The Llull-Cajal Model: towards a Spanish-style Bismarck model.

This working paper presents the Llull-Cajal Model, a comprehensive proposal for reforming the Spanish National Health System towards a regulated Bismarck-type system. The document analyzes the limitations of the current Spanish Beveridge model and proposes a transformation towards a compulsory social insurance scheme with managed competition, maintaining the principles of universality, solidarity, and financial protection.

The model is structured around six key dimensions: (1) health protection and regulation, (2) insurance and population coverage, (3) service provision and accessibility, (4) personnel management and social responsibility, (5) financing and sustainability, and (6) evaluation criteria and indicators.

Among the main proposals are: the centrality of Primary Care as the governance axis, a national reserve fund with sophisticated adjustments, professionalization and depoliticization of health management, the development of high-complexity monographic centers, complete digitalization with a single clinical record, systematic measurement of health outcomes (PROMs and PREMs), and strategic use of free patient circulation in the EU.

The document is developed in the context of a Master's degree in Hospital Management and represents a contribution to the debate on the sustainability and modernization of the Spanish NHS, aimed at improving equity, efficiency, and health outcomes for the population.