Endemic deficiencies in the territorial decentralization of the right to health care in spain and proposals for improvement

Abstract

The health crisis generated by the pandemic has exposed structural problems in our model of care for citizens. The current scenario is that of a multiplicity of autonomous health services that are susceptible to territorial differences in terms of health benefits. Our Constitution covers the territorial disparity manifested in a greater or lesser supply of health benefits covered by the public system, But it is in the concretion of the boundaries that the work of the State in drafting basic legislation and coordinating the system as a whole takes on particular importance. Health policy must be aimed at overcoming social and territorial imbalances, which requires an intense effort to implement effective coordination and cohesion mechanisms. The coordination mechanisms provided for by law have always suffered from serious shortcomings and the objective of overcoming territorial and social imbalances has not been met. The health benefits for which territorial inequalities are most evident are waiting lists; primary and specialized care; provision of high-tech medical-ATM equipment; geriatric provision; and provision of psychiatry. The proposals for improvement proposed in this study are: To strengthen the Interterritorial Council of the National Health System and to rethink its functions; to strengthen the reference services; to protect both the Health Cohesion Fund and the Health Care Guarantee Fund with adequate amounts in budget; and to move forward in the construction of the notion of “collective health interest” national, community and international, based on preventive and not only remedial policies.