RT Book, Whole T1 Can people afford to pay for health care? New evidence on financial protection in Spain A1 Urbanos Garrido, Rosa María A1 Peña Longobardo, Luz María A1 Comendeiro Malooe, Micaela A1 Oliva, Juan A1 Ridao López, Manuel A1 Bernal Delgado, Enrique AB This review is part of a series of country-based studies generating new evidence on financial protection in European health systems. Financial protection is central to universal health coverage and a core dimension of health system performance. Despite worsening during the economic crisis from 2008 to 2014, the incidence of catastrophic health spending in Spain is much lower than would be expected given Spain’s relatively heavy reliance on out-of-pocket payments. This can be explained by strengths in the design of coverage policy in the National Health System (NHS): entitlement to the NHS based on residence, with the same degree of entitlement for undocumented migrants; a generally comprehensive benefits package; limited use of co-payments; and multiple mechanisms to protect people from co-payments. There are gaps in coverage, however. Catastrophic spending is driven by dental care and medical products inall consumption quintiles, mainly because dental and optical care for eyesight problems are largely excluded from NHS coverage. Catastrophic spending in the poorest quintile is also driven by outpatient medicines, reflecting co-payments and inadequate protection for low-income households of working age. To reduce unmet need and financial hardship, policy should focus on expanding NHS coverage of dental care and optical care and further improving the design of co-payments to strengthen protection for poorer households in all age groups. PB World Health Organization, Regional Office for Europe SN 978-92-890-5618-2 YR 2021 FD 2021-11-04 LK https://hdl.handle.net/20.500.14352/119048 UL https://hdl.handle.net/20.500.14352/119048 LA eng NO World Health Organization DS Docta Complutense RD 17 abr 2025