The goal of this book is to assess the situation and recent performance of the National Health System in Spain and its regional differences, based on an analysis of its multiple dimensions from an economic standpoint. The aspects studied are various: the volume of financial and human resources employed and the contribution thereto of the public and private sector; the composition and evolution of health spending and the heterogeneity of health services, and how they fit with needs; and the identification of system strengths and weaknesses in terms of efficiency and equity.

Healthcare was in the front line of the crisis unleashed in 2020 by the COVID-19 pandemic, making it imperative to study how the Health System coped, with particular attention to the relationship between available resources and the pressure faced by the hospital systems of each autonomous region.

The authors have drawn for their research on a broad set of databases, which they explore from a dual perspective: temporal – focusing on the years of the 21st century – and territorial, looking at regional differences.

The results point to heterogeneity as a key feature of the Health System, accentuated by the strong decentralization of healthcare competences to seventeen autonomous regions, which has produced an enormous diversity in resources, medical practices and outcomes.

While part of this diversity springs from the exercise of regional power, another part, of varying origins, may have un welcome effects. In light of their findings, the authors suggest a series of ways in which undesired Health System heterogeneity could be reduced through improvements in efficiency and equity.

The results of this monograph will be of interest primarily to professionals and academics working in health economics, as well as those in charge of healthcare policy and management in Spain.