Retos, reformas y futuro del Sistema Nacional de Salud

Universalism and decentralization constitute the main characteristics of the Spanish SNS. In addition to the budgetary pressures common to all health systems in Western countries (growth of age-related health costs, increased social expectations, the consequences of the growing social inequality, and technological development) there are specific structural tensions that signal the weaknesses in the institutional architecture of the Spanish healthcare system (complexity of its multilevel governance structure). The current context of economic and fiscal crisis has led Spanish health authorities to adopt a series of measures (budget cuts, reduction in the coverage of the system,privatization, and reform of health governance) that threaten to undermine the SNS as a universalist and decentralized system as it has been built during the last three decades.