Competition and collaboration between public and private sectors: the historical construction of the Spanish hospital system (1942-1986)

Abstract

[Abstract]: In general, healthcare, along with diet, has historically 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 in health coverage. Its study from an economic history perspective is relevant since it stems from public and private investment and produces 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 a country of the European periphery which, in the late twentieth century, attained a degree of quality confirmed by the current international hospital rankings and even by the phenomenon of health tourism. The study analyses the creation of the Spanish hospital system during the Franco 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 needed to collaborate with the private hospital system and which was full of financial holes and tainted by corruption, while remaining at the service of privileged groups.