Spain’s decentralized health care system: 25 years later

Carme Valls y Llobet, President of the Foundation Cataluna S. XXI, left, speaks about the challenges facing the decentralized Spanish health care system. To the right are Juan Maria Gavin, Professor at the University of Lerida, Juan Luis Beltran Aguirre, Professor of Administrative Law, and Juan Luis Rodriguez-Vigil Rubio, former Minister of Health for the Region of Asturias.

The Forum and three local partners in Spain recently held a one-day seminar titled Decentralization of Health Care in Federations: Recent Trends and Lessons from Spain.

The event was co-organized with the Manuel Gimenez Abad Foundation for the Study of Parliaments and Autonomous status, in collaboration with the Legislature of the Autonomous Community of Aragón, called the Cortes of Aragón.

In the past 20 years, Spain has delegated the responsibilities for managing many nationwide programs to its 17 regions, known as Autonomous Communities.

Following that a series of reforms were passed in 2002 granting the authority to all of Spain’s 17 Autonomous Communities to run their respective health care systems. Both the funding of the system, and the universal standard of care requirements, remain under the authority of the central government in Madrid.

Spain enacted its National Health System law in 1986, legislation that provided for the uniformity of health care throughout Spain. Further legislation was passed in 2003 and later in 2006 to further heighten cohesion and uniformity of Spain’s’ health care system.

Now, after almost 25 years of decentralization, seminar participants discussed the advantages of the decentralized system, analyzed its performance and debated what further changes should be made to it.

Participants said that decentralization has brought about many positive outcomes including increased efficiency of the system, a decrease in disparities in health care among the Autonomous Communities, and the system’s economic sustainability, which is weathering the economic crisis that has hit Spain hard.

Despite the improvements the system still faces challenges. For example, in 2002, the central government assigned the responsibility of statistics collection to the Autonomous Communities. This has left Spain without a central data source, making accurate performance comparisons impossible between regions. This has led to inefficiencies in the system.

Delegates were in general agreement that Madrid needs to take on a co-ordinating role to ensure equality of care throughout the country, and that waste and overlap are minimized. Others suggested the need to revise the system’s legal and fiscal framework and increase citizen participation.

Professor John Kincaid, of Pennsylvania’s Lafayette College, and Prof. François Vaillancourt of the Université de Montréal, presented on the experiences of Canada and the United States and discussed differences and similarities to the Spanish system. The spiraling cost of national healthcare is a significant and common concern in all the three countries.

The one-day seminar was held in Zaragoza, Spain on June 18, 2010.

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