From an economic point of view, health care has been provided without taking into account spending levels for many years. And this is because health has been considered a pure and universal public good, and under this consideration, to value the levels of expenditure was considered secondary to the maintenance and recovery of health. Decisions on economic investments in material resources, welfare decisions, etc., were considered outside the chapters on expenditure, on the understanding that economic evaluation could not interfere with any consideration that affected the health of the population itself.

However, in recent years, the scarcity of funding has made health spending an enormously important consideration. The health administrations are exerting greater or lesser pressure for decisions to be taken in terms of efficient and sustainable health care costs.

At the centre of the debate has been placed the containment of expenditure which puts at the centre of health decisions, the way in which professionals carry out their work, in the same way as they monitor how health resources are used, which obliges professionals, on the one hand, to carry out practices aimed at guaranteeing the total quality of care and, on the other hand, to make spending responsible.

And this is why:

– Expenditure growth.

– The sustainability of universal health.

– The obligation of health organizations to be efficient.

– Awareness of sustainable spending and its relationship with the satisfaction of basic needs.

– Sustainable spending policies.

As it could not be otherwise, economic consideration in health has generated numerous conflicts and debates that have placed health spending at the center of the debate for two reasons.

The medicalisation of society. This is based on the fact that knowledge of the medical profession is at a level of importance above the levels of benefit it generates, that is, an unjustified excess of power. Among the causes we can find:

– The cession of health as an exclusive medical competence vis-à-vis the rest of the professionals.

– The consideration of a paternalistic medical model.

– Medical actions go beyond what is necessary and convenient.

– Health expenditure grows above health benefits.

– The confusion between the concept of health and healthcare expenditure.

– Attribution to medical knowledge of a higher value than the knowledge of other health professionals.

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