Telemedicine in Spain

Spain’s health and care system organisation

The Spanish national health system is the agglomeration of public health services. Management of these services has been progressively transferred to the distinct autonomous communities of Spain. In this Momentum report, the information relates specifically to Catalonia, which has the status of an autonomous region in its own right.

In Spain, public health competences are transferred to the autonomous regions. There is one National Health System (referred to as an SNS) composed of the different regional health services. Public funding for the SNS is fixed. Each regional health service has its own separate circumstances when it comes to the provision of services. In some regional health services, public provision operates as a monopoly while in other regions services are provided as a public-private mix.

In principle, telemedicine is financed through public resources in those cases where it replaces a traditional service. Given the demographic and socio-economic differences among the various regions in Spain, the regional authorities pursue different approaches to telemedicine deployment and acquisition.

In Catalonia, the main health authority is the Departament de Salut (the Ministry of Health), which is responsible for establishing service policies in accordance with the government health policies, determining the system of provisions, purchases and assessing results. Its policies and obligations to carry out a universal Health service is carried out by the public insurer, CatSalut.

The Catalan healthcare system is a mixed health care model that integrates in a single network all health resources, whether they are provided by public institutions or other organisations (such as health care funds, foundations, consortiums, and Church-run centres) that have traditionally engaged in health care.

The Health Department is responsible for planning and evaluating as well as developing the Health Care Decentralisation project, which has allowed the Catalan town councils to be incorporated in local health services. CatSalut, the public insurer, purchases and evaluates health care depending on the population’s needs.

In addition there are two other relevant organisations: Agencia de Qualitat i Avaluacio Saniteries (AIAQS), the evaluation agency, and TicSalut, the foundation for fostering ICT and innovation penetration in healthcare services.

More information is available at on the Catalan government website.

Spain’s health and care system financing

The system is publicly funded through taxes. In Catalonia, CatSalut contracts with organisations that provide health services to the people who are enrolled, in line with the government’s guarantees and policies. The service providers are responsible for the quality of their services.

The health care budget includes the following:

(a) the pay agreements of the XHUP (the hospital network);
(b) salary harmonisation in the publicly-subsidised residential care sector and in mental health;
(c) updating the collective agreement of the health care transport workers; and
(d) support to tertiary care and innovation.

CatSalut signs yearly contracts with the individual hospitals and primary care centres buying their services on a per capita basis. The model is established according to the reference population (the number of inhabitants they must serve and the type of population: such as elderly people, chronically ill, tourists, etc.). Every year, provision is made for services to be contracted out and which must be justified by the end of the year. Prices per activity unit vary depending on the type of hospital e.g., whether it is a reference hospital, university hospital, municipal hospital, or other.

Spain’s telemedicine strategy and legislation

The situation in Spain varies according to regions.  In terms of Catalonia, the regional health authority launched a strategy for telemedicine in 2012. It also has strategies in other health-related or IT domains that include telemedicine: chronic care management (launched in 2012); Health IT (2008); and IT Digitisation (2000).

Spain’s national health authority in 2012 launched a health IT strategy that affects telemedicine.

Spain does not have legislation that deals specifically with telemedicine. Neither is there legislation that hinders or obstructs the implementation of telemedicine services.