Spain

The Kingdom of Spain has one of the most dynamic economies in Europe today. The economy is growing at a rate of 3.5 percent and inflation (3.4 percent) is under control. However, relatively high unemployment (9.2 percent) continues to be of concern. The per capita income ($25,600) is 80 percent of that of the four leading European economies, and Spain ranks 36th in world incomes.

Spain's wealth is unevenly distributed among the rich and poor, and the top 10 percent of the population hold 25.2 percent of resources, while the bottom 10 percent share 2.8 percent. Spain has a Gini Inequality Coefficient of 32.5. The country is in the process of ongoing major economic and social reforms that have resulted in greater access to healthcare. A survey conducted by the government [Page 1586]in 1997 revealed that 99.8 percent of the population was covered by health insurance. According to the United Nations Development Programme (UNDP) Human Development Reports, Spain has the 19th highest standard of living among nations of the world.

Fifteen percent of the total budget is allocated to health. The government expends 7.7 percent of the Gross Domestic Product (GDP) on health-related programs, allocating $1,853 (international dollars) per capita. The government is responsible for 71.3 percent of total health spending, and 7 percent of government funds are directed toward social security. The private sector provides 28.7 percent of total health expenditures, and out-of-pocket expenses account for 82 percent of private spending. There are 3.30 physicians, 7.67 nurses, 0.15 midwives, 0.49 dentists, and 0.87 pharmacists per 1,000 population in Spain.

Spain's basic health plan is financed by taxes, and many Spaniards supplement this coverage with private insurance. Physicians are considered public employees in Spain, and their salaries are established by the government. The passage of Act 16/2003 on Cohesion and Quality in the National Health System instituted major health reforms that were designed to reduce inequities in healthcare among the Spanish population. As a result, most of the responsibility for healthcare was transferred to local communities. At the central government level, the Health Institute is charged with the responsibility for managing health-care. In practice, this role consists of coordinating healthcare among the various communities that are directly involved in delivering healthcare.

Social security covers the elderly, the disabled, and survivors. The system is classified according to occupation, and workers pay 4.7 percent of their wages into the program. Employers contribute an additional 23.6 percent of earnings, and government subsidies account for the remaining funds. Cash benefits are paid to workers who are seriously ill and to new mothers. Women on maternity leave and mothers of adoptive and foster children receive full salary for 16 weeks. Fathers may receive full salary for 10 weeks. If both parents are employed, they may share leave time.

With the 19th highest life expectancy in the world, the population of 40,397,842 has a life expectancy of 79.65 years, with females outliving males an average of seven years. The population is highly literate (97.9 percent), but there is a slight difference between male (98.7 percent) and female (97.2 percent) literacy. All of the relevant age groups are enrolled in elementary and secondary schools. Spain has the 14th lowest fertility rate in the world. Despite the fact that nearly three-fourths of the population are Roman Catholic, 81 percent of Spanish women use some method of birth control. Women give birth at a rate of 1.28 children each. The adjusted maternal mortality rate of four deaths per 100,000 live births is among the lowest in the world.

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