Spain decentralises its healthcare systemBMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7329.68/c (Published 12 January 2002) Cite this as: BMJ 2002;324:68
Spain's state health service became a totally decentralised system at the beginning of this year after the Cabinet approved in December two royal decrees to allow the transfer of health services from central government to the country's regions.
Ten of the 17 regional communities (also called autonomous communities) making up the geographic and political map of Spain will now manage their own public health services. The other seven—Catalonia, the Basque country, Valencia, Galicia, Andalucia, Navarra, and the Canary Islands—have received certain powers over their own health services during the past 15 years.
The definitive transfer of health services to the 10 communities means the effective end of Insalud—the health ministry based body responsible for running public health services in regions such as Madrid, Castilla, Murcia, Cantabria, and Aragón.
Insalud has now transferred 82 public hospitals, 35<thin>734 hospital beds, and 139<thin>564 public employees to regional control. Overall, £6.4bn ($9.2bn; €10.2bn) have been transferred, in what constitutes the highest cash transfer from the central government since the State of the Autonomous Communities was set up in Spain.
Madrid autonomous community will manage 24 public hospitals and over 61<thin>000 employees (£2.3bn). But the regionalisation of the health system will not lead to the health ministry losing total control over it.
In fact, the ministry is to deliver to parliament next month a new “law of coordination of the state health service” aimed at ensuring equal health care for all Spaniards.
After emphasising that “nothing related to health care will change” with the transfer, the health minister, Celia Villalobos, recalled that both the Spanish Constitution and the 1986 General Health Law provide the government with tutelage responsibilities on health care “to make effective the right that all Spaniards have to health.”
An important feature of the future coordination law will be the implementation of a standardised model of “health card” for the state health service, which will be linked to a unique model of medical record, with the aim of easing health care anywhere in the country. To develop the technological processes necessary to launch this initiative, the health ministry has arranged a deal with the science and technology ministry.
The ministry will retain responsibility for research issues, inspection, and the legalisation and approval of new drugs.
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