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The Spanish National Health System ((スペイン語:Sistema Nacional de Salud), SNS) is the agglomeration of public health services that has existed in Spain since it was established through and structured by the ''Ley General de Sanidad'' (the "General Health Law") of 1986. Management of these services has been progressively transferred to the distinct autonomous communities of Spain, while some continue to be operated by the National Institute of Health Management (''Instituto Nacional de Gestión Sanitaria'', INGESA), part of the Ministry of Health and Social Policy (which superseded the Ministry of Health and Consumer Affairs—''Ministerio de Sanidad y Consumo''—in 2009). The activity of these services is harmonized by the Interterritorial Council of the Spanish National Health Service (''Consejo Interterritorial del Servicio Nacional de Salud de España'', CISNS) in order to give cohesion to the system and to guarantee the rights of citizens throughout Spain. Article 46 of the ''Ley General de Sanidad'' establishes the fundamental characteristics of the SNS: * a. Extension of services to the entire population. * b. Adequate organization to provide comprehensive health care, including promotion of health, prevention of disease, treatment and rehabilitation. * c. Coordination and, as needed, integration of all public health resources into a single system. * d. Financing of the obligations derived from this law will be met by resources of public administration, contributions and fees for the provision of certain services. * e. The provision of a comprehensive health care, seeking high standards, properly evaluated and controlled.〔 * a. La extensión de sus servicios a toda la población. * b. La organización adecuada para prestar una atención integral a la salud, comprensiva tanto de la promoción de la salud y prevención de la enfermedad como de la curación y rehabilitación. * c. La coordinación y, en su caso, la integración de todos los recursos sanitarios públicos en un dispositivo único. * d. La financiación de las obligaciones derivadas de esta Ley se realizará mediante recursos de las Administraciones públicas, cotizaciones y tasas por la prestación de determinados servicios. * e. La prestación de una atención integral de la salud procurando altos niveles de calidad debidamente evaluados y controlados. ( Ley 14/1986 General de Sanidad. Organización General de Sistema Sanitario Público ), noticias.juridicas.com.〕 == Antecedents to the SNS in Spain == Public intervention in collective health problems has always been of interest to governments and societies, especially in the control of epidemics through the establishment of naval quarantines, the closing of city walls and prohibitions on travel in times of plague, but also in terms of hygienic and palliative measures. Al-Andalus—Muslim-ruled medieval Spain—was distinguished by its level of medical knowledge relative to the rest of Europe, particularly among the physicians of the Golden age of Jewish culture in Spain. In the years after the ''Reconquista'', the ''Real Tribunal del Protomedicato'' regulated the practice of medicine in Spain and in its colonies. However, the system of medical faculties at the various universities was very decentralized. Surgery and pharmacy were quite separate from medicine and were considerably less prestigious; the systems of Galen and Hippocrates dominated medical practice during most of the era of the ''Antiguo Régimen''. Medicine was one of the principle fields of activity for the ''novatores'' of the late 17th century, but their initiatives were individualized and localized. There is some continuity from their work to the broader work during the Age of Enlightenment, such as through the Colegio de Cirugía de San Carlos ("San Carlos College of Surgery") in Madrid. At the beginning of the 19th century, the Balmis Expedition (1803) to administer the smallpox vaccine throughout the Spanish colonies was a public health undertaking of unprecedented geographical scope. The Cádiz Cortes debated a sanitary code (the ''Código Sanitario de 1812''), but nothing was approved due to lack of scientific and technical consensus about the actions to be undertaken. During the bienio progresista, the Law of 28 November 1855 established the basis for a General Health Directorate (''Dirección General de Sanidad''), which was created a few years later and which would last into the 20th century. The Royal Decree of 12 January 1904 approved the General Health Instruction (''Instrucción General de Sanidad''), which altered little of the 1855 scheme besides the name; the name would later change to General Inspectorate of Health (''Inspección General de Sanidad''). After the Spanish Civil War, the ''Ley de Bases de 1944'' perpetuated this . The Law of 14 December 1942 create a system of obligatory health insurance under the already extant National Insurance Institute (''Instituto Nacional de Previsión'', INP). The system was based on a percentage tax linked to employment. This was further modified by the General Law of Social Security (''Ley General de la Seguridad Social'') in 1974, toward the end of the Franco regime.〔Decreto 2065/1974, de 30 de mayo〕 Social Security had taken on an increasing number of diseases within its package of services, as well as covering a larger number of individuals and communities. The General Health Law (''Ley General de Sanidad'') of 25 April 1986 and the creation of Health Councils (''Consejerías de Sanidad'') and a Ministry of Health, fulfilled the mandate of the Spanish Constitution of 1978, in particular Articles 43 and 49 which made protection of health a right of all citizens, and Title VIII, which foresaw that purview over matters of health would devolve to the autonomous communities.〔(Ley 14/1986, de 25 de abril, General de Sanidad ), ''BOE'' number 102 of 1986-04-29, pages 15207–15224. (Text of the law, in Spanish.)〕 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Spanish National Health System」の詳細全文を読む スポンサード リンク
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