Spain's healthcare 'most efficient in Europe', and when it's free, productivity rises

And State medical services in the country are the third-most efficient on earth, beaten only by those of Hong Kong and Singapore respectively.

The annual ranking compiled by Bloomberg covers 56 national health services in total, and Bulgaria sits at the bottom with the USA, where medical treatment availability depends upon patients' insurance covering it, is second from bottom, below Azerbaijan.

Even some countries in the European Union fare very badly in the Bloomberg ranking: perhaps surprisingly, Germany is among the least efficient at number 45 out of 56, having fallen six places from last year and beaten by Kazakhstan and Ecuador, whilst Hungary sits at 42.

Denmark, a nation far ahead of the rest of the world in many aspects including quality of life and employment, and generally among the most modern countries on earth, comes 41^st out of 56, climbing one place up from last year and beaten by Venezuela and Iran.

Belgium, at 38, ranks worse than Romania, and even Perú where crowded A&E departments and medical treatment coming at a cost to the patient mean even natives consider the service poor.

And if anyone was in any doubt about whether the NHS in the UK was as inefficient as mass media claims and was getting worse, its ranking of 35^th out of 56, a fall of 14 places on last year's 21 putting it behind Slovakia and Algeria, appears to be confirmation – and professionals fear the slide will continue if European staff carry on leaving as a result of the uncertainty of their post-Brexit future, and EU citizens' emigration to Britain is restricted after the end of March 2019.

With Austria at 32, the Czech Republic at 30, The Netherlands at 28, Poland at 24 and even Sweden at 22 – and the vast majority of the 56 countries on the list having seen a drop in their ranking from last year – it may seem as though Spain does not have a great deal of competition.

In fact, even Finland, Portugal and France fail to make it into the top 15, Greece, Ireland, Switzerland and Norway fall short of the top 10, even though the latter has climbed a very creditable nine places since 2017.

But Spain, with an efficiency score of 69.3 out of 100, ahead of Italy's fourth-placed 67.6 and South Korea's 67.4, beats Japan (64.3, in seventh place, down from fifth last year), and Australia (62, in eighth place, up from last year's 10), as well as Israel and Taiwan, the only other countries to achieve scores of higher than 60% efficiency.

Whilst a long way down from Singapore's 85.6% and Hong Kong's 87.3% efficiency rankings, Spain is still by far the best on the continent of Europe and the European Union, Bloomberg reveals.

Spanish residents live the longest in the EU

Also, Spain's life expectancy is the highest in the EU at 82.8, the second-highest on the continent of Europe, beaten only by Switzerland's 82.9, and the fourth-highest in the world – above Singapore's 82.7, but below Japan's 83.8 and Hong Kong's 84.3.

It comes as no surprise that Spain has some of the largest numbers of residents aged 100 and over – last year, the figure had quadrupled in a decade, reaching 15,413 by the end of April, of whom over three-quarters were women. A total of seven aged over 105 but not yet 110 have been verified by the Gerontology Research Group, although another 18 are said to be 110 or more but whose dates of birth have not been verified - the eldest of whom is Magdalena Oliver Gabarró who, if her age was certified by the GRG, would be Spain's oldest woman, celebrating her 115^th birthday on October 31.

In fact, at one point, Spain was home to the world's oldest man and woman at the same time – Ana María Vela Rubio was 116 years and 47 days old when she passed away on December 15, 2017, and Francisco Núñez Olivera, who was 113 and 47 days when he died on January 29 this year.

Cost of healthcare per person in Spain: About €2,000 a year

The Bloomberg ranking also gives the cost of healthcare per country in US dollars and as a percentage of the Gross National Product (GNP), which in Spain is 9.2% and an average of US$2,354, or about €2,000, a year, per person.

The most expensive healthcare system out of the 56 is in the USA, where it costs US$9,536 (about €8,100) per head per year, or 16.8% of the GNP.

In continental Europe, healthcare costs as a percentage of the GNP are more expensive in Norway (10%), Switzerland (12.1%), France (11.1%), Finland and Serbia (9.4% each), Sweden (11%), The Netherlands (10.7%), Austria (10.3%), the UK (9.9%), Belgium (10.5%) Denmark (10.3%), and Germany (11.2%), showing Spain may have room for investing a higher percentage of its GNP in its health system, potentially increasing its efficiency.

Costs per head are a little more difficult to compare, given the vastly varying overall prices and wages in each country, although taking those with a similar cost of living, Italy's healthcare is more expensive per head at US2,700 and Portugal's is much cheaper at US$1,722 per capita.

The UK's cost is nearly double that of Spain, at US$4,356 per head, but in comparison, its life expectancy is 81 years and its efficiency rating is 46.3%, compared with Portugal's 55.4% efficiency rating and 81.1-year life expectancy, Italy's 67.6% and 82.5 years, and Spain's 69.3% and 82.8 years.

Free healthcare for everyone increases productivity

Medical treatment and care in Spain has always been free of charge and available to everyone as long as they are legally resident, in accordance with Article 43 of the Constitution, although this has often seemed to be a grey area in the past – early-retired expats, non-EU citizens and anyone who has never been 'in the system', contributing to the Social Security pot via work, have frequently battled with conflicting and incorrect information.

A move to ban non-EU citizens without residence cards from using the health system for free except for emergency treatment, pregnancy and childbirth, or under-18s was met with mass protest in 2012, and many doctors exercised a conscientious objection, continuing to treat 'illegal immigrants'.

By this year, all bar two or three regions had effectively overruled the national law and continued treating everyone, although tourists are required to show their EHIC cards if they are EU citizens or health insurance if they are from the rest of the world.

In June, Spain's new socialist government once again made healthcare free and universal, meaning anyone living in the country, legally or not, can be treated for any condition without having to pay.

And so they should, according to Harvard University – because, as well as combating inequality, it increases productivity, making countries more wealthy.

Spain's government already said in June that immediate savings from restricting healthcare to 'contributors' and EU citizens only were negligible, and in the longer term, these policies actually cost more, since undocumented migrants ended up needing more expensive emergency and life-saving treatment for conditions that could have been easily and cheaply cleared up in the early stages if they had been entitled to free access to a doctor.

Now, Harvard's T. H. Chan School of Public Health has published a report in the magazine Science showing a direct and positive correlation between free and universal healthcare and productivity.

Author David Bloom says a balance needs to be struck between quality and blanket availability, but that it is 'difficult to think of an aspiration that reflects and contributes to human progress more than universal healthcare'.

“Most importantly, we should not focus exclusively on primary medical attention, nor on interventions that promote prevention and early detection of illness, but also on social and economic equity and international cooperation,” Bloom says.

World leaders issued the Alma-Ata Declaration 40 years ago in an attempt to raise global awareness of 'healthcare for everyone' being a basic and universal human right, and emphasising the importance of primary attention, at GP level.

“The benefits are abundant and go beyond improving health. It can generate economic gains and increase productivity, and can improve social and political stability whilst reducing disparities in health and social and economic inequality,” the Harvard report says.

“In countries where the bulk of medical costs are financed by the State, actual healthcare costs tend to be lower compared with those countries which rely more on private insurance, and are less likely to lead to families going bankrupt,” according to the research.

Spain's government said this summer that it wants healthcare to be on a 'resident, not contributor' basis, and not linked to whether or not patients pay into the State system 'like insurance policyholders'.

The second photograph shows Spanish twin sisters celebrating their joint 100^th birthday