverage. On the contrary, one of the most sure-fire vote getters for both left and right is the promise to build new hospitals using taxpayers' money.

For NPR News, I'm Jerome Socolovsky in Madrid.

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