Genealogy of hospital reform in Spain: the gestation of a new hospital-centric health culture

Abstract

In Asturias, Spain, a new way of understanding the hospital emerged at the end of the 1950s. This new model, designed to be used by all types of patients, regardless of their pathology or economic situation, would end up being a key influence on the modernization of Spanish hospital organization. Thus, the General Hospital of Asturias became a pioneer in Spain by opting for a hierarchical structure in all clinical medical services, whether for hospitalization, outpatient departments or emergencies. Another significant consequence was the introduction of specialized healthcare training in Spain via the creation of the first internal medicine residency programme. Until this time, the hospital had still been a healthcare resource that was not very accessible to large sectors of the population in Spain, unlike the situation in many European countries at the time. The new organizational model broke definitively with obsolete concepts of «autonomous» and «closed» hospitals. From then on, hospitals were «open» to the entire community and were integrated into a functional and hierarchical coordinated network of hospitals, in a process known as «regionalization». This new reality required the accreditation of hospitals in order to comply with criteria established by international hospital doctrine and to offer insurance companies and users a minimum guarantee of the quality and rationality of the health services provided. This process eventually led to a new healthcare culture, based on a hospital-centric visionvision of the health system, being assimilated by the Spanish population.