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Spain Government Health and Welfare Programs
Following the reform of the government's social
services in
1978, all social security benefits were under the
supervision of
the Ministry of Labor and Social Security. In addition,
the
Ministry of Health and Consumer Affairs was responsible
for
public health and health education programs. In the
government's
1988 budget, these programs were allocated about US$22.5
billion,
a 9 percent increase over 1987 and about 23.3 percent of
the
total budget.
Except for unemployment benefits, most social security
programs were administered under a single set of
institutions
created by the 1978 reform to replace the patchwork system
of
unions, insurance companies, mutual aid associations, and
state-run programs that had evolved in haphazard fashion
throughout the century. These institutions were not the
only
welfare system, but they did cover about 80 percent of the
population, and they offered a complete range of welfare
benefits, including cash payments, medical care, and
social
services. The programs were administered by three
government
agencies, together with the General Social Security
Treasury,
which was responsible for financial control. Cash payments
were
administered by the National Social Security Institute
(Instituto
Nacional de Seguridad Social--INSS); medical care, by the
National Health Institute (Instituto Nacional de
Salud--INSALUD);
and social services, by the National Institute for Social
Services (Instituto Nacional de Servicios
Sociales--INSERSO).
After the advent of the autonomous community system,
several
autonomous governments sought to have responsibility for
social
security transferred to their jurisdictions. The health
care
responsibilities of INSALUD were transferred to the
regional
government of Catalonia in 1982 and to that of Andalucia
in 1983.
The Pais Vasco and Valencia were scheduled to receive
their
authority in the health field in 1988.
As of 1984, residents had access to a fairly
comprehensive
program of health insurance coverage, paid for by joint
contributions from workers and employers; the state added
a
subsidy to cover deficits. Sickness benefits ranged
between 60
and 75 percent of covered earnings, and maternity benefits
amounted to 75 percent of covered earnings, paid both 6
weeks
before, and 8 weeks after, childbirth. Medical services of
all
kinds were provided to patients directly through state-run
hospitals and clinics, or through institutions under
contract to
the state. Pension insurance or retirement coverage was
available
to all employees in industry, including the service
industry, and
to their dependents. Benefits were financed by workers,
employers, and the state under the same general scheme as
that
used for health insurance. There were separate systems in
effect
for sectors that were difficult to cover in this way,
including
farm workers, domestic servants, seamen, public employees,
miners, and so forth. Old-age pensions were payable in
most cases
at age 65, and they constituted 50 percent of covered
earnings
(the average of the highest-paid 2 of the last 7 years)
plus 2
percent per year of contributions made from eleven to
thirty-five
years, up to a maximum of 100 percent. Pensions--usually
reduced
to a certain percentage of the original pension, but
equalling
100 percent under certain conditions--were also payable to
survivors of the covered worker.
Unemployment insurance has been available in Spain
since
1919, but the state has provided benefits to those out of
work
only since 1961. Insured workers contributed between 1.1
and 6.3
percent of covered earnings according to 12 occupational
classes,
while employers contributed between 5.2 and 6.3 percent of
payroll, and the state added a variable subsidy. Benefits
covered
the insured for up to twenty-four months under normal
circumstances, and they could range between 60 and 80
percent of
covered earnings. Only about 60 percent of the registered
unemployed received benefits, however, because the law
excluded
short-term and casual employees as well as those seeking
their
first jobs and because agricultural workers were covered
under a
special program.
During the 1980s, the state's share of funding for
social
security programs expanded rapidly, while the proportion
contributed by employers and employees declined
correspondingly.
In the 1970s, the state was contributing only 5 percent;
however,
by the 1980s the figure had risen to more than 20 percent,
still
quite low by West European standards. Many employers
complained
because of the relatively high proportion (85 percent)
that they
had to contribute to the non-state portion of social
security
funding; some even falsified records or refused to make
the
payments, leaving their employees without benefits.
Slightly less
than two-thirds of social security expenditures were paid
out in
cash benefits, principally in the form of pensions to the
aged,
widows, orphans, and the disabled. The remaining third was
spent
on health, on social services, and, in small part, on
administration.
