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This study investigates the application of the synthetic control method for the evaluation of public health policies, specifically assessing the impact of the 2010 anti-smoking legislation in Spain. This policy, which represented a paradigmatic shift, aimed to reduce smoking prevalence and its multiple consequences for public health. Utilizing data on tobacco consumption prevalence across various countries alongside key predictors of consumption, we examine the effectiveness of the legislation in reducing smoking rates. To achieve this, the synthetic control method is employed to construct a 'synthetic Spain' from a weighted combination of countries within a donor pool. This counterfactual represents the smoking prevalence that would have been observed in Spain in the absence of the law. The empirical results demonstrate that the legislation successfully reduced tobacco consumption. However, its gender-differentiated impact suggests the necessity of implementing gender-responsive regulatory frameworks.

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Spain has made relevant progress in the planning, visibility and organisation of palliative care, but territorial inequalities, differences in access and still insufficient guarantees for patients and families persist. In this context, a national palliative care law should be understood not as an ideological gesture or a reactive response to other debates, but as a tool for equity, public health and cohesion within the National Health System. The World Health Organization considers the existence of a legal framework that guarantees access to and regulates palliative care to be an indicator of development, and the European experience shows that the most useful laws are those that, beyond formal recognition, incorporate concrete mechanisms for implementation, financing, governance and evaluation. In light of these lessons, a future Spanish law should establish common minimum standards of access across the country, promote early and integrated care, strengthen professional training, support families and caregivers, ensure access to essential medicines and establish public monitoring indicators. The aim would not be to add one more regulation, but to reinforce a basic guarantee of the health system.

To describe potential conditioning factors and to analyse improvement measures proposed by reporters in hospitals of an autonomous region of Spain. A cross-sectional study was conducted analysing all notifications from the public hospital network reported in Aragon (Spain) during 2023. Among all reports (n=959), incidents related to medication prevail (22.9%), followed by falls (14.9%) and identification issues (6.2%). Most of the reports were submitted by nurses (79.14%). Free text categories mainly indicated a need for improvements in terms of correct identification of patients and samples, both interpersonal and family communication, and a need of improvement in hospital staff stability and training. Despite the limitations of the study, the main one being the voluntary and anonymous nature of the notification system, it presents a valuable source of knowledge to identify patient safety issues. In addition, following notifiers' reports, it raises several important challenges, including better training for the notifying staff and the adoption of legal measures that guarantee the safety of the notifiers.

To examine whether health problems, measured by the number of chronic conditions and self-perceived health status, are associated to the ownership and amount of consumer and mortgage debt in Spain. A cross-sectional study based on data from the SHARE survey, referred to 2021-2022. The final sample comprises 1583 individuals residing in Spain, mostly aged 50 and over. The empirical analysis was conducted in two stages: first, a probit model was used to estimate the probability of holding debt; second, a linear regression model was estimated using the log-transformed dependent variable to analyse the potential factors associated with the amount of debt. The empirical evidence reveals a positive association between the number of chronic health conditions and both the likelihood and amount of consumer and mortgage debt. Likewise, poor self-perceived health is also positively associated with the presence and volume of debt. The findings suggest that a poor health status is positively linked to the presence and volume of debt among the Spanish population aged 50 and over. These findings underscore the need to strengthen household financial planning to mitigate economic vulnerabilities arising from health deterioration, as well as to reinforce the healthcare system by expanding services or reducing waiting times. In a country with a high rate of population aging, such measures are crucial given the higher prevalence of illness in older age groups.

Embedded in Spanish neighborhoods and towns, there are hundreds of thousands of self-employed healthcare professionals who provide services within the private sector. In the absence of an official term, they are referred to here as "self-employed community healthcare professionals", as they practice within a community setting with a high degree of proximity to patients, participate to varying extents in health promotion activities, and operate independently from large organizations. Healthcare provision, whether public or private, has an impact on patients. It would therefore be reasonable for a regulated exchange of information to exist, allowing, when necessary and in accordance with the legal framework, collaboration for their benefit. In this context, it is important to better understand the reality of healthcare services delivered by self-employed professionals and the extent to which coordination with public healthcare exists, if any. Although the available knowledge about these services is limited, in most cases there is a low degree of coordination and/or collaboration with other healthcare professionals, both public and private. Despite the millions of interventions carried out, very few are captured within the electronic health record of the Spanish National Health System, resulting in two parallel and largely disconnected systems coexisting within the same territory, with minimal coordination as patients move between them. Pilot initiatives and statements from some professional groups suggest the need to integrate communication and collaboration systems to optimize patient care.

