Law 14/1986, of 25 April, General of Health, establishes the regulation of actions conducive to the effectiveness of the right to health protection recognized in Articles 43 and concordant of the Constitution.

The content of this right has a double dimension, collective and individual. The guarantee of the former is partly covered by another fundamental right, that of enjoying an appropriate environment in the terms of Article 45 of the constitutional text itself, but it also requires specific actions of defence of the public health, by means of the health inspection of foodstuffs and other products for human use or consumption, in accordance with the provisions of the relevant legislation, in particular the technical-health regulations for products, activities and services, the application of which is controlled by the health services.

The decisive importance of the collective dimension of the right to health protection is complete with the unrenountable core of the personal dimension, that is, by the relationship of every person with his or her own well-being. physical and mental, which must be respected and promoted by the public authorities beyond the establishment of norms or guidelines of health in the environment in which life develops.

This personal aspect of the law requires the action of public authorities in the double plane of prevention, for which educational work aimed at the dissemination of healthy habits of conduct in life is fundamental. (i) the need to ensure that the health and safety of workers are not subject to the necessary conditions. This way of focusing the guarantee of the right is explicit in the formulation of article 43 of the Constitution, in shaping it as a right to the protection of health and not as a right to health, contracted exclusively to the reception of an assistance in the event of an accident or illness.

The same conception inspires, as is logical, the General Law of Health, whose article 3.1 establishes that " the means and actions of the health system will be oriented primarily to the promotion of health and prevention of diseases ". Preventive and restorative assistance, by means of benefits financed by Social Security or State resources assigned to health, is the capital function of the National Health System, in compliance with the provisions of Articles 41 and 43.2 of the Constitution, developed in Articles 3.2, 6, 18, 45 and concordant of the General Law of Health and taking into account the provisions of Article 101 of the General Law of Social Security of 30 May 1974.

Precisely, Article 3.2 of the repeated Law, when introducing the transcendental principle of the universalization of the right to health care, the apostille ordering that " access and health benefits will be realized under conditions of effective equality. " This provision is only the application, in this particular field, of the right to equality recognized in Article 14 of the Constitution, the effective implementation of which must promote public authorities, in particular the State of the Regulation of the basic conditions guaranteeing such equality when fundamental rights are at stake (Article 149.1.1), as is the case in the present case with those recognised in Articles 41, 43, 49, 50 and 51, all of which are constitutional.

In the normative framework defined by the applicable constitutional and legal precepts, this Royal Decree orders and systematizes the direct and personal health care and benefits of the National Health System, starting from the levels achieved by the different public health protection schemes, but accommodating them to the basic principles laid down in the General Health Law, as provided for in their final provision fourteenth. Among these principles, which develop and concretize those formulated in a more abstract and general way in the constitutional precepts mentioned above, the following should be noted:

(a) The universalization of the right to health care in all cases of health loss (Articles 1.2, 3.2, 6.4, 46.a, 81 and the fifth transitional provision of the Law).

b) In connection with the former, the guarantee of the substantial equality of the entire population in terms of health benefits and the non-existence of any kind of discrimination in the access, administration and the provision of health services (Articles 3.2, 10.1 and 43.2.f of the Law, in relation to Articles 14, 138.2, 139.1 and 149.1.1. of the Constitution).

c) The effectiveness, economy, rationalisation, organisation, coordination and integration of public health resources in order to make health benefits effective and maintain high levels of quality properly assessed and controlled (Articles 7, 46 and 51.1 of the Law).

(d) The determination of common minimum purposes or objectives and of basic and common minimum criteria for health care (Article 70.2, paragraphs b) and d) of the Law).

(e) The approval of the care and benefits of the public health system which, as soon as they are financed from the Social Security or the State funds assigned to the health system, must necessarily conform to the allocation of financial resources, in accordance with the provisions of Article 134.2 of the Constitution, in Article 81 of the General Health Law and in the General Budget Law of the State of each year.

(f) The claim of the cost of the services provided whenever a third party is required to pay or if they do not constitute Social Security benefits (Article 83 of the General Health Law and additional provision 22) of the recast text of the General Law on Social Security, adopted by Royal Legislative Decree 1/1994 of 20 June.

