Spain: Quo Vadis? From Cost Containment to Structural Reforms

Abstract

The aim of this chapter is to critically describe the evolution of the Spanish National Health System (NHS) in the last 25 years and its current situation. We will also revise the main reforms which are currently under debate. During these years, even with its ups and downs, the NHS has become a cornerstone of the Spanish welfare state. Mostly financed through taxes and with the predominance of public provision, the system has been able to incorporate the latest medical advances, offering quality health services almost universally. At the same time, in an ad hoc and rather hasty manner, the system has gone through a decentralization process that started with the devolution of health competences to the so-called historical regions, and was finally extended in 2002 to the 17 Spanish Autonomous Communities (ACs). These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.