1. How different are the Swedish and Spanish
welfare states?
This report shows the differences between welfare states in Spain and Sweden with
regard to ideological basis and model, coverage offered to citizens and relative
public expenditure. This report briefly analyses the welfare system model that
applies to both countries, taking the typology designed by Gøsta Esping-Andersen
as a reference. The report also pays attention to two components of the welfare
state: the health care system and the expenditure on social benefits and its
effectiveness on reducing at-risk poverty, as an appropriate measure to assess
performance of both welfare systems.
Key words
Welfare state – public expenditure – Spain – Sweden – welfare system model – social
benefits – health care system
Carlos Palomo Lario1
carlosp.l.91@gmail.com
www.linkedin.com/in/carlospalomolario
E-magazine: www.scoop.it/t/welfare-states-spain-aand-sweden
This report has been prepared for

2. HOW DIFFERENT ARE THE SWEDISH AND SPANISH WELFARE STATES? By Carlos Palomo
This article will be useful for the client because it offers an overview of the welfare system in
Spain and Sweden that enables to know some of the most important features of both cases,
particularly in the area of social benefits, where important data on public expenditure are
provided. Moreover, data on the effectiveness of social transfers at reducing at-risk poverty,
which can be considered one of the most accurate measures to assess the quality of a welfare
state, are included. In addition, the client can also find qualitative information referred to
which model of welfare regime each country corresponds to and referred to the health care
system of both countries. In brief, this article tries to offer a short but comprehensive
introduction to some of the most important elements that comprise any welfare state.
Ideological basis and welfare system model
According to Gøsta Esping Andersen’s (1993 citated in Pérez Nieto, 2005: 22) classic
typologies of welfare state, the Swedish one belongs to the «social democratic» or
«Scandinavian» model. The underlying aim of this model is to build a universal network of
services with regard to citizenship (universal coverage by the public system), with standards
tending to optimum quality rather than minimum and trying to avoid state-markets conflicts
and tensions between social classes. The focus is on providing high-quality public
equalitarian services to every person, within a supportive and redistributive system.
Moreover, the Swedish welfare state shows commitment to sustained full employment for
men and women (Esping-Andersen, 1993: 285). However, the idea of the Swedish state as
universal provider can be challenged due to reforms in the last two decades.
Spain was not included in Esping-Andersen’s original typologies, but in the mid-90s scholars
started to pay more attention to it and considered this country as part of a new model: the
Mediterranean welfare state. Countries belonging to this model are considered an
underdeveloped form of the conservative-corporatist model, whose aim is at reducing social
differences up to an acceptable minimum but not trying to eliminate them (Pérez Nieto, 2005:
22). Spain has a model that combines universal services (education and health care) with
social insurance-based services together with a great importance given to the family as
services provider as a result of the believe that they are self-sufficient to take care of their
members (Moreno and Bruquetas, 2011: 26-27) and as result of the underfunding of social
services.
Health care
The Swedish health care system has a «cradle to grave approach» (Hort, 2008: 435): health
attention covers children before they are born and old people until their death. For mothers or
future mothers, the public system offers sexual health guidance, prevention centres, parental
education and regular check-ups of expectant mothers. All these services are free of charge
during the whole pregnancy (Hort, 2008: 435). For children and youngsters up to twenty years
old, full public medical attention is provided at no direct cost. Every adult has the right of free
dentist and general practitioner choice, notwithstanding the limited choice in sparsely
populated areas. For adults, the system is also heavily subsidised with public funds. However,
they have to pay a fee to use all services. Managed by the county councils with a high degree
of independence, hospitals have among them a competition-cooperation relation. Together
with the public system, there are also publicly subsidised private practitioners (Hort, 2008:
436). Swedish citizens, EU citizens and people from countries with agreements with Sweden
are entitled to use the Swedish public health care system.
In the case of Spain, universal health care is paid with funds taken from taxes and no direct
co-payment is required for users except for medicines, prostheses and other services, but the
general idea is that health care is free. The coverage used to be almost universal for residents
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3. HOW DIFFERENT ARE THE SWEDISH AND SPANISH WELFARE STATES? By Carlos Palomo
in Spain in equal conditions, but recent reforms have limited this situation. Since the 90s and
mainly in the 2000s, private management has increased in public services and
«mercantilisation» has grown due to the withdrawal of medicines from the public health
system. Both strategies were aimed at reducing the high structural deficit of the health care
system (Villota Gil-Escoin and Vázquez, 2008: 176). These strategies have also been
implemented «to balance the universal right to health with the economic interests of the
private sector» (Villota Gil-Escoin and Vázquez, 2008: 178).
