Social and political actors in the formulation of health reform in Spain

Abstract

An analysis of the participation of social and political actors in the process of formulating health policy allows one to understand the specific characteristics of the organization and operation of a health system. This study analyzes the drafting process for the General Health Act (LGS) in Spain with the purpose of establishing the relationship between social, political, and economic actors in both the formulation of the Act itself and the organization of the Spanish Health System. A case study was carried out from 1982 through 1986. Documentary parliamentary data, the medical press, national magazines and journals, and press reports by political, social, and public health actors were analyzed. The first version of the General Health Act presented by the Spanish Socialist Workers' Party (PSOE) proposed a health system with funding and public administration aimed at achieving universal health coverage, integrated care, community participation, and health education. This proposal was submitted to a complex negotiating process with business groups, unions, and health professionals. The General Health Act as finally approved excludes the principles of equity and incorporates private interests in health: "free choice of doctor and hospital", public funding and private administration of the health system, and the establishment of Social Security as the core of the entire health system.