American and Spanish Healthcare Systems

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The paper overviews and compares healthcare systems in the United States (US) and Spain. These countries are selected for the analysis mainly because their approach to system organization and management differ substantially.

Health Statistics and Costs

In this section, the comparison of statistics for the US and Spain is provided. The paragraph covers such matters as life expectancy, mortality rates, major health conditions/diseases, and health care expenditures.

The US

At-birth life expectancy for the total population in the country was 78.6 in 2017, and the age-adjusted mortality rate was 731.9 per 100,000 individuals (CDC, 2018). The same year, the leading death causes included heart disease, cancer, unintentional injuries, chronic respiratory diseases, and stroke (CDC, 2018). In 2017, per capita, health expenditure equaled $10,739, and it accounted for 17.9% of total GDP (CMS, 2018).


In 2016, life expectancy at birth was 80 for males and 86 for females (WHO, 2019a). The mortality rate in 2017 was 9.07 per 1,000 population (Statista, 2019a). The leading causes of death in 2017 were ischemic heart disease, Alzheimer’s disease, and stroke, whereas major causes of morbidity included lower back pain, headache disorders, and depression (IHME, 2019). Total healthcare expenditures per capita were $ 2,966 in 2014, and it equated to 9% of the national GDP (WHO, 2019a).


The death rate is slightly higher in Spain than in the US, and the countries differ a little in terms of major causes of mortality and morbidity. However, on average, Spanish citizens live longer and spend approximately 3.6 times less money on healthcare.

Healthcare Financing

This paragraph explains how healthcare is financed in both countries. It provides information on major sources of financing and the role of private and public sectors in the system.

The US

In 2017, 49% of US citizens had employer-sponsored insurance, 7% had private non-group coverage, 21% were covered by Medicaid, and 14% – by Medicare (KFF, 2017). The Affordable Care Act regulates tax policies for healthcare funding. The act expands social programs and Medicaid, in particular, which is primarily financed by the state and funded by federal subsidies. The law raises revenues through tax penalties on uninsured individuals and employers who do not offer coverage to workers (TPC, 2016). In addition, revenues are collected from higher-income individuals and surtax on investment (TPC, 2016).


Spanish Sistema Sanitario Público is funded from taxes and financed by local ministries. On average, healthcare accounts for about 30% of the total budget of autonomous communities (ACS) (García-Armesto et al., 2010). Private insurance comprises merely 13% of the total population (García-Armesto et al., 2010).


 It is clear that taxation serves as the major source of public healthcare funding in both countries and, in both states, social programs are financed at the state level. Nevertheless, the role of the private sector is much bigger in the US than in Spain.

Healthcare Administration

The paragraph outlines the main agencies involved in healthcare administration in the selected countries. Such functions as overseeing, regulation, and insurance are discussed.

The US

The federal government is responsible for the regulation of social programs and the provision of public care benefits for older citizens. State authorities coordinate the provision of healthcare benefits for lower-income, disabled, and other vulnerable populations as per Medicaid. Moreover, private insurances are administered by private, mainly for-profit organizations (Chua, 2006).


The national Ministry of Health is responsible for overseeing and regulating healthcare policy services at the central level, whereas ACs are responsible for the coordination of extended coverage and benefits, purchasing, and provision of services at the regional levels. Local authorities coordinate service provision at the municipal/provincial levels (García-Armesto et al., 2010).


In both countries, healthcare systems and decentralized and administered at multiple levels. Federal governments in both Spain and the US are responsible for country-wide overseeing of public services and coverage. In contrast to Spain, private enterprises are more involved in healthcare administration in the US.

Healthcare Facilities and Human Resources

Statistics on healthcare resources in the US and Spain are provided in this section. The focus is made on the availability of hospitals/hospital beds, nurses, and physicians.

The US

In 2015, the rate of community hospital beds per 1,000 population was 2.4 (Statista, 2019b). The number of physicians per 100,000 population was 259.4 in 2016 (WHO, 2019b). As for nurses, their number highly varied by state, “from fewer than 700 RNs per 100,000 population in Nevada to over 1,500 RNs per 100,000 in the District of Columbia” in 2018 (“Progress and precision,” 2018, p. S3).


The rate of hospital beds per 1,000 people was 2.98 in 2015 (OECD, 2018). In 2016, the number of physicians per 100,000 was 406 (WHO, 2019b). On average, Spain had 510 nurses on 100,000 population in 2015 (Ministry of Health, Social Services, and Equality, 2015).


Whereas the US has a larger nurse population, Spain has better physician availability, which may result in greater accessibility and quality of services in the latter country. The number of hospital beds available for immediate use is relatively low in both countries.

Conclusion: Access and Equity Issues

While the Spanish healthcare system provides insurance for all individuals regardless of their social-economic standing and even covers irregular immigrants (García-Armesto et al., 2010), the US system is associated with greater access disparities. Partially, Medicaid helped increase the number of insured individuals by offering some coverage advantages for lower-income households and increasing their access to healthcare. However, the total rate of uninsured people in the US was 9% in 2017 (KFF, 2017). Additionally, the AHRQ (2011) data indicates that racial minorities and less educated people have worse access to healthcare than whites and individuals with better educational status in the US.


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

CDC. (2018). Mortality in the United States, 2017. Web.

Chua, K. (2006). Overview of the U.S. healthcare system. Web.

CMS. (2018). Historical. Web.

García-Armesto, S., Abadía-Taira, M. B., Durán, A., Hernández-Quevedo, C., & Bernal-Delgado, E. (2010). Spain: Health system review. Health Systems in Transition, 12(4), 1-295.

IHME. (2019). Spain. Web.

KFF. (2017). Health insurance coverage of the total population. Web.

Ministry of Health, Social Services, and Equality. (2015). Annual report on the national health system of Spain 2015: International comparisons. Web.

OECD. (2018). Hospital beds. Web.

Progress and precision: The NCSBN 2018 Environmental Scan. (2018). Journal of Nursing Regulation, 6(4), S3-S6.

Statista. (2019a). Mortality rate in Spain from 2006 to 2017. Web.

Statista. (2019b). Community hospital beds per 1,000 population in the U.S. in 2000, 2010 and 2015. Web.

TPC. (2016). What tax changes did the Affordable Care Act make? Web.

WHO. (2019a). Spain. Web.

WHO. (2019b). Density of physicians (total number per 1000 population, latest available year). Web.

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NursingBird. "American and Spanish Healthcare Systems." October 4, 2021.