Towards a National Health Service in Spain: the Search for Equity and Efficiency

Abstract

All Southern European countries have enacted reform laws during the last decade with the in tention of turning their traditional social- security health-care systems into national health services. Spain was no exception to this reform thrust and the General Health Law of 1986 brought about a significant institutional change. The purpose of this article is twofold. First, it assesses the decision-making process that led to the approval of the 1986 reform law by contemplating the roles played by the main social and political actors. Moreover, the influence of policy legacies and the impact of regime change are considered. Second, the article evaluates the implementation process of the reform law as regards the coverage criteria and span, the financial sources and the services provided. The analysis of these indicators leads to the conclusion that the health-care system in Spain has been transformed into a national health service, although some minor characteristics of the previous model persist.