In the EU15 context, Spain and Sweden are in the ends when talking about copayment in
health care public services. In Spain, there is copayment mainly in medicines, whereas
general practice, consultancy attention, hospital attention and emergencies are free of direct
charge: they are paid through taxes. On the opposite, Sweden has the copayment system in all
the health care services, regardless of the voluntary decision of the patient to use the services
(general practice, emergencies, and medicines) or not (hospital attention and consultancy
attention). So, Swedish system aims at collecting money and discouraging potential patients
to use health services, whereas the Spanish one offers an open and almost free attention
(Cirera, Mas and Viñolas, 2011).
If we look at total expenditure on health care as percentage of GDP (OCDE, 2012), Spain
expended an average of 8.9% of its GDP in health care between 2004 and 2010, whereas
Sweden expended an average of 9.3 %. There is a slight difference, but the underlying trend is
much more interesting, as in 2004 Spain expended 8.2% and Sweden 9.1% of their respective
GDP in health. Six years later, in 2010, both countries expended the same: 9.6 % of their
GDP. Therefore, Spain has made a bigger effort to equalise expenditure on health. However,
with regard to the percentage of public expenditure over total expenditure on health
(OCDE, 2012), between 2004 and 2010 the average of the analysed years is 72.4 % in the
case of Spain, whereas the Swedish one is higher: 81.3 %. These percentages of public
expenditure are translated into an average public per capita expenditure between 2004 and
2010 (OCDE, 2012) of US$ 1,952.6 expressed in purchasing power parity (PPP) in the case
of Spain and US$ PPP 2,748.8 in the case of Sweden. Figures are clear: Sweden invested in
public health care roughly US$ PPP 800 per person on average more than Spain in the
analysed years.
Social benefits
Spain expended an average of 21.82 % of its GDP on social protection (Eurostat, 2012)
between 2005 and 2009 and Sweden expended an average percentage of 30.43 in the same
1
years. If we look at which functions expenditure on social benefits is dedicated to
(Eurostat, 2012), we see that Spain, between 2005 and 2009, expended an average of 7.4% in
disability whereas Sweden expended more than double: 14.9%. In both cases, respective
expenditure is roughly constant in all the years. In old age, Spain expended in the same years
an average of 32.2% of social benefits, whereas Sweden expended an average of 38.7% of
social benefits. The percentage of social benefits dedicated to families and children between
2005 and 2009 ranged between an average of 6.1% in Spain to an average of 10% in Sweden.
This small difference must be highlighted, as Sweden is considered a much more family-
supportive country. With regard to housing, Spain invested an average of 0.86% of social
benefits; Sweden invested an average of 1.6%, two times more than Spain. In social
1
Social benefits consist of transfers, in cash or in kind, by social protection schemes to households and
individuals to relieve them of the burden of a defined set of risks or needs. The functions (or risks) are:
sickness/healthcare, disability, old age, survivors, family/children, unemployment, housing, social exclusion not
elsewhere classified (n.e.c). Within social protection, apart from social benefits, administration costs and
miscellaneous expenditure by social protection schemes (payment of property income and other) are included.
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4. HOW DIFFERENT ARE THE SWEDISH AND SPANISH WELFARE STATES? By Carlos Palomo
exclusion, the Mediterranean country invested between 2005 and 2009 an average of 0.9% of
social benefits, whereas Sweden invested, on average, 2.1% of social benefits.
The average share of people at-risk poverty2 before social transfers between 2005 and
2011 was 25.45% in Spain and 27.8% in Sweden. As we can see, surprisingly, in Sweden the
share is bigger although the country is richer. However, the situation changes considerably
after social transfers, as they reduce poverty in Spain by 17.75% on average, which
represents an average of 20.1% of people below the threshold of poverty, whereas Sweden
reduces the share of people at-risk poverty by an average of 56.48%, which represents 12,1%
of its inhabitants under the poverty threshold, a great difference with the situation prior to
social transfers. To sum up, social transfers effectiveness is much higher in Sweden and,
therefore, more efficient. Although the Nordic country continues to be one of the countries in
the world with the lowest income inequality (the Gini coefficient is 0.24, lower than the rich
world average of 0.31), this indicator has increased over the last few years 3. With regard to
Spain, the Gini coefficient in the late 2000s was 0.3174.
