4. Paying for services
Adequate funding for health is important to manage the excess demands on the health system. This section considers how countries are PAYING FOR COVID-19 SERVICES. Health financing describes how much is spent on health and the distribution of health spending across different service areas. The section also describes who is covered for COVID-19 testing and treatment, whether there are any notable gaps (in population coverage and service coverage), and how much people pay (if at all) for those services out-of-pocket.
4.1 Health financing
On May 8, a new regulation allows Autonomous Communities to use up to EUR 3,200 million of the European Regional Development Funds for 2014-2020 to cover healthcare extraordinary expenditures. These funds could be allocated for paying healthcare equipment, tests, personal protective equipment, additional workforce, I+D+i interventions or surveillance apps development. In addition to the EUR 3,200 million, regulation allows Autonomous Communities to reallocate those already earmarked (but not yet executed) funds (https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/hacienda/Paginas/2020/070520-feder.aspx).
On June 16, the Spanish Government approved an extraordinary earmarked fund of EUR 16,000 million for the autonomous communities to face the impact of the COVID-19 crisis. The largest amount, EUR 9,000 million, will be allocated to healthcare expenditure, EUR 2,000 million will be funding education and the remaining EUR 5,000 million meant to compensate for the decrease of economic activity. This COVID-19 fund will not be accounted as regional public debt. Autonomous communities will be responsible for its allocation within their territories.
Different criteria have been taken into account to distribute these funds among the autonomous communities. In the case of healthcare funds, criteria include: covered population weighted by age, population density and insularity, the number of ICUs’ admissions, total hospitalisations and total PCRs performed. In the case of the education funds, criteria mainly included the size of the population under 16. Finally, the compensation for the decrease of the economic activity has been allocated according to local taxation revenues, population size and mobility requirements (Royal Decree Law 22/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-6232; https://boe.es/diario_boe/txt.php?id=BOE-A-2020-8093; https://boe.es/diario_boe/txt.php?id=BOE-A-2020-8294; https://boe.es/diario_boe/txt.php?id=BOE-A-2020-10124;
On October 26, the Spanish Government submitted the 2021 General Budget draft to the Spanish Parliament. The Budget foresees a total expenditure of EUR 7,330 million to reinforce health policies. Out of them, EUR 3,421 million would be allocated to the Ministry of Health, a ten-fold increase as compared to the 2020 Budget (2,964 million are expected to come from European funds). This amount is allocated as follows: EUR 1,000 million will be earmarked to purchase SARS-COV2 vaccines; EUR 73 million are aimed at purchasing medicines and devices; EUR 1,088 million to reinforce primary care; EUR 48.7 million to widen dental health coverage; EUR 400 million to update health technology and, EUR 295.5 million to improve the digital transformation of the health system. The budget also foresees pharmaceutical co-payment exemptions for 6 million people (social security pensioners, disabled under-aged youngsters or people in charge of one child), and allocates EUR 67 million to health cohesion policies aimed at reducing inequalities across autonomous communities (https://www.mscbs.gob.es/gabinetePrensa/notaPrensa/pdf/PGE2301020165006480.pdf; https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5107).
On 12 March, the government issued several measures aiming to alleviate the extraordinary and growing health expenditures resulting from the COVID-19 outbreak. Specifically, the contingency fund, a mechanism foreseen in the National Budget to finance an urgent need, has been injected with an additional EUR 1,000 million and allocated to the Ministry of Health. Depending on the progression of the epidemic, these extra funds could be increased irrespective of the usual restrictions on public debt and deficit control.
In addition, under the mechanisms that regulate the financing system of the Autonomous Communities, the government has released payments on account for a total amount of EUR 557.4 million, aiming to cover the Autonomous Communities’ most urgent needs in coping with the crisis (Royal Decree-Law 7/2020 https://boe.es/buscar/act.php?id=BOE-A-2020-3580).
Regarding services provided by private hospitals during the crisis, the Autonomous Communities are expected to pay for these services using public tariffs, the usual purchasing mechanism. Nonetheless, the specific amount and the timeline for payments have not yet been decided.
On March 31, the government approved an additional 300 million EURO transfer to the Autonomous Communities, as part of the plan of extraordinary economic measures aimed at mitigating the impact of COVID-19. Criteria for the distribution of these funds across ACs were: population size (80%), number of cases (15%) and ICU admissions (5%) (Press conference. Ministry of Health https://www.mscbs.gob.es/en/gabinete/notasPrensa.do?metodo=detalle&id=4834).