Social Security

The Autonomous Communities (AC), within the scope of their powers, will be able to approve their respective portfolios of services, which at the very least will include the portfolio of common services of the SNS (which must be guaranteed to all SNS users).

The AC may include, in their portfolios of services, techniques, technologies or procedures that are not included in the portfolio of common services of the SNS. In order to do this they must provide the necessary additional resources. Under no circumstances will these additional services be included in the general funding of SNS benefits.

Public Health

The public health benefit is a set of initiatives organised by the government to preserve, protect and promote the health of the public. It is a combination of sciences, skills and activities aimed at maintaining and improving the health of all people through collective or social action.

Public health benefits are provided entirely through the public health structures of civil service departments and the SNS primary care infrastructure.

The portfolio of services, aimed at designing and implementing health policies and citizens directly, includes:

• epidemiological surveillance and information.
• Health protection: design and implementation of health and exercise policies of the health care authority.
• Promotion of health and prevention of diseases and defects.
• Protection and promotion of environmental health.
• Promotion of food security.
• Surveillance and control of potential health risks arising from the import, export or shipment of goods and international travel, by the competent health authority.
• Protection and promotion of occupational health.

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Primary Health Care

Primary care is the initial and basic level of care, which guarantees the comprehensive nature and continuity of care throughout a patient's life, acting as a case manager and coordinator and a flow regulator. It shall include health promotion, health education, disease prevention, health care, maintenance and recovery, as well as physical rehabilitation and social work.

Primary care, which includes tackling health problems, risk factors and risk behaviour, includes the following services:

• On demand, planned and emergency health care, both through consultations and at the patient's home.
• Recommendation, prescription and implementation, as applicable, of diagnostic and therapeutic procedures.
• Prevention, health promotion, family support and community care activities.
• Health protection monitoring and information activities.
• Basic rehabilitation.
• Specific support and services for women, children, teenagers, adults, the elderly, risk groups and the chronically ill.
• Palliative care for the terminally ill.
• Mental health care in coordination with specialist care services.
• Dental and oral health care.

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Specialised Care

Specialist care includes support, diagnosis, therapy, rehabilitation and care, as well as health promotion, health education and disease prevention, the nature of which means that implementation at this level is advisable. Specialist care guarantees continuity in a patient's overall care, once the possibilities of primary care have been exhausted and until the patient is able to return to said level.

Specialist care is provided through external consultations and day care hospitals, as long as the condition of the patient so permits.

• Specialist care through consultations.
• Specialist care provided through day care, medical and surgical hospitals.
• Admission into hospital.
• Primary health care support for early hospital discharge and, where appropriate, home hospitalisation.
• Recommendation, prescription and implementation, as applicable, of diagnostic and therapeutic procedures.
• Mental health care.
• Rehabilitation of patients with recoverable functional deficit.

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Emergency Care

Emergency care is the care provided to a patient in cases where their medical condition is such that it requires immediate medical attention. It will be dispensed both at health centres and other locations, including the patient's home address and on-site, 24 hours-a-day, by means of medical attention and nursing care, in collaboration with other professionals.

The portfolio of common services for the provision of emergency care includes:

• The provision of telephone support through emergency care coordination centres. This includes medical control of the demand for care by assigning the most appropriate response to each medical emergency (information, guidance or health advice).
• The initial and immediate assessment of patients to determine the risks to their health and life and, where necessary, classifying these patients to prioritise the medical attention they require. The assessment can be completed by directing patients to a health centre, where necessary, to conduct the examinations and diagnostic procedures required to determine the nature and scope of the process and decide the immediate actions to be implemented in order to deal with the emergency situation.
• The conducting of the diagnostic procedures and medical-surgical therapeutic procedures required to appropriately deal with each emergency situation.
• The monitoring, observation and reassessment of patients, when their condition so requires.
• The provision of land, air and maritime health transport, with or without on-board medical care, according to the medical requirements of patients, in the cases in which it is required to suitably transfer them to the health centre that is best able to deal with the emergency situation.
• The provision of information and advice to patients or, where applicable, their support person, on the care provided and the subsequent aftercare measures to be adopted, in accordance with current legislation.
• Once the emergency situation has been dealt with, the discharge or placement of patients at the most appropriate level of medical care and, when the seriousness of the situation so requires, their admission to hospital, with the necessary medical reports to guarantee the continuity of care.
• The reporting of situations that need to be reported to the competent authorities, especially in cases of suspected gender-based violence or abuse of children, the elderly and people with disabilities.
  

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Pharmaceutical Benefits

They apply to all types of medicine, with certain legal exceptions, basically related to perfumes or medical dietetics, and they are dispensed:

• Free of charge for treatments received at Social Security healthcare facilities, those dispensed to Social Security pensioners and to workers temporarily disabled due to common disease and non-work-related injury.
  
