This publication examines the problems of today’s model of health system financing and the possibilities for a future reform, starting from a comparison with the healthcare systems of other OECD countries. The idea is to find benchmarks that can serve for the design of more efficient practices. It looks at the Spanish model of health system financing before and after the 1986 Health Act, the impact of the new regional financing model and methods to estimate future healthcare needs. It also discusses a possible future model, based on formulas offering a more precise measurement of relative needs per geographical area and that take into account the greater powers decentralised to Spanish regions and their co-responsibility in raising tax revenues, adjusting their financing capacity to their expenditure needs and evaluating the possible introduction of copayment systems.

In short, this book will serve to enlighten and enrich the debate about the reform of the regional financing system so it meets the three objectives of the model in place since 2002; namely, sufficiency, equity and autonomy. By doing so, it can help orient public policies in the economic, tax and health domains, and in connection with the thoroughgoing review of health system financing scheduled for 2007.