Spain’s health care system and the crisis: a case study in the struggle for a capable welfare state

Abstract

The economic crisis (2009-2014) and the austerity policies (2010-...) have notably affected Spanish society, its public services and the public health system. Unemployment and labor regulation has deteriorated the labor market, creating poverty and inequality, and consolidating low salaries, part-time work and contractual precariousness. No short-term impact on health (morbi-mortality and perceived health) was observed (except perhaps in mental health), but problems are expected in the medium-long term. The austerity has significantly affected the National Health System (NHS), imposing budget cuts close to 10%, through linear reductions in salaries, hiring and spending; but the NHS has been resilient, although it has accumulated structural tensions, has exhausted its reserves, and has accumulated waiting lists and criticism from patients. The need for reforms is clear, but distrust among all agents prevails. The political change of 2015 (end of bipartisanship), the Catalan conflict since 2017, the change of government in 2018 (PSOE), and the elections of 2019, will influence the next future agenda, oscillating between a liberal-conservative model (public health stagnant with increasing flight from the middle classes to private health care), and a social reformist one (reinvestment in health care, although with controversies in management models).