PÚBLICO Y PRIVADO EN LA SANIDAD.

This paper addresses the public-private mix in the Spanish National Health System (SNS) presenting six case studies dealing with both insurance and provision: 1. The special health insurance of civil servants.' 2. The construction of public hospitals with a PFI scheme; 3. The total healthcare concessions of the 'Alzira model' in the Valencian Community and Madrid, which subcontract public insurance; 4. The contract between a large private teaching hospital and the Madrid Health Service; 5. The provision of primary health care in Catalonia through cooperative-like companies of health professionals; 6. A Children s Dental Care Program using public and private dentists. The great complexity, opacity, cost overruns and difficulty of public control of the PFI contracts, the concessions as well as the activity-based contract for hospital services, point out to the outright rejection of theses systems. The comparative nature of the public-private debate in healthcare should emphasize that the problems of 'the public' in the SNS are not due to its public nature but stem from its governance and management arrangements, clearly in need of deep reforms, many of which are included in the Conclusion-Dictamen on health of the Reconstruction Commission of the Congress. [ABSTRACT FROM AUTHOR]