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Spain's population of 39,997,000 makes it closely comparable to California (33,871,648) plus the state of Washington (5,894,121). Infant mortality is 4.99 deaths/1,000 live births. Life expectancy at birth is 75.32 years for men and 82.49 years for women. All three figures are significantly improved over the US figures; that is, more than a whole point better for infant mortality and more than a whole year better for life expectancy for both sexes.
The per capita GDP is $17,300, of which Spain spends 7.3% on health care; $1263, or an amazing 29% of the $4363 spent in the US. This is a full 71% less cost, for significantly better results. How do they do it?
The country has had a comprehensive, single-payer national health service since 1978. The Constitution of 1978 explicitly affirms everyone's right to health care.
The Spanish health care system is funded by payroll taxes through the National Institute of Health program (INSALUD), which in 1984 was 75% financed by employers and 25% financed by employees. Those with higher incomes have the option of obtaining private medical care. Public hospitals are run by one of the provinces or municipalities. The INSALUD program operates a large network of hospitals and ambulatory care clinics. Hospital physicians are on full-time salaries. All medical and nursing education is free.