Dr. Josep Figueras:

It is the mix of staffing. Nurses play a very important role, for example, they do some prescribing. In my case, which was 20 years ago, I would share the prescribing duties with my nurse, although the practice is not totally approved. At that point, one had to be very cautious about legal issues. However, for chronic care and so on, this approach worked very well. Nurses also do prevention tasks, some screening tasks and so forth. There is also a good integration of services with the hospital level and so on. These are some of the reasons for the findings on primary care in Spain.

Another feature of the Spanish system is that Spain has adopted soft purchasing as opposed to hard purchasing, the approach taken in Britain which provides hard incentives and encourages provider competition. While strategic purchasing takes place in Spain, the country is associated with soft purchasing, agreements, contracts and transparency. I am reminded of the question on transparency and where the money goes. In any case, this approach could explain the strong good will shown towards public health.

Spain has a long coastline and grows large amounts of vegetables and fruit, which also helps. We also drink appropriate amounts of wine, rather than hard alcohol.