Inequalities in self-reported health within Spanish Regional Health Services: devolution re-examined?

There is evidence of small inter-regional inequalities in both health and health expenditure both before and after the decentralization of the Spanish National Health Service (Spanish NHS). However, it still has not been established whether devolution has exerted any influence on the development of intra-regional inequalities in health. This study examines the existence of socioeconomic health inequalities within the different Spanish healthcare services, using concentration indices. Data were taken from the most recent Encuesta Nacional de Salud (Spanish National Health Survey, 1997) and self-perceived health was used to measure health. It is argued that while inter-regional inequalities in health may have been unaffected by decentralization, intra-regional inequalities may be the undesired consequences of an efficiency-based NHS. The results suggest that devolution may have helped pro-equity policies but only in areas where the private sector is small.