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.

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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