[Rebuilding the healthcare system: governance, organization and digitalization. SESPAS Report 2022]

Reflection on three major levers for rebuilding the healthcare system: governance, integration of health and social care and digitalization. Spain has worrying levels of quality of democracy and public confidence in its politicians, and major changes are required in public administration to achieve a better state. Healthcare suffers from a deficient institutional architecture that prevents adequate macrogovernance. There is also a lack of autonomy in the management of public health centers, which hinders competition by comparison, care integration and coordination within and between levels of care. The pandemic has highlighted the value of professionalism and has shown that agile healthcare management is possible, but the challenge is to maintain this flexibility outside state of alarm. Care integration is more necessary as the population ages (albeit healthily), and per capita financing is a powerful tool to achieve it. Digitization concerns practically all areas of healthcare and population health, and will bring with it far-reaching organizational changes, requiring new methods of evaluation that differ according to the degree of intrusiveness in individual health. Telemedicine, sponsored during the pandemic with a view to permanence, induces changes in labor relations, among others. It is necessary to measure the value of digital tools and technologies. Spain has a unique opportunity for its digital transformation, thanks to European funds.