As in many other advanced industrial countries, Spain's
welfare system was under increasing financial pressure
throughout
the 1980s. This was due in part to the country's economic
distress, which created the dual pressures of declining
contributions and tax receipts on the one hand, and
increased
claims for unemployment assistance on the other. Another
important reason was the decline of the extended family,
which in
earlier times had absorbed part of the cost of helping
unemployed
or distressed family members. However, the main reason was
that,
like those in other Western countries, Spain's population
was
aging rapidly and therefore the state had to pay more and
more in
old-age pensions. These pensions tended to be quite
generous, the
highest, in fact, after Sweden's, in Western Europe.
Between 1972
and 1982, the number of pensioners rose by an average of
184,000
each year. By 1983, when there were 4.7 million
pensioners, for
every beneficiary of the pension program there were only
2.3
contributors, compared with an average of five in the rest
of
Western Europe. Thus, in the 1980s, officials began to
talk
seriously about the possibility of the bankruptcy of the
old-age
pension system. The private sector needed to become more
heavily
involved through private pension plans, but in the late
1980s,
legislation that would make these plans possible had
failed to
win government approval. In a country where the elderly
have
traditionally been held in high esteem and have generally
been
well treated, the dramatic aging of the population was
still a
relatively new experience that would greatly affect public
policies as well as the country's social values. In 1982
there
were only 62 homes for the elderly, and these cared for
some
12,500 persons; by 1986 the number of centers had
increased by
approximately 16 percent, to 72, and the number of elderly
residents had increased by 25 percent, to about 15,700.
Also in
1982, some 385 day-care centers provided services to about
1.1
million elderly; by 1986, just four years later, the
number of
these centers had increased by 13 percent to 435, and the
number
of elderly served by them had increase by 55 percent, to
about
1.7 million. In this same four-year period, government
expenditures on social services for the elderly rose by 87
percent, direct payments to the elderly rose by more than
170
percent, and investments in facilities for the aged
increased by
160 percent. It was clear that these figures would
continue to
increase well into the twenty-first century, raising the
highly
controversial political question of who would bear this
fiscal
burden.
* * *
Spain's transition to an advanced industrial democracy
has
been amply documented in a number of excellent books, most
of
which deal with the politics of the transition. Two recent
works,
however, stand out as readable accounts of the social
transformation as well. Both are by British journalists
who lived
in Spain for a number of years during the transition. John
Hooper's book, The Spaniards: A Portrait of the New
Spain,
contains a lengthy section on the regional and the ethnic
problems of contemporary Spain, while Robert Graham's
book,
Spain: A Nation Comes of Age, focuses primarily on
the
rise of the country's middle class and on important
institutions.
Also helpful are: Spain: The Root and the Flower by
John
Crow, Spain: From Repression to Renewal by Ramon
Arango,
and Spain: A Guide to Political and Economic
Institutions
by Peter Donaghy and Michael Newton.
Several American cultural anthropologists have written
books
on Spanish culture in recent years, thereby increasing
greatly
our understanding of life in rural and small town Spain.
The
principal of these works are William Douglass's Echalar
and
Murelaga: Opportunity and Rural Exodous in Two Spanish
Basque
Villages, Susan Freeman's The Pasiegos: Spaniards
in No
Man's Land, and David Gilmore's Aggression and
Community:
Paradoxes of Andalusian Culture. The politics and
culture of
Spain's ethnic groups have been dealt with by several
American
political scientists, including these: Robert Clark,
The
Basques: The Franco Years and Beyond; Oriol Pi-Sunyer,
Nationalism and Societal Integration: A Focus on
Catalonia; and Kathryn Woolard, The Politics of
Language
and Ethnicity in Barcelona.
Several Spanish sociologists have produced significant
studies of key elements of the Spanish transformation, of
which
the most readable and important are: Salustiano del Campo
and
Manuel Navarro, Nuevo analisis de la poblacion
espanola;
Salustiano del Campo, Manuel Navarro and J. Felix Tezanos,
La
Cuestion regional espanola; Amando de Miguel,
Manual de
estructura social de Espana; and Amando de Miguel,
Recursos humanos, clases, y regiones en Espana. The
standard work on Spanish
geography, now in its fifth edition, is by Manuel de
Teran, L.
Sole Sabaris, and J. Vila Valenti, Geografia regional
de
Espana.
Finally, for those who wish to remain abreast of
current
affairs in Spain, an accessible and readable periodical
that
covers Spain fairly regularly is The Economist,
published
in London. For
those able to read Spanish, the best source is the
international
edition of El Pais, published weekly in Madrid.
(For
further information and complete citations,
see
Bibliography.)
Data as of December 1988
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