Pathways towards chronic-care focused healthcare systems: evidence from Spain

Increasing health care expenditures is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation which include ageing, medical innovation, and changes in the burden of disease e.g. prevalence of chronic diseases. Most health care systems in developed countries have been designed to ‘cure’ acute episodes, rather than to ‘manage’ chronic conditions, and thereby they are not adequately and efficiently organized to respond to the changing needs and preferences of consumers. New models of chronic care provision have been developed to respond to the changing burden of disease and there are already practical experiences in different countries showing their advantages but also the difficulties in their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies directed at testing the viability of transiting towards chronic care models. In particular, we utilize a framework that identifies and analyses the 10 key pre-conditions of high performing chronic-care based healthcare systems and apply it to the current Spanish NHS. We find that the design of the Spanish National Health System already meets some of those pre-conditions. However, other features are still in their early stages of development or being applied in restricted geographical and clinical contexts. We propose a pathway to walk the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy for the Spanish NHS will significantly transform its current healthcare delivery model in the next few years.