performing a mammogram. the image is from the united states. health care centers, principally hospitals and specialty centers, have high technology capabilities used primarily to perform better patient diagnoses. the following breakdown of such facilities is based on the 2008 national catalog of hospitals. high technology equipment type of equipment total rate per million inhabitants x-ray computed tomography (ctc)65414.4 magnetic resonance imaging (mri)4179.2 gamma camera (gam)2325.1 hemodynamics (hem) facility2204.9 single photon emission computed tomography (spect)461.0 digital subtraction angiography (dsa)1944.3 extracorporeal shock wave lithotripsy (eswl)912.0 radiation therapy with cobalt400.9 medical linear particle accelerator (linac)1603.5 positron emission tomography (pet)320.7 mammography48110.6 bone densitometry1653.6 hemodialysis equipment3,22571.2 services article 7 of the law of cohesion establishes the catalog of services of the national health system, with the object of guaranteeing the basic and common conditions for an adequate level of integrated, continuous health care. health care services include prevention, diagnosis, therapy and rehabilitation, as well as promotion and maintenance of citizens' health. article 11 of the law establishes the basic lines of public health services: 1. the public health service is the ensemble of initiatives organized by public administrations to preserve, protect and promote the health of the population. it is a combination of sciences, capabilities and attitudes directed to the maintenance and improvement of the health of all persons through collective and social acts. 2. the services in this ambit include the following activities: epidemiological information and vigilance. protection of health. promotion of health. vigilance and control of possible health risks derived from the importation, exportation and transit of merchandise and of international travel. promotion and protection of environmental safety. promotion and protection of health on the job. 3. public health services are to be exercised with an integral character, from public health structures to administrations and the infrastructure of primary care of the national health system. primary care services primary care services constitute the majority of the services of the sns; this is true of health promotion and education, prevention of illness, hands-on health care, health maintenance, recuperation, rehabilitation, and social work. the following catalog demonstrates preventive activities, health promotion and education, family care and community care as performed in primary care centers. inculcate healthy life habits in adolescents with respect to the use of tobacco, alcohol and recreational drugs as well as harmful eating disorders and healthy conduct with respect to sexuality. orientation of women during pregnancy and birth, early diagnosis of gynecological cancers and breast cancer, detection and care of problems related to menopause. family planning. pediatrics, including infant and child health care, nutrition, general counsel on child development, health education and childhood accidents. vaccinations. care for adults in risk groups or with chronic conditions. counsel on healthy life styles and detection of health problems. geriatrics: promotion of health and prevention of illness. homecare for the housebound. detection of violence against women and domestic abuse, as well as child abuse, elder abuse, and abuse of disabled people. dentistry: care, diagnosis and therapy, health promotion and education, and illness prevention related to the teeth and mouth. care of terminal patient: integral, individual and continual care either in the home or at a health center. mental health care: prevention and promotion to maintain mental health, in coordination with specialists. specialized care laparoscopy is a specialized diagnostic tool. here, a colangiography image done during a laparoscopic cholecystectomy. at times, patients will require specialized health care services. these may be provided in external consultations, day hospitals, or on an inpatient basis. examples of specialized services are intensive and critical care, anesthesia, defibrillation, but also some forms of hemotherapy, rehabilitation, and even nutrition, diet, post-partum treatment, and family planning, especially assisted reproductive technology. specialized treatment can also be involved in detection, prescription and implementation of diagnostic and therapeutic procedures, especially those related to prenatal diagnosis in risk groups, diagnosis by imaging, interventionist radiology, hemodynamics, nuclear medicine, neurophysiology, endoscopy, lab tests, biopsies, radiotherapy, radiosurgery, renal lithotripsy, dialysis, techniques of respiratory therapy, organ transplants and other tissue and cell transplants. urgent care emergency room of the virgen del rocío hospital, seville. emergency medicine is health care provided in cases where emergency care is needed. emergency medicine is practiced both in healthcare facilities and at the site of