The long-standing delay in the institutionalization of public health in Spain is directly related, both as a cause or effect, to its academic and professional weaknesses. This second part examines the necessary, yet challenging, relationship between academia and administration, describing how public health research and training have developed in the country, primarily since the transition to democracy. One of the keys to consolidating the progress already made is connecting the day-to-day work of research with professional practice. That is linking the knowledge generated through research and innovation with the implementation of policies and programs. Investing in research and professional training, with sufficient and sustained resources, is the best way to prepare ourselves to face the present and future challenges of public health. Scientific societies play a unique role in connecting academia and administration.

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To compare gross annual remuneration across ten professional categories in the Spanish National Health System in 2024, using the Canary Islands Health Service (CHS) as a reference, in both nominal terms and adjusted for purchasing power parity (PPP). We conducted a cross-sectional comparative study based on official data on healthcare remuneration across regional health services. Ten professional categories were analysed. For the two medical categories (primary care and hospital), we developed a simulation tool (available as supplementary material) to estimate total annual remuneration for homogeneous professional profiles, considering seniority, career progression, exclusivity, and on-call duties. Comparisons were performed using rankings and ratios of CHS remuneration relative to the average of other regions. Remuneration was also adjusted using regional PPP estimates. In nominal terms, health care remuneration in the Canary Islands is close to the national average, with substantial heterogeneity across profiles. The relative position of the Canary Islands is more favourable for younger physicians without exclusivity arrangements than for those with exclusive dedication and greater profesional experience. In other professional categories, remuneration is generally above the national average, except for primary care nurses. PPP adjustment increases the relative position of the Canary Islands without altering the observed patterns. Health care remuneration in the Canary Islands is close to the national average in nominal terms and higher when adjusted for price levels. The heterogeneity across medical profiles highlights the importance of interpreting comparisons at a disaggregated level.

Patient and public involvement (PPI) is an essential component of Health Technology Assessment (HTA), as it enhances the relevance and transparency of evaluation processes. Nevertheless, the scope of such involvement varies considerably across contexts, and empirical evidence on current practices within the National Health System remains limited. This study will examine the extent to which HTA reports incorporate PPI and how these practices are performed and described. We will conduct a cross-sectional meta-research study of HTA reports produced by the Spanish Network of HTA Agencies (RedETS) between 2020 and 2026. Eligible reports will be identified through public repositories (https://redets.sanidad.gob.es/). A random sample of 150 reports will be selected. General and methodological characteristics, and PPI reporting practices will be extracted (by at least three researchers) from each HTA report using a standardised data extraction form. Descriptive analyses will be carried out to synthesise PPI reporting practices. Open Science Framework (https://osf.io/k6e3q/).

Care coordination constitutes a fundamental pillar for improving the efficiency of healthcare systems and ensuring the sustainable use of resources. The aim of this chapter is to demonstrate the impact of various coordination strategies on clinical practice variability, continuity of care, patient safety, user satisfaction and experience, as well as on the efficiency and sustainability of health systems. Effective healthcare coordination does not rely on a single intervention, but rather on the synergy between clinical, organizational, technological, and financial components. Reducing unwarranted variations requires a multifaceted approach, including the promotion of evidence-based practice, ongoing professional education, the implementation of clinical audits, and the reinforcement of shared decision-making. At the organizational level, the successful implementation of integrated care models requires a systemic approach tailored to the local context, with a long-term vision that prioritizes patient health outcomes, quality of care, efficiency, and system sustainability.

To describe the evolution of individually notifiable sexually transmitted infections diagnoses in the city of Barcelona between 2007 and 2024, and to analyse their association with sociodemographic variables and the type of reporting centre. Temporal trend analysis based on population-level data on cases of syphilis, gonorrhoea, chlamydia and lymphogranuloma venereum in the city of Barcelona. Annual incidence rates and adjusted incidence rate ratios were estimated using robust Poisson regression, adjusting for sociodemographic variables and stratifying by type of centre. Overall, 44.3% of diagnoses were made in community-based services, 30.6% in primary care and 24.9% in hospital-based care. Men accounted for 78.6% of cases and were predominantly diagnosed in community settings, whereas women were mainly diagnosed in primary care. Compared with the 25-34-year age group, the probability of being diagnosed in any type of care setting decreased with increasing age. Being born in Central or South America was associated with a 112% higher probability of diagnosis in primary care and a 144% higher probability in hospital care. Low socioeconomic status was associated with a 238% higher probability of diagnosis in primary care. Sexually transmitted infections diagnoses in Barcelona show potential inequalities by sex, country of birth and socioeconomic level, which are reflected in the type of healthcare setting where diagnoses are made. The COVID-19 pandemic appears to have accentuated these patterns, with a relative shift in diagnostic activity towards community-based services. Strengthening primary care and improving coordination between healthcare settings are needed to move towards a more equitable model of sexual health care.

