Spain: health system review

This review of the Spanish health system analyses recent developments in health organization and governance, financing, health care provision, recent reforms and health system performance.Overall health status continues to improve in Spain, which presents the highest life expectancy in the European Union – although some socioeconomic inequalities in health persist and risk factors such as overweight, tobacco and alcohol consumption and illegal drug use remain a concern. Health system reforms since 2018 have focused on widening the population covered by the health system, reducing co-payments, improving the scope of coverage in terms of increasing provided services, and the reinforcement of primary care. Future challenges for the health system include addressing access gaps, such as the limited coverage of some services (such as dental and optical care), and large waiting lists for some services. Some gaps in efficiency remain, such as the low numbers of qualified personnel in some medical specialties, the shortage of mental health resources, the underuse of effective treatments, and the overuse of non-appropriate orineffective procedures.

Denmark: health system review

This analysis of the Danish health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Population health in Denmark isgood and improving, with life expectancy above the European Union average but is, however, lagging behind the other Nordic countries. Denmark has a universal and tax-financed health system, providing coverage for acomprehensive package of health services. Notable exclusions to the benefits package include outpatient prescription drugs and adult dental care, which require co-payment and are the main causes of out-of-pocket spending. The hospital sector has been transformed during the past 15 years through a process of consolidating hospitals and the centralization of medical specialties. However, in recent years, there has been a move towards decentralization to increase the volume and quality of care provided outside hospitals in primary and local care settings. The Danish health care system is, to a very high degree, based on digital solutions that health care providers, citizens and institutions all use. Ensuring the availability of health care in all parts of Denmark is increasingly seen as a priority issue.Ensuring sufficient health workers, especially nurses, poses a significant challenge to the Danish health system’s sustainability and resilience. While a comprehensive package of policies has been put in place to increase thenumber of nurses being trained and retain those already working in the system, such measures need time to work. Addressing staffing shortages requires long-term action. Profound changes in working practices and workingenvironments will be required to ensure the sustainability of the health workforce and, by extension, the health system into the future.