[Analysis of the origins, situation and future perspectives of the health care decentralization process in Spain].

The de-centralisation of health services in any country is a process that involves profound change. This is what has occurred in Spain, where the entities that have received authority for de-centralised services (Autonomous Communities) are regional and have assumed political as well as administrative responsibilities within, what could be defined as, a process of "devolution". Firstly, the reasons behind the Spanish process are analysed. The nature of the process enables it to be confirmed that it has been a result of causes non-related to the health sector, which has had to adapt to the global political change. A second feature is the coinciding of territorial distribution of authority and services with the possibility of further de-centralisation of a functional nature in the managing of health centres and services. The combination of both types of processes has enabled a large number of diversification possibilities for the Spanish Health System. This study refers, in quantitative terms, to the increase or decrease in differences between regions, the de-centralisation process and, therefore analyses certain general qualitative effects. Developing of ways to co-ordinate the health system, to be studied later, has been limited and further developments are necessary in this area. Finally, future prospects of a de-centralised Spanish health system are considered in relation to two principal issues: firstly, the level of difference amongst autonomous health services that is compatible with the ability to maintain health protection for all citizens throughout Spain and, as the case may be, establishing of the limits to guarantee such level; secondly, defining of the relations between autonomous health services in terms of cooperation of competition.