Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

80 Special Solidarity Fund KCE Reports 133
Keypoints Spain
• Organization of the Spanish health care system is rather complicated.
Competences are divided between the national level and the autonomous
communities.
• A minimum health care provision is guaranteed (as regulated at national
level within the National healthcare System). This minimum comprehends
primary care, specialised care and pharmaceutical products.
• At Regional level this minimum provision of health care services can be
expanded. This additional health care provision is however not financed by
the NHS. The regions have full competences but have to support financing
them on their own.
• The ambulatory care within the NHS is organized through the primary care
centers were patients see their general practitioner, nursing staff and were,
depending of the size of the centre, basic technical medical exams can be
performed.
• Hospital care is organized through a network of public and private hospitals.
The NHS has agreements with certain private hospitals. These agreements
make these private hospitals accessible for patients under the NHS system.
• Medication as well as medical techniques or devices that are financed
through the NHS are included in the ‘Cartera de servicios comunes de
prestación farmacéutica’ and for hospital care in the ‘cartera de servicios
communes de atención especializada’. Authorisation and acceptance is
regulated by the AEMPS (Agencia Española de Medicamentos y Productos
Sanitarios). Acceptance and financing under the NHS is decided by the
Ministry of Health in accordance with the ‘Consejo Interterritorial del
Systema Nacional de Salud’.
• Medication and medical devices that are not included in the Service portfolio
of the NHS (Cartera de servicios), are not financed under the NHS. The
autonomous regions can expand this service portfolio but, if they do so, they
have to finance the costs themselves.
• For medication that is distributed at primary care level through the local
pharmacies, the patient has to pay a part of the costs (co-payment). It varies
from 40% to 0% depending from the type of drugs and the personal situation
of the patient.
• Medication and medical devices that are used at hospital level are included
in the hospital budget. Costs of medication are not charged to the patient.
• If the medication or the devices are included in the ‘cartera de servicios’
from the NHS, these are available if prescribed by a medical specialist. For
medication or medical devices not included in the ‘Cartera de servicios’ of
the NHS, decisions on the use of them are taken at hospital level. The
policies on this varies between the Autonomous Communities since they can
expand the ‘cartera de servicios’ for their region.
• Spain has no specific national plan for rare diseases at national level. Several
Autonomous Communities did develop their own plan or framework.
• Specialised reference centres for rare diseases and exceptional care are
being established in cooperation between the national and the regional
authorities. These are to be equally accessible for al Spanish citizens and are
covered by the NHS.
• Spain recently passed new legislation on the access to medication in special
situations, the use of medication in pre-market authorisation stage, the use
in conditions other than those authorised and for foreign drugs. Acceptance
is organised at central level by the AEMPS.