Neurorehabilitation in Spain

Francisco J. Juan, MD. MHM.
Neurorehabilitation Department. POVISA Medical Center, Vigo. Spain.
President Spanish Society of Neurorehabilitation

Brief description of the Spanish health care system:

Health care provision in Spain is a mix of public provision (approximately 4/5 of total health care) and private (the other 1/5). The present system evolved from health care services that were largely fragmented, having scattered competencies and involving a multitude of bodies. The trends have been to universalize public health care coverage, decentralize management and public financing.

The Spanish Constitution of 1978 provided for the decentralization of some responsibilities to the 17 Spanish autonomous communities. Seven of these (the Basque Country, Navarra, Catalunya, Galicia, Andalucia, Valencia and the Canary Islands) now have responsibility for health care services.

The latest available data on the Spanish hospital system as regards the number of hospitals, sizes and bed number, reveal that the Sistema Nacional de Salud was composed of 198 hospitals (of a total of 787 in Spain) which provided 86 thousand beds (of a total of 169 thousand), concentrated for the most part in hospitals with more than 200 beds (which differs considerably from private non-profit hospitals which mostly have less than 200 beds) and, most importantly, with a high concentration of acute care patients (and less geriatrics and long-term care cases). Data contained in the “Catálogo Nacional de Hospitales” reveals that 68% of beds are publicly owned. Of this subtotal, 83% are for acute care. Public hospitals account for 73% of total days of stays and 75% of discharges. The number of acute beds has slightly declined (in fact, to the levels of 1973) as the length of stay has decreased. In general, chronic patients have filled empty acute beds.

The Primary Care reform provided better working facilities for doctors (in new Health Centres), promoted team working conditions and with some incentives for following special programs (such as smoking and breast cancer prevention). At present, the primary sector has been reformed under this new pattern but with significant differences between regions. In fact, health policy in Spain is at present a complex puzzle with cross fire resulting from two different main themes: First, different views on the extent of private production under public provision. Second, differences in the financing of health services and the way resources are distributed.

Neurorehabilitation in Spain

In Spain, the development of neurologic rehabilitation came from the specialty of Rehabilitation Medicine and there are now more than 1200 full-time rehabilitation medicine consultants in our country that mean a rate of 3.16 physiatrists per 100.000 inhabitants. The number of neurologists in Spain is 1.66 per 100.000 inhabitants. Wards in General Hospital have specific beds for neurorehabilitation or neurologic patients, these beds are used during the acute or subacute phase of neurological rehabilitation, i.e., spinal cord injuries, stroke or head injury. Only a few rehabilitation centers for neurological patients, mainly spinal cord or head injury had been set up during the last two decades. We have seen significant growth in small centers across the country that specializes in neurological rehabilitation for children and people with significant behavioral problems or head injury. Like United Kingdom we have a split between spinal injury and the rest of neurologic rehabilitation. This spinal cord injury units, of which there are about 11 in Spain, are now changing and probably some of these centers will be transformed in Regional Neurological Rehabilitation attending not only spinal cord injury, i.e., complex disabilities, particularly head injury and multiple sclerosis as well as stroke patients. The neurorehabilitation attention received by this group of patients has recently been significant drive toward community services and community oriented rehabilitation teams but the number of health center for outpatient and professionals in the field of neurorehabilitation per 100.000 inhabitants available in this country is not sufficient to care for so high an outpatient care demand.

In conclusions we have a low number of neurorehabilitation specialist and absence of homogeneous care organization. Neurorehabilitation services working in close interdisciplinary collaboration with other specialists are necessary. It is necessary how neurorehabilitation care can be standardized in our country and to clearly define the minimum and place of each level of care involved in the treatment of this group of patients.

Spanish Society of Neurorehabilitation

The Spanish Society of Neurorehabilitation was established in 1998 to advance the clinical and research needs in patients with neurological disabilities. The aim of the Spanish Society is to create a platform tocooperate with all disciplines included in neurological rehabilitation. We want , as well as others societies, to liaise closely with the existing professional associations within rehabilitation medicine.

The main focus of the society is to develop quality standards in Neurorehabilitation and to ensure cost-effective quality care.

The Spanish Society of Neurorehabilitation provides a multidisciplinary organization. We believe that all disciplines involved in neurological rehabilitation will cover a wide variety of topics with the idea of a loose organization with multidisciplinary membership with the benefits of learning from one another. Active members is open to all health care professionals and scientist interested in Neurorehabilitation

Copyright © 2002-3 Sociedad Española de Neurorrehabilitación Última modificación: 30 Junio, 2005