Financing Mental Health Care in Spain: Context and critical issues

Background: Financing and the way in which funds are then allocated are key issues in health policy.They can act as an incentive or barrier to system reform , can prioritise 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 collaboration 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 expenditure 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 estimates 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 discretionary, and provides only limited coverage.This level of expenditure also appears low by European standards, accounting for just 0.6% of GDP.