The 2nd HPD report - Health Policy Monitor

Non-party agreement
on dependency
insurance
No comprehensive
approach
All social
sectors involved
Idea
Pilot
Policy Paper
Legislation
Adoption
Evaluation
Change
A new convention within the Toledo Agreement aiming at the introduction
of reforms (e.g., for sustainable funding of the social
security system) was reached in early October 2003.
The Toledo Agreement (“Pacto de Toledo”) of 1995 is a convention
about public pension schemes within the Spanish social
security system. It is a non-party agreement on the gradual reform
of certain old-age benefits to ensure sustainable financing.
With respect to dependency insurance, the Toledo Agreement
does not recommend specific procedures. However, it recognizes
the need for a comprehensive coverage system covering physical
as well as mental disorders and an integrated approach to the delivery
of health care and social care.
Spain has yet to define a comprehensive, multidisciplinary approach
to these challenges. Regional authorities provide health
services on a universal coverage basis, while either municipalities
or regional governments provide dependency coverage on a
means-tested basis combined with co-payments.
The public system basically covers individuals with low incomes
and little or no social support. Middle-income people are
not eligible for public assistance although they may not be able to
afford private services either. Moreover public institutions and
public services are unable to provide a satisfactory number of care
facilities.
Proposals to effectively address the problems of an aging population
in Spain come from a variety of social sectors: academics,
politicians, private institutions and foundations, medical associations,
consumer associations, trade unions. All sectors of society
are demanding sustainable solutions for enhanced public coverage
of the needs of older citizens. Financing of public coverage
will be the main challenge, possibly answered by a sound mixture
of public and private commitments. Another issue is the integration
of health and social care with respect to funding and supply.
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