The Spanish healthcare system requires greater awareness with respect to the costs for those involved: professionals, users and financiers. Efficacy, efficiency and equity constitute the three basic pillars on which the reforms of the healthcare system should be based. This study, with which the BBV Foundation contributes to a reflection on the question, examines the situation of the Spanish Health System from 1987 to 1997, starting with the General Health Law of 1986. The authors first select all the measures of healthcare policy geared to modifying behavior on the demand side, then move on to an assessment of changes produced in the systems for financing hospitals, as well as the differences in management models developed within INSALUD and the respective regional health services that form part of the national system. The research also analyzes the resistance to progress in the reforms introduced to achieve the desired objectives.