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New legislation transforms Spain’s health system from universal access to one based on employment

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3196 (Published 09 May 2012) Cite this as: BMJ 2012;344:e3196
  1. Aser García Rada
  1. 1Madrid

Spain’s public health service is to shift from one that provides universal coverage through general taxation to a system funded through social security contributions, after the conservative People’s Party government of Mariano Rajoy passed new legislation.

Although the new law represents a major change to the General Health Act that established Spain’s national health service in 1986, the legal mechanism chosen by the government was a royal decree, which does not require parliamentary debate.

The so called “royal decree on urgent measures to ensure the sustainability of the national health system and improve the quality and safety of its services” includes decisions previously taken by the Inter-territorial Council on 18 April and on 20 April by the cabinet.1 Among other things, these measures extended drug copayments and limited illegal immigrants’ access to healthcare.

However, the full extent of the changes being imposed on the …

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