Regarding to the path dependence of the Spanish public health institutions, the international experience and the observed health technological changes, this paper tries to ground some theoretical bases for the organisational change in our health system.

This is done by building the argument from the very basic public goal: the improvement of the health status of the Spanish population, that requires a better integration of health care services.

To this regard, capitation in finance shows some comparative advantages: it takes an integral view for the care of the population, it allows for a better decentralisation of risks to health providers and fosters health medical effectiveness and its problem-solving capacities, the best proxy for efficiency in clinical practice. However, the paper shows some potential limitations for this purpose and the need of a gradual strategy for its implementation.