Suchergebnisse

Este trabajo persigue como principal objetivo analizar cómo se gestaron y se debatieron en el arlamento las bases del actual modelo sanitario español desde el inicio de la transición democrática hasta la aprobación de la Ley General de Sanidad en 1986. Durante este período se produjo un importante debate sobre el modelo y funcionamiento del sistema sanitario en España que orbitaba en torno al papel que debía representar el Estado en la gestión, financiación y prestación de servicios y sucompetencia o cooperación con el sector privado. El estudio pone en evidencia que el debate sanitario ha venido protagonizado por dos modelos diferentes de sanidad que se han enfrentado desde los primeros momentos de la transición hasta el presente. La herida entre estas dos facciones sigue abierta y el consenso global lejos de ser alcanzado. ; This paper aims to analyze how the foundations of the current Spanish health model were developed and debated in Parliament from the beginning of the democratic transition until the approval of the General Health Law in 1986. During this period there was an important political debate on the model of the health system in Spain that orbited around the role that the State should represent in the management, financing and provision of services and its competence or cooperation with the private sector. The study shows that the health debate has been carried out by two different models of health that have been faced from the first moments of the transition to the present. The wound between these two factions remains open and the global consensus far from being reached.

AbstractThroughout history, healthcare, along with diet, has been an essential component of life and a country's welfare. In particular, a country's hospital system is a key indicator for analysing the level of welfare achieved by health coverage. From an economic history perspective, the study of hospital systems is relevant since they stem from public and private investment and produce positive externalities by creating employment and stimulating other economic sectors such as construction and health. Spain provides a significant case study for determining the factors of backwardness in the construction of a modern hospital system in a country on the European periphery. Moreover, it also helps us understand how, despite initial obstacles, this system had attained a significant degree of quality by the end of the twentieth century, as confirmed by its current international hospital rankings and even by the phenomenon of health tourism. The study analyses the creation of the Spanish hospital system during Franco's dictatorship and the transition to democracy. It reveals how the maintenance of a regressive tax system, the use of health policy as political propaganda, and disputes within the political elite of the dictatorship led to an inadequate and fragmented public hospital system, which had to collaborate with the private hospital system, was full of financial holes and tainted by corruption, and remained at the service of privileged groups.

This paper aims to analyze how the foundations of the current Spanish health model were developed and debated in Parliament from the beginning of the democratic transition until the approval of the General Health Law in 1986. During this period there was an important political debate on the model of the health system in Spain that orbited around the role that the State should represent in the management, financing and provision of services and its competence or cooperation with the private sector. The study shows that the health debate has been carried out by two different models of health that have been faced from the first moments of the transition to the present. The wound between these two factions remains open and the global consensus far from being reached. ; Este trabajo persigue como principal objetivo analizar cómo se gestaron y se debatieron en el arlamento las bases del actual modelo sanitario español desde el inicio de la transición democrática hasta la aprobación de la Ley General de Sanidad en 1986. Durante este período se produjo un importante debate sobre el modelo y funcionamiento del sistema sanitario en España que orbitaba en torno al papel que debía representar el Estado en la gestión, financiación y prestación de servicios y sucompetencia o cooperación con el sector privado. El estudio pone en evidencia que el debate sanitario ha venido protagonizado por dos modelos diferentes de sanidad que se han enfrentado desde los primeros momentos de la transición hasta el presente. La herida entre estas dos facciones sigue abierta y el consenso global lejos de ser alcanzado.

La dictadura franquista por motivos de estrategia política intentó influir en materia de seguros sociales, en especial en la cobertura de la enfermedad, en los países iberoamericanos durante las décadas de 1940 y 1950. Los resultados de esta colaboración resultaron mediocres en la práctica y produjeron pocos avances reales, al margen de la imitación de las instituciones de gestión y algunos cursos de formación actuarial y estadística. Este fracaso se debió en gran medida al propio atraso y debilidad del modelo de cobertura sanitaria de la dictadura franquista ahogado por un déficit financiero crónico y con graves limitaciones tanto en la cobertura de la población como en las prestaciones ofrecidas. A partir de la década de 1960, una vez superada la etapa de aislamiento y autarquía, las autoridades franquistas redujeron su interés en la estrategia iberoamericana y comenzaron a mirar a Europa. ; For reasons of political strategy, the Franco dictatorship sought to have an influence in matters of social insurance, especially sickness coverage, in Latin American countries during the 1940s and 1950s. The results of this collaboration were mediocre in practice and led to little real progress, apart from imitating management institutions and some actuarial and statistical training courses. This failure was due to a large extent to the backwardness and weakness of the Franco dictatorship's own model of health care provision, stifled by a chronic financial deficit and with serious shortcomings in both coverage of the population and provisions offered. Beginning in the 1960s, once the stage of isolation and autarky was overcome, the Francoist authorities reduced their interest in the Latin American strategy and started to look towards Europe.

