Intended for healthcare professionals

Education And Debate

Devolving health services to Spain's autonomous regions

BMJ 1999; 318 doi: (Published 01 May 1999) Cite this as: BMJ 1999;318:1204
  1. Diego Reverte-Cejudo, head of internal medicine service (,
  2. Marciano Sánchez-Bayle, paediatric nephrologistb
  1. aHospital General de Segovia, E-40002 Segovia, Spain
  2. bHospital del Niño Jesús, E-28009 Madrid, Spain
  1. Correspondence to: Dr Reverte-Cejudo

    Editorials by Leys and Diderichsen

    The 1978 Spanish constitution laid down the rights of all Spaniards to health and to health care. It also established regional governments and a process of profound political decentralisation. Seventeen autonomous regions were formed, with sizes ranging from 5045 km2 in La Rioja to 87 500 km2 in Andalusia, populations ranging from 263 644 in La Rioja to 7 238 459 in Andalusia (1998 census figures), and population density ranging from 21.6/km2in Castille-La Mancha to 634 200/km2 in Madrid. Each region has its own cultural, socioeconomic, and historical identity and some regions (Catalonia, the Basque country, and Galicia) have their own languages.

    Devolution has been more rapid in some regions than others

    Summary points

    In 1981, Spain began a process of decentralisation of the management of health services to its 17 autonomous regions; by 1995 seven autonomous regions (covering 62% of the population) had taken over health care provision

    Although devolution may bring control of health services closer to the people who use them, it can lead to differing health policies between regions

    Methods used to allocate resources for health services have not yet improved, so inequalities in resource allocation between regions continue

    Devolution can also lead to an increase in bureaucracy, …

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