Resumo

BELENES, R.. A personal balance of 25 years modern health care management in the Spanish Public Health System. Gac Sanit [online]. 2003, vol.17, n.2, pp.150-156. ISSN 0213-9111.

At the beginning of 2002, the transference of authority over public health care services from the Spanish national health System (INSALUD) to all the autonomous communities hitherto lacking this authority closed a period of modern halthcare management in Spain which, nevertheless, had lacked tye dynamism and innovative capacity of business management. Despite this, during these 25 years, Spanish healthcare management underwent a spectacular growth. The problems of the Spanish public health system are either linked to the inherent problems of a system of universal coverage, with generous provisions and clear underfinancing, or they are characteristic of an obsolete organizational model in which centers and healthcare professionals lack autonomy, or they are related to users' increased expectations and to the enormous complexity of the medicine of the future. All these questions should be approached from the perspective of a new form of management appropriate to the new century. Despite is serious defects and problems, the public values the Spanish public health system; the main risk is chronic and progressive desligitimization wich causes users to loese faith and trust in the public health system.

Palavras-chave : National Health System; Healthcare management; Healthcare policy; Managers; Healtcare reforms.

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