This provision is made in accordance with the provisions of Articles 9.2, 31.2, 41, 43, 49, 50, 51 and paragraphs 1, 16 and 17. of Article 149.1 of the Constitution.

In its virtue, on the proposal of the Minister of Health and Consumer Affairs, prior to the reports of the Sanitary Professional Organizations, the Council of Consumers and Users and the Interterritorial Council of the National Health System, agreement with the Council of State and after deliberation by the Council of Ministers at its meeting on 20 January 1995,

DISPONGO:

Article 1.

The National Health System will provide health care and assistance to the entire population, as provided for in Law 14/1986 of 25 April, General of Health, in this Royal Decree and other provisions resulting from the application.

Article 2.

1. They constitute health benefits, provided directly to the persons by the National Health System and financed by Social Security or State funds assigned to the health, as listed in Annex I to this Royal Decree.

2. These benefits shall be provided, in accordance with the rules governing the organisation, operation and arrangements of health services, by health professionals and primary health care services and by those of the specialties referred to in Article 1 (1). Article 3 (1) and (2) of the Annex to Royal Decree 127/1984 of 11 January 1984 on medical specialties; Royal Decree 992/1987 of 3 July 1987 on nursing specialties; first group of Article 3 of Royal Decree 2708/1982 of 15 October 1982 on specialisations of the pharmaceutical profession, or the rules which modify or replace them, and by other professionals, specialists and legally recognised health services.

3. In any event, the care, activities or services in which one of the following conditions is met shall not be considered to be included in the health benefits:

(a) That there is insufficient scientific evidence on their safety and clinical efficacy or that they are clearly exceeded by other available evidence.

(b) That their effective contribution to the prevention, treatment or cure of diseases, preservation or improvement of life expectancy, self-sufficiency and elimination or reduction of pain and pain is not sufficiently proven. suffering.

(c) Other activities of leisure, rest, comfort, sport, cosmetic or cosmetic improvement, use of water, spas or residential centres, or other similar activities, without prejudice to their possible care for social services or other nature.

Article 3.

1. The health care referred to in Annex II of this Royal Decree may be carried out in the field of the National Health System. However, as provided for in Article 83 of the General Health Law and the additional provision 22 of the recast text of the General Law on Social Security, adopted by Royal Legislative Decree 1/1994 of 20 June, the to claim the amount of the services made to the third parties obliged to pay.

2. It shall also make the claim for the amount of the services to users without the right to the assistance of the health services, admitted as private patients, in accordance with Article 16 of the General Health Law.

Article 4.

The benefits listed in Annex III to this Royal Decree will not be financed from funds from the General Budget of the State and from Social Security for health care. However, they may be carried out in the field of the National Health System, either from other public funds or from the individuals who request them.

Article 5.

1. The use of the benefits shall be made with the means available in the National Health System, in the terms and conditions provided for in the General Law of Health and other provisions that are applicable and respecting the principles of equality, proper and responsible use and prevention and punishment of cases of fraud, abuse or diversion.

2. The benefits listed in Annex I shall be payable only in respect of the personal, own or concerted staff, facilities and services of the National Health System, except as provided for in the international conventions.

3. In cases of urgent, immediate and vital health care, which have been taken care of outside the National Health System, the expenses of the system will be reimbursed, once it has been proven that the services could not be used in a timely manner. of that and that it does not constitute a deviant or abusive use of this exception.

Article 6.

1. Health services shall inform citizens of their rights and duties, of the benefits and services of the National Health System and of the requirements necessary for their use, as provided for in Articles 9, 10.2 and 11 of the General Law. Health.

2. The various health centres and establishments shall also provide information to the public about the services, services and activities which they carry out duly authorised.

Additional disposition first.

1. The incorporation of new diagnostic or therapeutic techniques or procedures, in the field of the benefits referred to in this Royal Decree, must be valued, in terms of their safety, efficacy and efficiency, by the Health Administration of the State, as provided for in Article 110 of the General Law on Health.

