[Identification and prioritization of interventions to improve efficiency in the National Health System]

To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government.

A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods.

The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high.

There are several opportunities to improve the efficiency of the Spanish NHS beyond the "anticrisis" measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.