Int J Health Serv. 2014;44(1):25-51. doi: 10.2190/HS.44.1.c.
Spain has an advanced, integrated health care system that has achieved remarkable results, including substantially improved health outcomes, over a relatively short time. Measures introduced by central and regional governments to combat the financial crisis may be severely affecting the health sector, with proposed changes potentially threatening the principles of equity and social cohesion underlying the welfare state. This article examines recent developments in Spanish health care, focusing on the austerity measures introduced since 2010. In Spain, as in other countries, evaluation of health care changes is difficult due to the paucity of data and because the effects of measures often lag well behind their introduction, meaning the full effects of changes on access to care or health outcomes only become apparent years later. However, some effects are already clear. With exceptions, Spain has not used the crisis as an opportunity to increase efficiency and quality, rationalize and reorganize health services, increase productivity, and regain public trust. We argue that immediate health care cuts may not be the best long-term answer and suggest evidence-driven interventions that involve the portfolio of free services and the private sector, while ensuring that the most vulnerable are protected.
西班牙拥有先进、综合的医疗保健系统，在相对较短的时间内取得了显著的成果，包括大幅改善了健康状况。中央和地区政府为应对金融危机而采取的措施可能会严重影响卫生部门，拟议的改革可能会威胁到福利国家的公平和社会凝聚力原则。本文探讨了西班牙医疗保健的最新发展，重点关注 2010 年以来实施的紧缩措施。在西班牙，与其他国家一样，由于数据匮乏，以及措施的影响往往远远滞后于其实施，因此评估医疗保健的变化非常困难，这意味着对医疗保健的获得或健康结果的影响只有在几年后才会完全显现。然而，一些影响已经很明显。除了一些例外情况，西班牙并没有利用危机来提高效率和质量、合理化和重组卫生服务、提高生产力，并重新获得公众的信任。我们认为，立即削减医疗保健支出可能不是最好的长期解决方案，并建议采取循证干预措施，涉及免费服务组合和私营部门，同时确保保护最弱势群体。
