La gestión sanitaria: orientaciones a futuro para el cambio organizativo, del control y la financiación

This paper offers a general view of changes in health care management in the Spanish Health System. We focus on the organisational, financing and accountability aspects of health care provision. We do this by encompassing managerial changes and social change and well-grounded in theory health economics literature. In this way we try to link applied economics and management issues, as we did in a former paper, ten years ago on the same basis (López-Casasnovas, 2002). We emphasise mistakes and milestones in the way forward to improve health systems by better understanding the public nature of health policies. Key aspects of this are to achieve a better allocation of responsibilities to providers on patients’ health, to incentive the organisation of medical self-managed health care institutions and to build global budgets on risk-adjusting capitation and better integrated health care providers on a community basis.