En el proceso de difusión del seguro de accidentes de trabajo iniciado en 1900, España impuls6 y favoreció el desarrollo de rnutualidades patronales de accidentes de trabajo que se caracterizaron por su marcado ámbito local y provincial. A pesar de que las sucesivas leyes mantuvieron un trato preferente, la universalización de este seguro durante la I1 República desató un aumento de la competencia en este ramo, tanto entre rnutualidades y compañías mercantiles como entre las propias mutualidades, 10 que obligó a estas últimas a importantes transformaciones ; During the spreading of the industrial accident insurance in Spain, at the beginning of 20" century, the Government propelled and helped the development of accident insurance and employer's mutuals. Those mutuals were characterized by their local and provincial bounds. The socialization of that insurance during the Second Spanish Republic caused an increase of competence in that business despite the fact that the successive legislation supported them. The competence between mutuals and commercial companies and also among mutuals, leaded finally to severe transformations

The backwardness of actuarial techniques in Spain and the lack of Spanish mortality tables had a bearing on the development of life insurance in Spain. The actuaries of the domestic and foreign companies operating in this country used other countries' mortality tables, corrected upwards, to draw up their policies. With actuarial reports from the Gresham Life Assurance Society, established in Spain in the 1890s, the difficulties actuaries had to confront to adjust expectations to Spanish reality can be followed for decades. On the basis of statistical information from 1896 to 1937, a comparison is made between expected and actual death rates. Furthermore, the information from this company enables a comparison with other countries in which it operated (more developed and less developed than Spain) and with the profit and loss results of other domestic and foreign companies operating in the country. Moreover, the problems caused for actuaries by unforeseen events that affected the Spanish population in particular, such as the "Spanish Influenza" or the Civil War, can also be studied. On the basis of this valuable documentation, certain patterns of the difficulties faced by actuaries operating in economically backward countries before World War II can be established.

For reasons of political strategy, the Franco dictatorship sought to have an influence in matters of social insurance, especially sickness coverage, in Latin American countries during the 1940s and 1950s. The results of this collaboration were mediocre in practice and led to little real progress, apart from imitating management institutions and some actuarial and statistical training courses. This failure was due to a large extent to the backwardness and weakness of the Franco dictatorship's own model of health care provision, stifled by a chronic financial deficit and with serious shortcomings in both coverage of the population and provisions offered. Beginning in the 1960s, once the stage of isolation and autarky was overcome, the Francoist authorities reduced their interest in the Latin American strategy and started to look towards Europe. ; La dictadura franquista por motivos de estrategia política intentó influir en materia de seguros sociales, en especial en la cobertura de la enfermedad, en los países iberoamericanos durante las décadas de 1940 y 1950. Los resultados de esta colaboración resultaron mediocres en la práctica y produjeron pocos avances reales, al margen de la imitación de las instituciones de gestión y algunos cursos de formación actuarial y estadística. Este fracaso se debió en gran medida al propio atraso y debilidad del modelo de cobertura sanitaria de la dictadura franquista ahogado por un déficit financiero crónico y con graves limitaciones tanto en la cobertura de la población como en las prestaciones ofrecidas. A partir de la década de 1960, una vez superada la etapa de aislamiento y autarquía, las autoridades franquistas redujeron su interés en la estrategia iberoamericana y comenzaron a mirar a Europa.

[Abstract:]Using new statistical data on financing, coverage and economic and health care provisions, this article analyses how sickness insurance was introduced, managed and extended in Spain, under the Franco dictatorship, between 1939 and 1962. This article highlights how the dictatorship accelerated its implementation for political motives and this resulted in a failure of the system due to the lack of public financing and the high pharmaceutical, medical and infrastructure costs

[Abstract:]This article analyzes the basic characteristics of the labor and social policies of the Franco dictatorship established in Spain after the Civil War (1936-1939), and the links which existed between them. The offer of support to working families was presented through a paternalistic discourse of 'social justice' which was combined with tough repressive measures in the labor market. Within this context, compulsory social insurances pursued a political end, as they served to mitigate social tensions in a context of worker repression and harsh living conditions. Sickness insurance was a key element in this strategy, and it turned out to be very economical for the dictatorship, as the burden of financing the system was placed on employers and, above all, the workers themselves. This led to financial and management problems within a system providing imperfect coverage, with low benefits and serious inequalities in protection. Consequently, Spain moved away from other advanced countries which, at this time, were establishing their welfare states on the basis of two pillars: the universalization of benefits and the redistributive character of the system from a social point of view.

SummaryThe main aim of this paper is to analyse the singularity of the Spanish position with regard to coverage of the risk of sickness within the context of the different welfare models described in international literature. This analysis enables us to verify that in Spain, as in other countries, there were initially different forms of sickness coverage which coexisted, created by the market, by workers themselves and, gradually, by the state. Within this so-called mixed economy of welfare, the most extensive health coverage for the Spanish population was a result of the self-organization of workers, and this continued until the Civil War (1936–1939), not so much due to its efficacy and viability, as to the slow development of private insurance companies and the inability of the state to implement compulsory sickness insurance. The installation of the Franco dictatorship meant that the introduction of compulsory sickness insurance was further delayed, and when it was eventually passed, it offered only limited coverage, was enacted more for political than for social ends, and was to result in the virtual disappearance of friendly societies.