The Health Care Counter-Reform in Spain

Abstract

I 1 5 The Spanish Health Care System's present configuration had its origin in the I986 General Health Act, when the socialist government then in power put in place the National Health System, whose major characteristics are: public funding; free access (except for a small sum in pharmaceutical expenses for the non-retired); unification of the pre-existing health networks; an autonomous organisation of health care resources (each Autonomous Community or Region should run its own Regional Health Service, with great powers of management, planning and even legislation); prevention and promotion defined as major factors in the System's function; and the development of Primary Health Care as its basic element. Although the System's evolution was not as good as it should have been, important advances were made, and quality of care was in general achieved with modest expenditure (the smallest in dollars per capita in the E.U. after Portugal and Greece). The program was widely approved by the population. Nevertheless, some important items remained untouched, such as hospital reforms, hospital coordination with Primary Health Care, and, above all, the implementation of effective mechanisms for community and professional participation. The Popular Party government designed on the contrary a different policy, following in the footsteps of the conservatives in the U.K. This policy, in the best Thatcher style, was set out in a document named "Agreement for the Improvement and Consolidation of the NHS," passed against the parliamentary opposition of the left, and aiming to