Chuliá Rodrigo, M. Elisa2024-05-202024-05-202021-07978019189256110.1093/oso/9780198860525.003.0015https://hdl.handle.net/20.500.14468/15679This chapter offers an in-depth look at health politics and the tax-financed, universal health system in Spain. It traces the development of the Spanish healthcare system, focusing in particular on its double transition in the 1980s and 1990s from a centralized social insurance system, mostly funded through workers’ and employers’ contributions, to a decentralized universal model financed by general taxation. The new national health system aimed at covering all residents and transferred healthcare competences to the regions, i.e. the seventeen Autonomous Communities, a process completed in 2001. Key issues include rationalization, harmonization, and territorial equity-building of the decentralized healthcare system; efficiency improvement through the introduction of private management elements; and cost containment to bolster the system’s financial sustainability in the context of growing demand and scarce resources. As the chapter argues, these challenges along with the remarkable changes in the political party system have increased the political salience of healthcare in public debate in the 2010s, but the prospects for developing consensual healthcare policies have worsened, such that structural problems are likely to persist.eninfo:eu-repo/semantics/closedAccesscapítulo de libroSpainhealth politicstax-financed health systemuniversal modelnational health systemregionalizationfinancial sustainability