To identify and evaluate the questions included in Spanish national and regional surveys on emerging tobacco products, and to assess whether these questions regarding electronic cigarettes (e-cigs) comply with the stablished recommendations. The websites of national and regional public organisms were reviewed to identify surveys that included questions on the consumption of emerging tobacco products, and to extract and evaluate the wording; for e-cigs, the alignment of the questions with the criteria recommended was assessed with an ad hoc scale. Three national and seven regional surveys were identified, of which nine assessed the exclusive use of e-cigs, three surveys assessed the exclusive use of water pipes and one assesses the use of e-cigs and/or heated tobacco products. With regard to e-cigs, the surveys differ in the questions used and do not follow the recommendations. Health and drug surveys conducted in Spain, at the national and regional levels, collect information on a limited number of emerging tobacco products, focusing primarily on e-cigs and, to a lesser extent, water pipes. Having detailed information on new forms of consumption, the characteristics of the device used in the case of e-cigs, the perceived risk, and the reasons for use can help evaluate prevention campaigns and public health measures.

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To advance towards a more responsive, equitable and sustainable model of primary care, it is necessary, among other actions, to move beyond the traditional structure centred on the roles of nurses and physicians. The existence of the primary care team is grounded in the principles established in the Declaration of Alma-Ata (1978). This article analyses the factors that currently hinder its effectiveness, based on the needs it is expected to address, and proposes criteria that may contribute to its improvement and further development, focusing efforts on providing comprehensive care to individuals from an individual, family and community perspective. Such development is possible by giving greater prominence to collaborative clinical management processes, as well as to training, communication and intra-team coordination, together with the assumption by all team members of new professional profiles and competencies, so that each activity is carried out by the professional most competent to do so. This transformation redefines professional roles, resulting in an interdisciplinary and multiprofessional team that brings together nurses, physicians and administrative staff with other professional roles -established roles that are not yet fully integrated into primary care teams-, such as physiotherapists, pharmacists, dentists, psychologists and nursing assistants. The aim is to jointly address diagnoses, treatments and care, as well as complex care processes, thereby enhancing problem-solving capacity and expanding care delivery beyond the physical structure of the health centre.

The objective of this paper is to describe and analyse the healthcare reform project in Chile following the 2019 social uprising. It outlines the progress, obstacles, and challenges within its historical context. Chile presents very positive health indicators, but also marked inequities stemming from the existing inequality in the country. The Chilean healthcare system has experienced a pendulum swing throughout its history, going from being one of the first integrated healthcare services in Latin America to becoming one of the best examples of the neoliberal model, before attempting to transition once again toward a social protection system with universal access and coverage. The arrival of President Boric to power in 2022 was accompanied by a program that established a conception of health as a social right, generating an agenda of transformations in the sector, consistent with the principles of universal healthcare. Although significant progress has been made (zero co-payments, universal Primary Health Care), the inability to pass the tax reform that would guarantee the structural financing of these changes, along with the difficulties in creating a Universal Health Fund and advancing the transformation of private health insurers (Isapres) into supplementary insurance providers, has significantly limited the scope of these transformations. The difficulties observed in Chile in moving towards a single insurance model demonstrate that the dismantling of welfare states proceeds much more easily than the strengthening of social protection.

This study analyzes the arguments underlying hesitation to receive any COVID-19 vaccine and how these discourses may have evolved throughout the pandemic. An exploratory, descriptive qualitative study was conducted in 2021-2022 in the province of Granada (Spain). Data were collected through four semi-structured interviews and three focus groups using theoretical sampling with individuals who expressed hesitancy toward COVID-19 vaccines. A thematic analysis was performed, leading to the development of a typology of vaccine-hesitant profiles. Participants' narratives about the origin of the virus ranged from moderate interpretations to conspiratorial explanations, while COVID-19 was perceived either as a mild illness or as one exaggerated by the media. The overabundance of information encouraged reliance on alternative sources and personal experience as evidence. Hesitant arguments clustered around two domains: scientific-public health concerns (including doubts about vaccine effectiveness, accelerated approval processes, components, and potential adverse ef fects) and ethical-political concerns (such as bodily autonomy, stigma, implicit mandates, and sociopolitical polarization). Four profiles of hesitancy were identified: empowered, infoxicated, paralyzed and resistant. These profiles reflecting different levels of agency, uncertainty, and distrust toward scientific and governmental institutions. The "neo-hesitancy" emerging around COVID-19 vaccines exhibits distinct features compared with "classical" vaccine hesitancy, incorporating a political dimension that undermines trust in health authorities and public health policies. Non-coercive, profile-specific strategies and transparent public communication that integrates scientific and community collaboration are recommended to strengthen preparedness for future health crises.