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Reflexiones acerca de la nueva financiación autonómica de la sanidad

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  • Guillem López Casasnovas
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    Abstract

    RESUMEN Ni los más optimistas podían pensar que el Gobierno central iba a alcanzar en Julio del 2001 un acuerdo con las Comunidades Autónomas que incluyeran las competencias sanitarias en la financiación autonómica general. Hoy, con los nuevos acuerdos, las quejas contra la Administración central acerca de futuros déficits de financiación deberán de perder peso en la arena política. En todo caso, el punto de partida no es el de una España desigual en financiación per cápita y en indicadores de salud interregionales. Las diferencias observadas, de poca entidad deberían en todo caso ser decidas autónomamente y en consecuencia autofinanciadas con los propios recursos de las Comunidades Autónomas, dado que existen pocas justificaciones para su subsidiación vertical u horizontal. Ello parece ser el caso, aunque hace falta reconocer que sabemos poco en lo relativo a diferencias de salud que tengan que ver con diferencias en la calidad asistencial y variaciones en la práctica clínica. Pero para el análisis de las desigualdades anteriores no está claro que existan pautas regionales distintas y que el foco de atención debiera redirigirse a como cada Comunidad despliega sus recursos y define sus políticas dentro de su propio territorio. ABSTRACT Even the most optimistic did not believe that the central Government were to reach in July 2001 a new fiscal agreements with the Autonomous Communities which included placing health care under regional responsibility for them all. Now under the new arrangement complaints about central under finance of regional health care will have to cease. Despite common perception, Spain is not an unequal country in terms of health delivery and finance. At any rate the minor observed differences should cause little concern in equity terms as they reflect different political views on public preferences. They should be self financed as there seems little basis for interregional transfers to support them. Having said this, we should also recognise that we know relatively little about health differences which derive from variations in quality of care and variations in clinical practice. It is probably not the case that there is a fundamental regional pattern in such disparities. The main equity concern probably relates to intra regional differences rather than interregional differences. Those who have spoken loudest against the dangers of interterritorial inequities have not usually made most effort to redress imbalances between local areas within the regions.

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    Bibliographic Info

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

    Volume (Year): 02 (2003)
    Issue (Month): ()
    Pages: 107-113

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    Handle: RePEc:rer:articu:v:02:y:2003:p:107-113

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    Keywords: Descentralización sanitaria; Sistema sanitario español; Federalismo fiscal;

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