2. The Ministry of Health and Consumer Affairs may authorise, on its own initiative or on a proposal from the relevant health services and prior to its widespread application in the system, the use of certain techniques or procedures. for a limited period and in the form and with the guarantees it deems appropriate.

3. This provision is without prejudice to the assessment and promotion of the quality of care, the promotion and implementation of research and actions aimed at the prevention of diseases.

Additional provision second.

The incorporation of new health benefits from the National Health System, under the responsibility of Social Security or state funds assigned to health, will be carried out by Royal Decree, after the Council has been informed. Interterritorial of the National Health System and the opinion of the State Council and shall take into account its effectiveness, efficiency, safety and therapeutic usefulness, the advantages and the care alternatives, the care of groups less protected or of risk and social needs.

Additional provision third.

The pharmaceutical supply will be governed by its own provisions.

Additional provision fourth.

The attention to the problems or social situations or non-sanitary care that are present in the situations of illness or loss of health will have the consideration of social care, guaranteeing in any case the continuity of service through appropriate coordination by the relevant public administrations of health and social services.

Additional provision fifth.

The provisions of this Royal Decree do not affect the health services and activities carried out by the Autonomous Communities, with their own resources or by means of prices, fees or other income, according to their Statutes. of Autonomy and standards of development.

Additional provision sixth.

This Royal Decree is issued under the terms of Article 149.1, 1st, 16th and 17th, of the Constitution.

Single repeal provision.

As many provisions of equal or lower rank are repealed, they oppose the provisions of this Royal Decree, in particular:

1. Articles 1.1, 15, 18, 19, 21 to 30, 31, paragraphs 1 and 2, 32, 33 and the final provision of Decree 2766/1967 of 16 November on the provision of health care and management services medical services in the general system of social security.

2. Decree 1872/1971 of 23 July 1971, as soon as it amends the provisions of Decree 2766/1967 of 16 November 1967.

3. Decree 2575/1973 of 14 September 1973 amending Article 18 of Decree 2766/1967 of 16 November 1967.

Single end disposition.

The Minister of Health and Consumer Affairs will dictate how many provisions will require the application of what is established in this Royal Decree.

Given in Madrid on January 20, 1995.

JOHN CARLOS R.

The Minister of Health and Consumer Affairs,

MARIA ANGELES AMADOR MILLAN

ANNEX I

Health benefits, directly provided to persons by the National Health System and funded by Social Security or state funds attached to health.

1. Modalities of health benefits

1. Health benefits comprise the following modes:

a) Primary care.

b) Specialized care.

c) Pharmaceutical benefits.

d) Complementary benefits.

e) Health information and documentation services.

2. The preventive personal benefits are considered as integrated in the previous ones, in the form that is specified in each case.

3. The above mentioned benefits will also include preventive measures and health care that the health authorities consider necessary in the cases of diseases or communicable risks or health hazards. of the population, referred to in Articles 1 and 2 of the Organic Law 3/1986 of 14 April, of special measures in the field of public health.

2. Primary Care

In general, primary care will comprise:

a) Health care in consultation, services and health facilities.

b) Healthcare at the home of the patient.

c) The indication or prescription, and the execution, if any, by the primary care physician, of the basic diagnostic tests and means.

(d) Activities, scheduled by health services, in the field of health education, vaccinations, health examinations and other activities or measures planned for the prevention of diseases, health promotion or rehabilitation.

e) The administration of parenteral treatments and cures and minor surgery.

(f) Other services, services and services that are indicated or specified below.

1. Attention to women.

In addition to what has already been stated in general, primary care for women will be:

a) Early care and health monitoring of pregnancy.

b) Preparation for delivery.

c) The visit during the first month of postpartum.

d) The detection of risk groups and the early diagnosis of gynecological and breast cancer, in accordance with the programs established by the health services.

e) The treatment of the pathological complications of menopause, according to the health services programs.

