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HEALTH CARE AND FISCAL DECENTRALISATION IN SPAIN HEALTH CARE AND FISCAL DECENTRALISATION IN SPAIN THE SPANISH NHS THE SPANISH NHS THE SPANISH NHS EL SISTEMA SANITARIO ESPAÑOL EN LA OCDE EL SISTEMA SANITARIO ESPAÑOLGasto sanitario per cápita total, público, privado en $ ppp Países OCDE AÑO 2000 THE SPANISH NHS (approach of flows) HEALTH CARE AND FISCAL DECENTRALISATION IN SPAINTHE SPANISH NHSHealth care provisionin Spain is a mix of public provision (approximately 70% of total health care spending) and private (the other 30%, partly publicly financed). In 2001 total health expenditureamounts 7.5% of the Spanish Gross Domestic Product, 1.594 US $ pc.THE SPANISH NHSMain sources of financing the system:Public Expenditure1986: General revenues (23.77%), social insurance contributions (74.27%), Other sources (1.96%).1995: General revenues (77.28%), social insurance contributions (20.43%), Other sources (2.29%).2001: General revenues (97.6%), Other sources (2.4%)THE SPANISH NHSPrivate expenditure(in thousand million current pesetas and %) 1986: Health insurance Premia(24%) with 4.301 thousand enrolees and out of pocket (76%).1995: Health insurance Premia(30%) with 6.700 thousand enrolees and out of pocket (70%).2001: Health insurance premia holding relative share by increasing rates at equal number of enrolees EL SISTEMA SANITARIO ESPAÑOL EN LA OCDEEL SISTEMA SANITARIO ESPAÑOLGasto sanitario per cápita total, público, privado en $ ppp Países OCDE AÑO 2000THE SPANISH NHS (approach of flows)Source: HIT. WHO and own elaborationPRIVATE HEALTH CARE INSURANCESPAIN 2001: Premia 2.945 m Euros: 15.5% ofthe population, ofwhich one third under substitutive coverage)–Double coverage: 10.5%IN CATALONIA: 25% ofpopulation (total: 6 M) only 12% under substitutive coverage.–Double coverage: 22%GENERAL OVERVIEWONFISCAL DECENTRALISATIONIN SPAINSPANISH CONSTITUTION 1978GENERAL LAW FOR THE FINANCE OF AUTONOMOUS COMMUNITIES 1980 -BASQUE (FORAL) COMMUNITIES (INCLUDING NAVARRA) -AUTONOMOUSCOMMUNITIES (CC.AA.) * ORDINARY STATUS CC.AA. (BASICALLY WITHOUT HEALTH EXPENDITURE,UP2002): ART. 143 (9) * PARTICULAR STATUS (HISTORIC CC.AA. (Plus others) ART. 151 (4: CATALONIA, ANDALUSIA,GALÍCIA, VALENCIA)FINANCE FOR HEALTH CARE,OUTOF THE GENERAL FINANCING SYSTEM -UP2002-(AROUND ONE THIRD OF THE REGIONAL FINANCE), BASICALLY UNDER CAPITATIONHEALTH CARE AND EDUCATION REPRESENT TWO THIRDS AT LEAST OF THE CC.AA. EXPENDITUREMULTIJURISDICCIONAL PUBLIC EXPENDITURE: CONSOLIDATED TOTAL EXPENDITURE OF PUBLIC ADMINISTRATIONSBASICMECHANISMS OF FINANCETYPES OF TRANSFERSSOME CAVEATS