Clinical management levels.

The Spanish health system has undergone spectacular development in recent decades. It now provides universal access, almost without direct costs for patients, and achieves high levels of quality and excellence. However, in parallel with other Western countries’ health systems, the Spanish system is showing signs of strain as it faces ever-greater costs as a result of the increased resources needed to meet the health care demands of an aging population, diseases converting to chronic conditions, and new treatments and technologies becoming available to a growing number of patients. These factors, together with today’s budgetary constraints, make health systems extremely vulnerable, especially in the case of Spain.