Public health funding in Spain1

1. INTRODUCTION Health spending in Spain has two very distinct characteristics. On the one hand, citizens, users or not of public health, highly value the service provided as well as the form of public funding through the general taxation system. And consequently, they refuse to a hypothetical management or !nancing, which wholly or partly include some form of private participation. Furthermore, after the process of decentralization of competencies and the assumption of management and !nancing of health services by the Autonomous Communities, some !nancial bottlenecks have emerged in certain territories which still have not been resolved, despite having introduced some parascal levies as the so-called "centimo sanitario (health cent)". Consequently, the stable origin of funds to ensure a level of health services with the same quality as perceived today still remains unresolved, in times when public funds are depleted. Without prejudice to the principle of non-involvement between income and expenditure described in the Spanish Constitution, one can establish a relationship between collection, by means of social security contributions, and levels of public health spending, with the intention to determine the incidence of these coercive incomes in employment levels, and if such a negative correlation between contributions and employability is determined, then, !nancing measures to ensure a certain level of health service should be considered. There is a practical doctrinal unanimity at establishing a positive relationship between high levels of public spending on health and growth of Gross Domestic Product. The last reason that justi!es this statistical relationship is that a healthy population with a high rate of longevity is in better condition to work than those individuals whose health is weakened 287 CAPÍTULO 12. PUBLIC HEALTH FUNDING IN SPAIN and, simultaneously, on those economies in which the National Incom