Following the adoption of the country's constitution, Spain's health care system underwent major reforms in the 1980s and 1990s. Instead of being organized directly as part of the social security system, it was transformed to the more decentralized National Health System. Coverage was extended further than before and the primary care network was reorganized. Spanish officials say that public contributions to the cost of health care must be limited in the face of potentially unlimited demand. As of 1999, total health care expenditure was estimated at 7% of GDP.
The public sector in health care is the largest and continues to grow. In 1991, there were 354 public hospitals, 149 private hospitals, and 312 private business hospitals. The public health sector contracts a significant number of beds from both types of private hospitals. As of 1999, there were an estimated 3.1 physicians and 3.9 hospital beds per 1,000 people. Recent programs have created special residences for elderly and retired people, eye clinics, a network of government health centers in the principal cities, and more than a dozen human tissue and organ banks for transplantation and research.
As of 2002, the crude birth rate and overall mortality rate were estimated at, respectively, 9.3 and 9.2 per 1,000 people. In 1990– 95, about 59% of married women (ages 15 to 49) were using contraception. Average life expectancy in 2000 was 78 years. The infant mortality rate was 4 per 1,000 live births, down from 38 in 1965. Immunization rates for children up to one year old in 1997 were: diphtheria, pertussis, and tetanus, 88%; polio, 88%; and measles, 90%.
Leading causes of death in 1990 were delineated as follows: communicable diseases and maternal/perinatal causes (45 per 100,000 people); noncommunicable diseases (410 per 100,000); and injuries (42 per 100,000). There were about 59 cases of tuberculosis per 100,000 reported in 1997. As of 1999 the number of people living with HIV/AIDS was estimated at 120,000 and deaths from AIDS that year were estimated at 2,000. HIV prevalence was 0.6 per 100 adults.
The smoking rates for both men and women in Spain are above the average of "high human development" countries as defined by the World Bank. In 1986–94, 58% of men and 27% of women were smokers. Tobacco consumption rose from 2.3 kg(5.1 lbs) a year per adult to 2.5 kg (5.5 lbs) a year per adult in 1995.
The likelihood of dying after 65 of heart disease during 1990– 93 was below the highly industrialized country average at 235 (male) and 277 (female) per 1,000 people.