Abstract

LOPEZ-CASASNOVAS, G.  and  RICO, A.. Decentralization: part of the health system problem or the solution?. Gac Sanit [online]. 2003, vol.17, n.4, pp.319-326. ISSN 0213-9111.

The greatest change experienced by the Spanish health system in the last two decades has probably been the devolution of power to the autonomous communities composing the Spanish state. This may generate tensions in the status quo and poses questions of whether decentralization of the health system is compatible with a cohesive national health system and whether this devolution of power is part of the problem of the health system or part of its solution. Generalized devolution occurring as rapidly as that produced in Spain (negotiated in slightly less than 6 months, with minimal financial agreements, without explicit legal frameworks in the areas of coordination and development of basic norms, and with a new agreement of general financing of the autonomous communities which possibly contains lacunae, etc.) presents an uncertain panorama. The possible misuse of the wide powers recently transferred to the autonomous communities could easily be used by those who would like to see a restoration of pre-democratic centralism to sow fear of the collapse of the health service as the cornerstone of the welfare state among the general public. The present article briefly addresses these questions.

Keywords : Health care decentralization; Geographical equity; Health system efficiency; Political accountability; Horizontal and vertical coordination; Spain.

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