  
• The contribution is 10% of the retail sale price, up to a maximum of ?2.64 in certain cases.
  
  
• In the contributory scheme for the rest of the beneficiaries, with a share equal to 40% of the retail sale price.

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Orthotics and Prosthetics Benefit

The orthotics and prosthetics benefit consists of the use of implantable and non-implantable medical devices, with the aim of totally or partially replacing a body part, or modifying, correcting or aiding its function. It shall include the elements required to improve a patient's quality of life and autonomy.

This benefit will be provided by the |SPS or give rise to financial grants, as applicable, in accordance with the regulations set forth by the competent health authorities.

The orthotics and prosthetics benefit includes surgical implants, external prosthetics, wheelchairs, orthotics and special orthotics and prosthetics.

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Dietary Supplements

The dietary supplements benefit includes the dispensing of dietary-therapeutic treatments to persons suffering from certain congenital metabolic disorders and home enteral nutrition for patients who, as a result of their medical condition, are not able to meet their nutritional requirements with normal food consumption.

This benefit will be provided by the health services or will give rise to financial grants, as applicable, in accordance with current regulations.

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Health Transport

Health transport, which must be accessible to people with disabilities, consists of the transfer of patients for exclusively medical reasons when their condition prevents them from being transferred via ordinary means of transport. This benefit will be provided in accordance with the rules set forth in regulations by the competent health authorities.

The portfolio of common services for health transport includes transport without on-board medical care, which is designed for the special transportation of patients or victims of accidents that require technical health care en route.


Transfer of patients between Autonomous Communities

When an Autonomous Community decides to transfer a patient to another Autonomous Community in order to provide them with medical care that they are not able to provide with their own resources, the patient will be provided with the appropriate health transport, both for their transfer to the health centre and for their journey home, if the reasons for needing this benefit persist. When air or maritime transport is being used, the Autonomous Community receiving the patient will be responsible for the transfer of the patient from the airport, heliport or port to the health centre, as well as their return to the airport, heliport or port if the reasons for needing the health transport persist.

When patients are receiving periodic treatment, such as dialysis or rehabilitation, and they are transferred to another Autonomous Community for a certain length of time, it is this Autonomous Community which, by applying the criteria used to authorise the use of health transport in their region, is responsible for providing the benefit to receive this treatment to patients (who require this treatment for strictly medical reasons).

When a patient who has been temporarily transferred to another Autonomous Community has received emergency medical care, the Autonomous Community where the patient came from is responsible for the health transport (that they require for strictly medical reasons) to transfer them back to this Autonomous Community, either to their home address or another health centre.

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Health Information and Documentation Services

Persons who receive benefits from the portfolio of common services, shall be entitled to information and documentation on health care and support, in accordance with Law 41/2002 of 14 November, regulating Patient Autonomy and Rights and Obligations regarding Clinical Documentation and Information, and Organic Law 15/1999, of 13 December, on Personal Data Protection.

Users of SNS will also be entitled to:

• Information and, where appropriate, paperwork on the administrative procedures required to guarantee continuity of health care.

• The issuing of sick leave, sick leave confirmation and medical discharge certificates, as well as any other reports and documents required for the assessment of disability or other purposes.

• Documentation or medical certification of birth, death and other cases for the Civil Registry.

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Work-related injuries and occupational diseases

In the event of occupational contingencies, maximum health benefits will be provided and they will have the same content as those arising from non-occupational contingencies and, alsoart.  11 Decree 2766/1967, of 16 November):

• Supply and renewal of the necessary prosthetic and orthopaedic devices and vehicles for disabled persons.
• Appropriate repair and plastic surgery, when after the wounds arising from work-related injuries have healed there are deformities or mutilations that have caused a significant alteration in the physical appearance of the injured party or hinder their functional recovery for their previous job.
• During the health care period and as a part of this health care, the necessary rehabilitation should be carried out to achieve a more complete recovery in the shortest possible time or to achieve an improved capacity to carry out their job.
• This treatment may also be performed after medical discharge with or without sequelae, and as long as it enables a more complete recovery of their capacity to work in relation to the relevant Social Services.
• Pharmaceutical benefits are provided free of charge.
• Supply companies with first aid kits to provide first aid materials in the event of work-related injuries, as long as they are responsible for providing their workers with protection for occupational contingencies.

When occupational contingencies are covered by the INSS , this Institute must pay the Public Health Services of the Autonomous Communities for the health care, pharmaceutical and recovery benefits arising from occupational contingencies suffered by affiliates with coverage for said contingencies at this Managing Body (59th Additional Provision of Law 30/2005, of December 29, of the 2006 General State Budget, implemented by TAS  Order 131/2006, of 26 January).