Financing Mental Health Care in Spain: Context and critical issues

Resumen

Background: Financing and the way in which funds are then allocated are ke y issues in health policy. They can act as an incentive or barrier to system reform , can pri- oritise certain types or sectors of care and have long term consequences for the planning and delivery of services. The way in which these issues can impact on the funding of mental health services across Europe has been a key task of the Mental Health Economics European Network. (MHEEN) This paper draws on information prepared for MHEEN and provides an analysis of the context and the main issues related to mental health financing in Spain. Methods: A structured questionnaire developed by the MHEEN group was used to assess the pattern of financing, eligibility and coverage for mental healthcare. In Spain contacts were made with the Mental Health agencies of the 17 Autonomous Communities (ACs), and available mental health plans and annual reports were reviewed. A direct col- laboration was set up with four ACs (Madrid, Navarre, Andalusia, Catalonia). Results: In Spain, like many other European countries mental healthcare is an integral part of the general healthcare with universal coverage funded by taxation. Total health e xpenditure accounted for 7.7% of GDP in 2003 (public health expenditure was 5.6% of GDP). Although the actual percentage expended in mental care is not known and esti- mates are unreliable, approximately 5% of total health expenditure can be attributed to mental health. Moreover what is often overlooked is that many services have been shifted from the health to the social care sector as part of the reform process. Social care is dis- cretionary, and provides only limited coverage. This level of expenditure also appears low by European standards, accounting for just 0.6% of GDP. Comments: In spite of its policy implications, little is known about mental healthcare f inancing in Spain. Comparisons of expenditure for mental health across the ACs are prob- lematic, making it difficult to assess inequalities in access to services across the country. The limited data available on mental healthcare expenditure suggests that level of funding for mental health is low compared with many of the EU-15 countries. This may indicate inefficient and inequitable funding given the significant contribution of mental disorders to the overall burden of ill health. Attention needs to be directed to redressing both the information deficit and also in using a range of financing mechanisms to promote greater investment in mental health.