[Health crisis or crisis of medicine?]

The paper compares the existence of a crisis of medicine (characterised by a lack of assessment mechanisms of the medical treatment outcomes and their health alternatives) with a health crisis (characterised by the existence of health's determinants outside the health service area and the increase in the health demand) and the need to search for adequate solutions in order to solve them. We approach the problem from different standpoints. First, we search for ideas in the free market. Second, we propose several considerations on the "Health Maintenance Organisation" (HMOs) in the USA as well as on their limitations. Third, we study the radical proposals of change in Spain, Holland and the United Kingdom with the problems that competition can bring about, emphasizing the current difficulties in the British reforms and the lessons to consider from the Spanish case. Finally, the author concludes by pointing out the need for a more efficient use of resources and a better choice of priorities in Health.