Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

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196 Special Solidarity Fund KCE Reports 133 9.16.1.2 Interviews • Telephone interview Dr. Javier Bautista Paloma, Chief Farmacian Hospital Universitario Virgen del Rocio, Sevilla. • Telephone interview Sra Estrella Guerrero Solana, FEDER (Federación Española de Enfermedades Raras - Spanish Federation for Rare Diseases) Avda. San Francisco Javier, 9 Pl. 10 M.24 (41018) Sevilla and mail from D. Moisés Abascal, vicepresidente FEDER. • Telephone interview Sr.Ester Tallon, Agencia Española de Medicamentos y Productos Sanitarios. • Telephone interview Sra Sandra Flores, Agencia de Evaluación y Technologia Sanitaria. • Telephone interview and mail Ministerio de Sanidad y Consumo, Madrid, Mª Dolores Vaquero García; Subdirectora general de calidad de Medicamentos y productos sanitarios Dirección General de Farmacia. 9.16.1.3 Websites: • www.enfermedades-raras.org FEDER • www.agemed.es Agencia Española de Medicamentos y Productos Sanitarios • www.msc.es Ministerio de Sanidad y Política social 9.16.2 Introduction to the Spanish healthcare system The Spanish health system is organized at different levels. Since the transition to democracy one of the main elements of the country’s transformation has been a profound political decentralization of the state structures. The organisation of the Spanish state is made up of the central state and 17 autonomous communities (Comunidades Autónomas). The autonomous communities are highly decentralized regions, each of them with their own regional government and parliament. They have gained competences on important issues and have become crucial in the organisation of the public healthcare system. The Spanish Constitution of 1978 established the right of all citizens to health protection and set out a new regionally based organizational framework. The constitution recognizes the right of all citizens to adequate public health services. It introduced the territorial division of powers between the central state and the regions in the fields of public health and health care. This political structure has great impact on the organization of the Spanish public health system. Legislation on public health and health care provision, since is as well at national as at regional level. The basic law regulating the public health system is the General Health Care Act of 1986. 46 It outlines the main principles for the Spanish National Health System (NHS).It also introduced a formal transition from a system of social security to an NHS model, with a progressive transition from payroll contributions to general taxation as the main source of financing. The general principles of the National Health System are: • universal coverage with free access to health care for almost all inhabitants • public financing (mainly through general taxation) • integration of the different former national health service networks under the National Health System structure (INSALUD) • political devolution to the autonomous communities and region-based organization of health services into health areas and basic health zones
KCE Reports 133 Special Solidarity Fund 197 Today the 17 autonomous communities have considerable legislative power and autonomy with regard to health care policy and most social services. The devolution of powers to the regional level (the autonomous communities) has been realized over a rather long period. The transition from the national level (former INSALUD - Central National Health Institute) to the regional level (regional health services depending from the regional governments) took more than 10 years. It was implemented gradually per autonomous region. Cataluña was the first autonomous region to have the public health competences transferred to in 1981. The last transfers took place in 2002 when the decentralization process was finished. The Autonomous Communities are responsible for the delivery of their own health services. Through their Regional Health services they are the administration level in charge of health management and control. They have the authority to decide how to organize or provide health services. Every citizen adheres to the Regional health service of the region he lives in. It’s the regional health service that is responsible for the organization of the primary care as well as the hospital care and emergency care. At central level, the Spanish Ministry of Health and Consumer Affairs establishes norms that define the minimum standards and requirements for health care provision. These are (as a minimum) equal for all Spanish citizens. An important role in the Spanish national health system is played by the Interterritorial Council of the National Health System (Consejo Interterritorial de salud), which guarantees a minimum of coordination between the regions and the national level. Since the Law on Cohesion and Quality of 2003 47 the council is composed of the National Minister of Health and Consumer Affairs and the Ministers of all the Autonomous Communities that are responsible for health issues at regional level. It coordinates, sets up information systems and assures cooperation between the national and the regional health authorities. In the context of the decentralized health care system, the Law on Cohesion and Quality outlines the framework of cooperation between public administration departments and proposes significant future reforms. A number of strategies, such as the establishment of the NHS Agency on Quality, the Health Information Institute and the National Observatory of the NHS, have already been implemented. Central government has the responsibility for promoting coordination and cooperation in the health sector. It assumes responsibility for certain strategic areas, including: • general coordination and basic health legislation; • financing of the system, and regulating the financial aspects of social security; • definition of a (minimum) benefits package guaranteed by the NHS; • international health; • pharmaceutical policy. The regions are responsible for: • Health planning; • Public health; • Care delivery. The Communidades Autonomas are responsible for the organization of care. Financial means (mainly tax income) are transferred to the regions and the regions manage, control and organize the care delivery system. They are responsible for the organization of primary care, specialist care (hospital level), pharmaceutical services and emergency care in their region. The regions (through the regional health authorities) that manage health care provision and health care institutions. As such every region has the power to expand care delivery and provide additional care and coverage next to the minimum benefits package that has to be guaranteed (determined at national level).
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Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

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