Health system resilience in Spain

The 2008 Great Recession deteriorated the Spanish health system, although no significant impact on health indicators was found. But other aspects amplified the damage of austerity: the unspecific and thoughtless governance mechanisms that were put in place (linear cuts and budget rationing) and some dysfunctional features of the healthcare organization whose reforms had been long postponed. The radical decentralization of healthcare in 17 Autonomous Communities, completed in 2002, showed the difficulty of health authorities in leading common resilient responses; the lack of wise health governance during the crisis was replaced by a direct takeover by the economic authorities of the central government. The 2020 COVID-19 pandemic showed the failures in resilience generated by the austerity policies of a decade ago, applied in a system with structural weaknesses not addressed by the necessary reforms and ill managed due to poor governance. Therefore, where there seems to be a resilient response from a health system, there may be damage that manifests itself later. The current crisis in primary care, which has been an essential element of the Spanish model, is one of the most worrying problems.