Public Healthcare: The Impossible Reform

The public health system suffers two sets of problems, related to the demand and the supply of healthcare: gratuitousness causes systematic shortages whereas public provision is inefficient. The 1991 "Abril Report" recommended introducing fees for services and similar cost-conscious measures, to contain excess demand; and to transform hospitals in companies, building an “internal market” where financing and provision of healthcare services would depend of different departments, and providers would compete between among themselves. Such proposals are still on the table in 2011.