Challenges to Achieving Value in Drug Spending in a Decentralized Country: The Spanish Case

This article presents an overview of the Span-ish health sector variables and drug policies as well as highlights the perspectives of new reforms. Methods: Initially, the text frames the health sector in the sociodemographic context; it describes the past two dec-ades of demographic changes noting particularly the very low birth rate and the growth in the proportion of the eld-erly. It also summarizes the main aggregate economic trends emphasizing the gross national product growth of near an annual 4 % for the past 10 years and the decrease in the unemployment rate from high values of approxi-mately 20 % to half that rate in the same period, together with a stabilization of the inflation rate around 4%, still higher than EU average values. Second, this article describes the Spanish health sector organization and financing, underlining that it is mostly a publicly funded system (approximately 80 % of total health-care expendi-tures are public) and that the universal coverage is financed out of general taxation after two decades of tran-sition from social security-based premiums. Simultane-ously to that universalization of the health-care rights, Spain started a political decentralization process in almost all the spheres of the public administration, health issues included. The article describes the changes in budgeting, management, and funding that nowadays fully belong to the regions. Results