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La descentralizacion fiscal en España en la disyuntiva de la nueva financiacion autonómica. Algunas reflexiones generales y específicas al caso de la sanidad

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  • Guillem López Casasnovas
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    Abstract

    RESUMEN Ubicada ya definitivamente la financiación sanitaria en el conjunto de la financiación autonómica (donde se han de producir los balances y compensaciones intersectoriales respetuosos con la autonomía de las CC.AA.), entra en vía muerta la visión ‘gestora’ del ejercicio competencial de la autonomía, que se expresaba en la pretensión de fundamentar desde una perspectiva central una asignación de recursos según criterios supuestamente normativos de "necesidad sanitaria", para dejarlos en su ejecución a manos de las CC.AA. La distribución territorial parametrizada entre comunidades se ha mostrado infactible (desde el propio concepto de ‘necesidad’ a su materialización en variables aproximables empíricamente, operables en sus ponderaciones estándar, y agregables en un índice.), poco rigurosa (qué fondos distribuyen y con qué condicionamientos.) y, sobre todo, contraria a la propia descentralización fiscal. Se ha abierto así hoy una nueva agenda más centrada, por un lado, en la financiación global del gasto social (el grueso de las competencias autonómicas), con compensaciones implícitas, inergias e interrelaciones entre partidas priorizadas en los gobiernos de cada Comunidad y, por otro, en cómo se asignan intra-comunitariamente cuales sean los recursos disponibles, a la vista de los objetivos de los parlamentos con competencias en la materia, la oferta instalada y las prácticas clínicas observadas. ABSTRACT Once central finance of regional health care has been definitively integrated on the whole regional finance, a new perspective is open to health care decentralisation. Regional Parliaments get a definitive say on the day to day of health care management and finance, and the need of intersectorial balances and local spending and fiscal priorities start to dominate the autonomous political agenda. The former approach, based on much of central ‘spending power’ seems finally dead and the aim to define centrally parameterised ‘regional needs’ is not anymore at the central core of the political debate. Now it is time for health policies to adequate initially centrally defined finance with regional final expenditure by raising own taxes, improve regional health expenditure and promote better prevention policies, since no more revenues can be raised by claiming regional spending overruns. The equity debate is then limited to the central plafond (here with population changes and migration representing still further refinements to be made) and the ‘within’ disparities in health should be the main concern on internal regional policies. This makes for a substantial change, according to the author’s perspective, that requires accommodating the research agenda to this new situation for the near future.

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    Bibliographic Info

    Article provided by Universidades Públicas de Andalucía in its journal Revista de Estudios Regionales.

    Volume (Year): 01 (2007)
    Issue (Month): ()
    Pages: 29-74

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    Handle: RePEc:rer:articu:v:01:y:2007:p:29-74

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    Related research

    Keywords: Descentralización fiscal; Políticas sanitarias regionales en España; Desigualdades territoriales internas y externas; Perspectivas de la equidad;

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