Alma: "Hola! Ich arbeite seit einem Jahr als Pflegekraft in Madrid und habe ich das Gefühl, wirklich Teil der Gemeinschaft zu sein. Die Spanier sind unglaublich herzlich, und das spiegelt sich auch in der Arbeitsatmosphäre wider. Die Patienten sind sehr respektvoll, und es herrscht oft eine familiäre Stimmung, besonders in kleineren Kliniken. Ein großer Pluspunkt ist das Wetter – es gibt kaum etwas Besseres, als nach einer anstrengenden Schicht bei angenehmen Temperaturen an die frische Luft zu gehen. Allerdings hatte ich am Anfang Schwierigkeiten mit der Sprache. Spanisch ist ein Muss, besonders da ältere Patienten oft kein Englisch sprechen. Ich habe intensiv Sprachkurse besucht, und es hat sich gelohnt. Eine weitere Herausforderung ist das Gesundheitssystem, das in manchen Regionen weniger gut ausgestattet ist. Die Ressourcenknappheit bedeutet, dass wir oft kreativ sein müssen, um das Beste für die Patienten herauszuholen."
Spain's healthcare system, known as the"Sistema Nacional de Salud" (SNS), is primarily tax-funded and provides universal access to all residents. It includes a mix of public and private healthcare services, with the public sector offering free or low-cost medical care, including primary care, specialist treatments, and emergency services. Many Spaniards also use private health insurance to reduce wait time sand access specialist care.
Key features:
Background information about…
Long-term care can take the form of inpatient care in dedicated long-term hospital beds or“single-specialty” geriatric hospitals, or as part of the services provided in the context of Law 39/2006 for the Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency, namely SAAD.
When it comes to dedicated long-term hospital beds, the SNS has 10 899 long-term care beds that represent 9% of public beds, and 77% of long-term care beds in the country, according to 2015 data (MSSSI, 2017m). Additionally, private hospitals (usually, not-for-profit) hold 3102 beds that might be used to complement public supply (MSSSI, 2017m). Typically, hospital long-term beds cover palliative care needs, either in chronic patients or patients with cancer.
When it comes to SAAD, services are provided through a network of social centres and services available in the ACs, including regional public institutions, services provided by the municipalities, national reference centres for support of specific causes of disability, as well as accredited partner private centres. ACs have total freedom to set up this network of providers where nongovernmental organizations and not-for-profit institutions are considered as priority partners (compared with for-profit providers). Priority in access to services is determined by the assessment of the applicants’ degree of dependency and financial assets.Services are co-paid according to the type of service required and the ability to pay.
The package of benefits comprises the following services: (a) promotion of personal autonomy and prevention of dependency; (b) tele-assistance; (c) home aids (housekeeping, personal care, day-centre and specialized day-care services); and, (d) residential services (nursing home for dependent older people or residential stays for dependent persons, adapted to the type of disability).
One positive return from the development of SAAD is that, since 2012 when unemployment rates started decreasing, the number of workers in the social sector joining SAAD has increased slightly but steadily, with 391 589 employees currently working in the sector, 13% more than in 2012 (MSSSI,2017n).
Despite the extraordinary efforts in the implementation of SAAD, there are issues that require improvement; so a dedicated Commission composed of representatives of the central government and seven ACs (Catalonia, Galicia, Andalusia, Asturias, Aragon, Canary Islands and Castile-Leon) have raised the need to reconsider the current financing mechanism to guarantee the coverage of all beneficiaries as well as the sustainability of the system – currently long-term care represents 1% of the Spanish GDP, 60% less than the EU average (OECD/EU, 2016).
Palliative care in Spain may take the form of dedicated beds in acute hospitals, outreach services provided by specialists in palliative care with (or without) the involvement of primary health care professionals, nonspecialized services directly provided by primary health care professionals, beds in not-for-profit or for-profit hospitals, purchased or not by the public system, OOP services or services provided in the context of the SAAD. Depending on the place of residence and the centre of treatment, the pathway followed by a patient with palliative care needs varies substantially and the treatment might involve a variety of providers. According to the latest report of the Spanish Society for Palliative Care, only 49% of patients requiring palliative care have access to the services covered by the SNS (SECPAL, 2016).
There are no recent official reports on the state-of-the-art of palliative care in Spain. A recent report by the not-for-profit Spanish Cancer Association points out that there were 458 teams, 383 of them specialized in palliative care, in 2013. According to them, “200more specialized teams will be needed to reach international standards”, which implies that 15 ACs (out of the 17) should increase their current supply (AECC,2014).
Since 2010, efforts have been oriented to implement the 2010–2014 National Strategy for Palliative Care (MSSSI, 2012d) and the design of the National Strategy for Paediatric Palliative Care, whose main goals are: (a) defining the actual care needs for this population subgroup as well as the organizational model for the provision of palliative care for children; (b) promoting patients’ and families’ autonomy; (c) developing specific training programmes for professionals and relatives; and (d) developing specific research lines on the topic (MSSSI, 2014d). Both strategies have been implemented but they have not been assessed yet; nonetheless, there are concerns with their uneven adoption across ACs.
Quelle:WHO/European Observatory on Health Systems andPolicy Monitor (HSPM) (https://eurohealthobservatory.who.int/monitors/health-systems-monitor/compare)
