Publication: Las decisiones en las políticas de los modelos del servicio nacional de salud descentralizados: los casos de la Comunidad de Madrid y la región de Lombardía (2000-2014)
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2016-06-08
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Universidad Complutense de Madrid
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Abstract
El presente trabajo de investigación se ha centrado en las decisiones de las políticas sanitarias de los modelos de National Health Service descentralizados, cuyo study case se ha focalizado en los casos de la Comunidad de Madrid y la Región de Lombardía. La política sanitaria constituye uno de los pilares fundamentales del Estado de Bienestar, siendo una de las políticas públicas de mayor peso e importancia en términos de legitimidad política. Su formulación, programación y puesta en marcha dependen de la voluntad política de los gobiernos, de la existencia de alternativas y recursos, pero también de la interacción de una pluralidad de actores, que se encuentran implicados en los mecanismos de decisión. Varios países europeos iniciaron un largo recorrido en la transformación de sus propios modelos sanitarios en las últimas décadas del siglo pasado, coincidiendo con la crisis del Estado de Bienestar. De hecho desde mediados de la década de los 70 a mediados de los 90, varios países europeos emprendieron reformas de signo neoliberal en campo sanitario, endureciendo los criterios de elegibilidad para poder beneficiarse de los servicios o introduciendo copagos. Las decisiones tomadas al respecto han derivado en múltiples expresiones, en cuanto a modelos sanitarios se refiere, pero también en diferentes procesos de reformas, llevadas a cabo con una flexibilidad distinta, adaptándose al terreno concreto y circunstancias de cada país. Es necesario recordar que los sistemas sanitarios europeos se forjaron en el periodo de maduración del Wefare State (1960-19752), cuando éste asumió la responsabilidad de la producción directa de bienes y servicios. Pero al entrar en crisis, el Estado del Bienestar tuvo que afrontar su propia transformación adecuándose a las exigencias del contexto económico y social, sin desatender el compromiso generado en su origen con los ciudadanos. Sin embargo, hoy día esa transformación, está ligada al surgimiento de nuevos problemas colectivos (Dente y Subirats, 2014, pag.44). Concretamente y en relación a la política sanitaria, estos problemas son derivados del aumento de los costes asistenciales, a su vez ocasionados por la innovación de las nuevas tecnologías, pero también por el envejecimiento de la población...
This research paper is centered on the decisions of the health policies of the decentralized models of the National Health Service. The study case of this paper has focussed on the cases of the Community of Madrid and the Lombardy Region. Health policy is one of the fundamental pillars of the Welfare State, as it is one of the public policies of greatest weight and importance in terms of public legitimacy. Its formulation, programming and launching depend on the political will of governments, the existence of alternatives and resources, but also on the interaction of a plurality of actors that find themselves involved in the mechanisms of decision. Many European countries embarked on a long journey in the transformation of their own health models in the last decades of the last century, coinciding with the Welfare State crisis. In fact, from the mid-70's to the mid-90's, many European countries undertook reforms of neoliberal character in the area of health, toughening the eligibility criteria to benefit from the services, or introducing co-payments. The decisions taken in this respect have derived into multiple expressions, with regards to sanitary models, but also in different processes of reform, undertaken with a different flexibility, adapting to the specific terrain and circumstances of each country. It's necessary to recall that the European health systems were forged in the period of maturity of the Welfare State (1960-19751), when it assumed the responsibility of the direct production of goods and services. But upon entering into crisis, the Welfare State had to confront its own transformation, adapting to the demands of the social and economic context, without overlooking the commitment generated at its origin with the citizens. However, that transformation today is linked to the emergence of new collective problems (Dente and Subirats, 2014, p.44). Specifically, and related to health policy, these problems stem from the increase in the costs of care, caused in turn by the innovation of new technologies, but also by population ageing. These are the main causes that defy heath policies today, favouring a replacement of the current health systems and their models...
This research paper is centered on the decisions of the health policies of the decentralized models of the National Health Service. The study case of this paper has focussed on the cases of the Community of Madrid and the Lombardy Region. Health policy is one of the fundamental pillars of the Welfare State, as it is one of the public policies of greatest weight and importance in terms of public legitimacy. Its formulation, programming and launching depend on the political will of governments, the existence of alternatives and resources, but also on the interaction of a plurality of actors that find themselves involved in the mechanisms of decision. Many European countries embarked on a long journey in the transformation of their own health models in the last decades of the last century, coinciding with the Welfare State crisis. In fact, from the mid-70's to the mid-90's, many European countries undertook reforms of neoliberal character in the area of health, toughening the eligibility criteria to benefit from the services, or introducing co-payments. The decisions taken in this respect have derived into multiple expressions, with regards to sanitary models, but also in different processes of reform, undertaken with a different flexibility, adapting to the specific terrain and circumstances of each country. It's necessary to recall that the European health systems were forged in the period of maturity of the Welfare State (1960-19751), when it assumed the responsibility of the direct production of goods and services. But upon entering into crisis, the Welfare State had to confront its own transformation, adapting to the demands of the social and economic context, without overlooking the commitment generated at its origin with the citizens. However, that transformation today is linked to the emergence of new collective problems (Dente and Subirats, 2014, p.44). Specifically, and related to health policy, these problems stem from the increase in the costs of care, caused in turn by the innovation of new technologies, but also by population ageing. These are the main causes that defy heath policies today, favouring a replacement of the current health systems and their models...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Ciencias Políticas y Sociología, leída el 18-12-2015