Conclusions
Given the previous exposition, I conclude that the hypothesis is partly verified. The welfare
regime models are considered by scholars very different with regard to their ideological basis
and their focus on services to citizens. Hence, the hypothesis related to this aspect is verified.
When talking about health care, qualitative differences are not so easy to see in the presented
information. The only one I consider is clear enough to remark is the difference in co-
payment: access to attention is easier in Spain and, hence, better for users. However, there is
not sufficient information in this work to verify or refute the hypothesis. Further research is
necessary. Regarding public expenditure on health care, the situation is the opposite: I
consider that public expenditure is quite different in both countries in terms of percentage of
public expenditure and per capita public expenditure. So, the hypothesis related to this
concrete variable is verified.
Finally, data from expenditure on social benefits also show an important gap in the percentage
dedicated to this matter. However, it is not as big as initially expected. Moreover, there is a
greater difference in social transfer effectiveness in reducing at-risk poverty: Sweden is much
more effective. Therefore, with regard to this aspect, the hypothesis is clearly verified.
However, no qualitative differences related to coverage can be concluded.
Overall, it is important to note that, in order to have a more detailed picture of both welfare
systems, further research is necessary, and this work can be useful as a starting point for that
aim.
References
2
Eurostat describes this at-risk poverty rate as the share of persons with an equivalised disposable income below
the risk-of-poverty threshold, which is set at 60 % of the national median equivalised disposable income.
3
The new model, The Economist, October 13 th 2012 (online):
http://www.economist.com/node/21564412?fsrc=scn/tw_ec/the_new_model [check: 4th November 2012].
4
Income distribution-inequality, OECD (online): http://stats.oecd.org/Index.aspx?DataSetCode=INEQUALITY
[consultation: 24th November 2012].
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5. HOW DIFFERENT ARE THE SWEDISH AND SPANISH WELFARE STATES? By Carlos Palomo
Hort, S. (2009), «The Swedish welfare state: A model in constant flux» in The Handbook of
European Welfare States, eds. Klaus Schubert, Simon Hegelich and Ursula Bazant, London,
New York: Routledge
Villota Gil-Escoin. P. and Vázquez, S. (2009), «The welfare state in Spain: Unfinished
business» in The Handbook of European Welfare States, eds. Klaus Schubert, Simon
Hegelich and Ursula Bazant, London, New York: Routledge
Mas, N., Cirera, L. and Viñolas, G. (2011), «Los sistemas de copago en Europa, Estados
Unidos y Canadá: implicaciones para el caso español», Documento de Investigación DI-939,
Public-Private Research Center, IESE Business School, 1-22 (online):
th
http://www.iese.edu/research/pdfs/DI-0939.pdf [last check: 24 November 2012].
Pérez Nieto, E. (2005), «El estado del bienestar y las políticas públicas» in Análisis de
Políticas Públicas, ed. Margarita Pérez Sánchez, Granada: Editorial Universidad de Granada.
Moreno Fuentes, F. J. and Bruquetas Callejo, M. (2011), Inmigración y Estado de bienestar
en España, Barcelona: Obra Social “la Caixa”.
Esping-Andersen, G. (1993), Los tres mundos del Estado del bienestar, Valencia: Edicions
Alfons el Magnànim.
«Sweden: The new model», The Economist, 13th October 2012 (online):
http://www.economist.com/node/21564412?fsrc=scn/tw_ec/the_new_model [consultation: 4th
November 2012].
Eurostat [last check: 29th November 2012].
- Expenditure on social protection (% of the GDP) (online): http://ow.ly/fHdwX
- Social benefits by function (% of social benefits): http://ow.ly/fHdCL
- At-risk-poverty rate before social transfers by sex: http://alturl.com/vuqpf
- At-risk poverty rate after social transfers by sex: http://alturl.com/gju8p
OECD Health Data 2012 – Frequently Requested Data (online): http://ow.ly/fHf1H [last
check: 29th November 2012].
- Total expenditure on health, % gross domestic product.
- Public expenditure on health/capita, US$ purchasing power parity.
- Public expenditure on health, % total expenditure on health.
OECD, Income distribution-inequality, (online):
th
http://stats.oecd.org/Index.aspx?DataSetCode=INEQUALITY [last check: 24 November
2012].
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