Spanish National Health System

The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España, CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain.

Article 46 of the Ley General de Sanidad establishes the fundamental characteristics of the SNS: Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of epidemics through the establishment of naval quarantines, the closing of city walls and prohibitions on travel in times of plague, but also in terms of hygienic and palliative measures.

Al-Andalus—Muslim-ruled medieval Spain—was distinguished by its level of medical knowledge relative to the rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain.

Surgery and pharmacy were quite separate from medicine and were considerably less prestigious; the systems of Galen and Hippocrates dominated medical practice during most of the era of the Antiguo Régimen.

At the beginning of the 19th century, the Balmis Expedition (1803) to administer the smallpox vaccine throughout the Spanish colonies was a public health undertaking of unprecedented geographical scope.

The Cortes of Cádiz debated a sanitary code (the Código Sanitario de 1812), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken.

The presumption underlying the adopted model is that in each autonomous community, authorities are adequately equipped with necessary territorial perspective, so that the benefits of autonomy do not conflict with the needs of management efficiency.

Without interfering with the diversity of forms of organization, management and services inherent in a decentralized system, it attempts to establish certain basic, common safeguards throughout the country.

Toward these ends, the law created or empowered several specialized organs and agencies, all of which are open to the participation of the autonomous communities.

The basic organ of cohesion is the Interterritorial Council of the Spanish National Health Service (Consejo Interterritorial del Servicio Nacional de Salud de España), which has great flexibility in decision making, as well as mechanisms to build consensus and to bring together the parties taking such decisions.

The Royal Decree 1041/2009 of 29 June lays out the basic organic structure of the Spanish Ministry of Health and Social Policy.

The objective of this reorganization is to reinforce the role of the single ministry as the instrument of cohesion for the National Health System (SNS), adding to the portfolio of the Secretary General of Health purview in matters of the quality of the SNS by adding to it the Agency of Quality of the National Health System (Agencia de Calidad del Sistema Nacional de Salud) and the General Directorate of Advanced Therapies and Transplants (Dirección General de Terapias Avanzadas y Trasplantes).

The 2003 Law of Cohesion and Quality of the SNS introduced significant changes in the composition, functioning, and purview of the CISNS.

Under this law, the CISNS functions variously as a plenary body, by delegated committees, through technical commissions, and through work groups.

Under the Law of Cohesion, CISNS functions mainly through the adoption of and compliance with joint accords, through the political use of the plenary sessions, with each member making an uncompromising defense of the interests of its region.

Important committees include:[10] Articles 69, 70 and 71 of the Law of Cohesion regulate the principal functions of the Interterritorial Council of the SNS.

Its effect on the healthcare provision can be seen in the following articles: Article 10 of the Law of Cohesion establishes that the financing of the Spanish health system is the responsibility of the autonomous communities in conformity with the accords of transfer and the current system of autonomic financing, notwithstanding the existence of a third party liable to pay.

The Clinical History of the [Spanish] National Health System (Historia Clínica Digital del Sistema Nacional de Salud, HCDSNS) is intended to guarantee citizens and health professionals access to whatever clinical information is relevant for medical care of a particular patient.

Primary health care includes service provided either on-demand, scheduled, or urgently, both in the clinic as well as in the patient's home.

[25] Article 14 of the Law of Cohesion defines social-health care (atención sociosanitaria) as the combination of care for those patients, generally those with a chronic illness, whose would benefit from the simultaneous and synergistic provision of health services and social services to increase their personal autonomy, palliate their limitation or hardships, and facilitate their social reinsertion.

[28] According to the 2008 National Catalog of Hospitals (Catálogo Nacional de Hospitales 2008), Spain in 2007 had a total of 10,178 consultorios that allowed health professionals to provide more local services than the health centers in their respective zones, with the purpose of bringing basic services closer to people who reside in nuclei dispersed through rural areas that tend to have an older than average population.

[29] A health center (centro de salud, distinct from the smaller "healthcare center" centro sanitario) in Spain's SNS is main physical and functional structure devoted to coordinated global, integral, permanent and continuing primary care, based in a team of health care professionals and other professionals who work there as a team.

Some of these clinics include very up-to-date operating theaters capable of providing minimally invasive surgery, and "hospitalization zones" where patients can recuperate on an inpatient basis.

General hospitals treat a broad range of pathologies and typically provide services including surgery, obstetrics and gynecology, and pediatrics.

Examples of specialized services are intensive and critical care, anesthesia, defibrillation, but also some forms of hemotherapy, rehabilitation, and even nutrition, diet, post-partum treatment, and family planning, especially assisted reproductive technology.

Specialized treatment can also be involved in detection, prescription and implementation of diagnostic and therapeutic procedures, especially those related to prenatal diagnosis in risk groups, diagnosis by imaging, interventionist radiology, hemodynamics, nuclear medicine, neurophysiology, endoscopy, lab tests, biopsies, radiotherapy, radiosurgery, renal lithotripsy, dialysis, techniques of respiratory therapy, organ transplants and other tissue and cell transplants.

[43] One of the SNS's priorities with respect to pharmaceuticals is to teach patients to make rational use of medications and to avoid, insofar as possible, unsupervised self-medication.

Pharmaceutical services include medications and health products are provided to patients according to their clinical needs, in precise doses and over an adequate period at the least cost possible.

According to data from the National Institute of Statistics (Instituto Nacional de Estadística, INE), as of January 1, 2018,[48] Spain has a population of 46,659,302, of whom 22,882,286 (49,04%) are male and 23,777,015 (50.96%) female.

The health care system must also provide services for thousands of illegal immigrants and for the many tourists who visit Spain each year.