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The Spanish National Health System, structured by the General Health Law of 1986 and tax-funded, provides services to the insured population and their beneficiaries, and operates mainly within the public sector with coordination of health care provision assumed at the regional level and regulation and strategic planning hold by the Ministry of Health.

As in many others developed countries, the cost of delivering health has risen exponentially due to ageing populations, increases in chronic diseases, and rapid technological improvement. With restricted budgets, the Spanish government looked for solutions to contain costs and improve health outcomes and thereby meet some of the critical goals in their health policies. One key change was the introduction of market-driven mechanisms through the separation between the purchasers and health care services providers, steered by the “Abril Report”(1991). The social …