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American and Spanish Healthcare Systems


The paper is aimed to contrast and compare the information and statistics related to health care systems in the United States (US) and Spain. The purpose of the discussion is the identification of differences and issues observed in the selected health systems.

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Health Statistics

The following discussion provides information about health statistics and the costs of the US and Spain. Health statistics include mortality rates, health conditions and diseases, and GDP expenditures.

The US

According to a 2014 report on the US mortality rates, eight deaths per 1.000 people were registered in the country (Xu et al., 2013). The main causes of death include heart diseases, tumors, diabetes mellitus, respiratory diseases, and Alzheimer’s disease (Xu et al., 2013). In 2015, the national GDP was 17.1% (Health expenditure, 2016).


In 2014, nine deaths per 1.000 people were registered in Spain (Instituto Nacional de Estadistica [INE], 2014). The major causes of mortality are tumors, ischemic heart diseases, cardiac failure, Alzheimer’s disease, diabetes, pneumonia, and chronic diseases of respiratory tracts (INE, 2014).

In 2015, the expenditures on health service in Spain was 9% (Health expenditure, 2016).


The death rates in Spain are slightly higher than in the US while the US GPD is 36 times higher than in Spain. It is possible to say that economic growth is interrelated with health and mortality indicators, and the performance of the health care system.

Health Care Financing

The following discussion focuses on the ways of health care financing in the public and private sectors.

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The US

The major insurance programs in the USA are Medicare and Medicaid, which are supported by Medicare Payroll Tax, Excise Tax, and Tanning Tax (Jackson & Nolen, 2010). Moreover, employers with more than 50 subordinates are obliged to provide them with private health insurance (Jackson & Nolen, 2010). The Americans prefer private health insurance in three times more often (Ward et al., 2014).


Insurance coverage in Spain is almost universal (99.5%) (Garcia-Armesto et al., 2010). The coverage is independent of economic status and wealth. The governmental funding primarily consists of the collected tax revenue: “40% of personal income tax,… the corporate tax, inheritance transfer tax and wealth and gift taxes” (Garcia-Armesto et al., 2010).


Access to public insurance in Spain is facilitated, and only 5% of the population is left out of the program. US insurance coverage depends on the level of income and offers a limited number of medical services. As a result, a large part of the US population remains uninsured.

Health Care Administration

The analysis includes information about governmental agencies regulating the provision of health care, their functions, missions, and objectives.

The US

The Department of Health and Human Services (HHS) is the principal government agency responsible for health care services (Mossialos & Wenzl, 2015). It includes the organizations regulating insurance coverage, research conduction, and initiation of programs aimed to protect public health. One of the HHS’s objectives is the improvement of health care access for individuals who are “uninsured, isolated, or medically vulnerable” (Mossialos & Wenzl, 2015, p. 157).


The main governmental agency responsible for the provision of health services is the Consejo Interterritorial del Sistema Nacional de Salud (CISNS) consisting of the central Minister of Health and 17 regional ministers (Garcia-Armesto et al., 2010). It generates information, assesses, and coordinates the Health System’s performance. The CISNS’s objectives include innovation and an increase in quality and population’s access to healthcare benefits through the development of normative projects and control of expenditures (Garcia-Armesto et al., 2010).


The missions of the governmental agencies in both countries are similar: the improvement of health care provision and quality. The administrative bodies consist of multiple organizations that have their own functions, and their final decisions are usually adopted by consensus.

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Health Care Personnel

The discussion is based on statistics on health care personnel and facilities. The numbers of medical staff and hospitals’ density are introduced.

The US

The density of physicians per 10.000 population is 26.7 while the density of nursery and midwifery personnel is 98.2 (World Health Organization [WHO], 2011). The number of hospital beds per 10.000 people is 31 (WHO, 2011).


The density of physicians per 10.000 people is 37, and the density of nurses is 51.6 (WHO, 2011). The number of hospital beds per 10.000 population is 32 (WHO, 2011).


The differences in hospitals and physicians’ density demonstrate that the US faces greater difficulties in the provision of health care services to the population. At the same time, the density of nurses in the country is almost two times higher than in Spain. It means that the US health system may provide better conditions of work for nursery staff and encourages the retention and attraction of personnel.


Access and Inequality Issues

The US spends more than many other countries on health care, however, the national level of inequity in access to health care remains one of the highest in the world (Agency for Healthcare Research and Quality, 2011). Uninsured citizens cannot receive routine treatment and usually wait until a health problem develops to be able to receive free service in the emergency departments.

In Spain, the improvement equity of access to health care was observed during 1987–2001 (Garcia-Armesto et al., 2010). Nowadays, income differences do not cause a difference in access to general health care services. Nevertheless, referral to special care units is facilitated for those who have private insurances.

Although inequality issues are present in both countries, it is possible to say that they are qualitatively different. The US experiences greater challenges in the provision of medical service due to the dependence of insurance coverage to the socioeconomic status.


Agency for Healthcare Research and Quality (AHRQ). (2011). Disparities in healthcare quality among racial and ethnic groups: Selected findings from the 2011 National Healthcare Quality and Disparity reports. Web.

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Garcia-Armesto, S., Abadia-Taira, M., Duran, A., Hernandez-Quevedo, C., & Bernal-Delgado, E. (2010). Spain: Health system review. Health Systems in Transition, 12(4), 1–295. Web.

Health expenditure, total (% of GDP). (2016). Web.

Instituto Nacional de Estadistica. (2014). Deaths according to Cause of Death. The year 2012. Web.

Jackson, J., & Nolen, J. (2010). Health Care Reform Summary: A Look at What’s in the Act. Web.

Mossialos, E., & Wenzl, M. (2015). International profiles of health care systems. Web.

Ward, B., Clarke, T., Freeman, G., & Schiller, J. (2014). Early Release of Selected Estimates Based on Data From the 2014 National Health Interview Survey. Web.

World Health Organization. (2011). World health statistics. Web.

Xu, J., Murphy, S., Kochanek, K., & Bastian, B. (2016). Deaths: Final Data for 2013. National Vital Statistics Reports, 64(2), 2-119. Web.

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