Decentralization and regionalization in health in Spain: trajectories, characteristics and conditions

The article discusses the decentralization and regionalization of the Spanish health system from 1980 to 2012. Considering the historical institutionalism approach, the study analyzed the trajectory, characteristics and conditions of these processes, in broader the context of democratization and reform of the State. The results suggest different degrees of power between the central and subnational governments in the political, administrative and fiscal/financial dimension. It is concluded that the return to democracy, the regionalist pressures, the politicalterritorial decentralization and the antecedent of the health system were the main factors that influenced the configuration of the health system in Spain.

本文探讨了1980年至2012年间西班牙医疗体系的分权化与区域化进程。本研究以历史制度主义（historical institutionalism）为分析视角，在国家民主化与改革的更广阔语境下，对上述进程的发展轨迹、特征与形成条件展开了分析。研究结果表明，中央与次国家政府（subnational governments）在政治、行政及财政/金融维度上的权力分配存在差异程度不一的情况。最终研究结论显示，民主制度的恢复、区域主义诉求、政治-领土分权进程以及西班牙医疗体系的前期积淀，是影响该国医疗体系架构形成的核心驱动因素。