work accidents, traffic accidents, etc. or in the home of a patient whose condition prevents them from getting to a healthcare facility. emergency medicine is a 24-hour-a-day service provided, in particular, by physicians and other medical professionals in hospital emergency rooms, but also in ambulances, medical evacuation helicopters, etc. en route to such facilities. pharmaceutical services medications in spain are regulated under law 29/2006 of 26 july, of guarantees and rational use of medications and health care products (ley 29/2006, de 26 de julio, de garantías y uso racional de los medicamentos y productos sanitarios). one of the sns's priorities with respect to pharmaceuticals is to teach patients to make rational use of medications and to avoid, insofar as possible, unsupervised self-medication. pharmaceutical services include medications and health products are provided to patients according to their clinical needs, in precise doses and over an adequate period at the least cost possible. medications are dispensed by pharmacies, each of which is headed by a licensed pharmacist. all medications to be prescribed to patients must either be authorized and registered by the spanish agency of medicines and medical devices (agencia española de medicamentos y productos sanitarios), or must be formulations prepared by licensed pharmacists. exceptions to this requirement are cosmetics, dietetic products, dental products and other sanitary products, as well as drugs classified as advertising, homeopathic medicines, and articles and accessories advertised to the general public and where the purchaser pays the full price (that is, no money comes from sns-related sources). runner oscar pistorius, with his orthopedic leg. spanish patients make a copayment when they acquire pharmaceuticals. the distribution of the cost is as follows: medications dispensed as part of hospitalization are free to the patient. other prescriptions are financed as follows most pensioners and their beneficiaries receive their medicines for free. pensioners who were public functionaries and are protected by muface (mutualidad general de funcionarios civiles del estado) pay 30 percent of prescription cost. non-pensioners pay 40 percent of the price of prescription drugs. active functionaries protected by muface pay 30 percent. communities affected by toxic oil syndrome and patients with aids receive their prescriptions for free. individuals with toxic treatments pay 10 percent, up to a maximum of 2.64 euros per prescription. orthoprosthetic and complementary services orthoprosthetic services can be permanent surgically implanted prostheses, external prostheses, special orthoses and prostheses including hearing aids and earmolds for children up to age 16 with bilateral hearing impairments. "complementary services" include complex dietary therapies, vehicles for invalids, and home oxygen therapy. health care transport dya ambulances in the basque country. the health care transport infrastructure transports people who are ill, accident victims, or otherwise in need of medical attention. it includes ambulances, as well as air ambulances: helicopters and airplanes whose interiors are specially modified for the purpose. for most purposes, of course, ground transport is preferred, but sometimes distances or the difficulty of reaching particular locations make air transport more practical. demographics of spain population pyramid 2008 % males age females % 0.62 85+ 1.40 0.99 80–84 1.57 1.57 75–79 2.16 1.92 70–74 2.31 1.90 65–69 2.10 2.48 60–64 2.65 2.69 55–59 2.62 3.09 50–54 3.12 3.65 45–49 3.60 4.11 40–44 3.96 4.38 35–39 4.09 4.65 30–34 4.30 4.15 25–29 3.89 3.15 20–24 3.00 2.62 15–19 2.47 2.37 10–14 2.25 2.43 5–9 2.29 2.61 0–4 2.45 according to data from the national institute of statistics (instituto nacional de estadística, ine), as of january 1, 2018, spain has a population of 46,659,302, of whom 22,882,286 (49,04%) are male and 23,777,015 (50.96%) female. in recent years, this population has been increasing slowly but progressively. in the last decade, the increase has been largely through immigration: 4,572,055 spanish residents are foreigners. these numbers count only citizens and legal immigrants. the health care system must also provide services for thousands of illegal immigrants and for the many tourists who visit spain each year. population pyramid analysis of the population pyramid shows that 20 percent of the total population is under 20 years of age. 24 percent of the total population is 20 to 40 years of age. 31 percent of the total population is 40 to 60 years of age. 25 percent of the total population is at least 60 years old. this structure is typical of a modern demographic regimen, with an evolution toward an aging population and a declining birth rate. this means that spain has to expect an increase in use of the services that are targeted at older adults. this effect is further exacerbated by a steadily increasing life expectancy. demographic evolution of spain 1920–2018 graphic from the spanish-language wikipedia, based on data from the ine