This report aims to contribute to the debate on the regional healthcare financing system in its three major axes: estimates of public revenues and health spending, the measurement of relative need, and the impact on system equity.

After seven years of the model’s operation, it is shown that the sustainability of the financing system could be threatened in the absence of vertical adjustments reflecting the changing needs of different levels of government, especially at a time of fiscal constraints.

The Council of Fiscal and Financial Policy finally reached an agreement to reform the financing system of the autonomous communities in July 2009. The new system is oriented toward the need criterion, refining it through better alignment of funding to real needs and reviewing the criteria for population adjustments. Autonomy and fiscal responsibility are also increased, with explicit consideration of the equalization of basic public services and the creation of special funds to advance real convergence between the autonomous communities.