摘要：The health system is not immune to the public sector crisis, in fact it is the fastest growing expenditure. Nothing is free. A public system requires no opting out. This does not mean a monopoly. Redistribution is on ideological issue. Matte compensatory policies carry a moral risk that favours a lack of healthy habits. Equity means a fair innings. Everything is reformable except opting out: the mixture between private and public institutions, rationing, and health production. Efficience validates any redistribution objective. Government and markets are not ends, rather instruments to attain objectives. Catalonia has a tradition of 50% private medicine, the result of historical discrimination by the Spanish government. Mortality is among the best in the world. 81% of men and 75% of women consider their health good or excellent. However there are problems for the future because of growing cancer, aids and accident costs. Little has been done to apply antismoking laws. Finance is a big problem because the Spanish government pays per head while expenditure is by income level, which is higher in Catalonia. The resulting deficit must be,financed in an undercover way. More descentralization is required. Although the English model cannot he applied, there is leeway for more competition. The health system should stay above politics.