2. Attention to childhood.

In addition to what has already been stated in general, primary care for minors, up to fourteen years of age, will include:

a) Health information and education to stakeholders and their parents, guardians, teachers, teachers, or caregivers.

b) Vaccinations according to the official health service calendar.

c) Reviews of the healthy child, according to programs established by the health services.

3. Adult and elderly care.

In addition to what has already been stated in general, primary care for those over fourteen years of age will include:

(a) The vaccinations recommended in the health services programs.

b) The detection of risk factors, where measures of proven effectiveness exist to eliminate or reduce them.

c) Education, health care and assistance to patients with chronic processes.

d) Attention to specific health problems, during the third age, as provided for in Article 50 of the Constitution.

e) Home care to immobilized patients and terminals.

4. Urgent Care.

Primary emergency care, to persons of any age, will be continued on a continuous basis, during the twenty-four hours of the day, through medical and nursing care, on an outpatient basis or at the address of the in cases where the situation of the patient so requires.

5. Focus on oral dental health.

Primary health care-dental health will include:

a) Information and education in the field of hygiene and dental health.

b) Preventive and care measures: application of topical fluorine, sealing, sealing of fissures or other, for children, according to the funding and special programs for the buco-dental health of each year.

c) Treatment of acute dental processes, including the extraction of dental parts.

d) Preventive screening of the oral cavity to pregnant women.

6. Other services, care and primary care benefits.

a) The application and replacement of vesical and nasogastric sondages.

(b) The referral or referral of patients to specialised care, by indication of the primary care physician, as referred to in paragraph 3, 2. (a).

c) Basic rehabilitation treatments, after medical indication, in accordance with the programs established by the health services.

d) The indication and follow-up of the various methods of contraception.

3. Specialist care

1. Modes of specialized assistance.

Care and specialist healthcare, once the possibilities for diagnosis and treatment of primary care are exceeded, will include:

a) Outpatient care specialized in consultations, which may include performing minor surgical procedures.

b) The outpatient care specialized in "day hospital", for those patients who require continued specialized care, physicians or nursing, including major surgery as soon as it does not require a hospital stay.

c) Specialist assistance in inpatient treatment, including medical, surgical, obstetric and pediatric care for acute processes, resharpening of chronic processes, or performing treatments or procedures diagnosis as advised.

d) Mental health care and psychiatric care, including clinical diagnosis and follow-up, psychopharmacotherapy and individual, group or family psychotherapies and, where appropriate, hospitalization, agreement with the provisions specified in the previous paragraph.

2. Access to specialized assistance.

a) Access to specialized outpatient care.

In general, access to specialized outpatient care will be performed at the indication of the primary care physician.

b) Access to inpatient care.

With a general nature, access to specialized care in the treatment of hospitalization will be done by the doctor or by the emergency services, when the patient is expected to be in need. special and continuous care, not to be provided on an outpatient basis or at home.

c) Access to referral hospital services.

Access to the reference hospital services shall be carried out on the basis of the other specialised services, in accordance with the procedure laid down by the health services, taking into account the provisions of the Article 15.2 of the General Law on Health.

3. Content of hospital care.

Specialist hospital care, except as set out in Annex III, shall comprise:

(a) The conduct of diagnostic tests and tests, including the neonatal examination, and the application of therapeutic treatments or procedures that the patient needs, whether or not their need is caused by the process or reason for admission and hospitalization.

(b) Treatment or surgical interventions aimed at the preservation or improvement of life expectancy, self-validation and elimination or reduction of pain and suffering.

c) Treatment of possible complications that may occur during the care process.

d) Rehabilitation.

e) Implantation of prostheses and their timely renovation.

f) Medication, cures, medicinal gases and fungible material and sanitary products that are accurate.

g) Food, according to the prescribed diet.

h) parenteral and enteral nutrition.

i) Stay in a shared room, or individual when the patient's special circumstances require it, including basic hotel services directly related to the hospitalization itself.

4. Health Care and Hospital Emergency Services.

Emergency care in hospitals will be provided, during the twenty-four hours of the day, to unadmitted patients suffering from an acute clinical situation requiring immediate attention from the hospital's services.

The patient's access to the hospital emergency service will be made by referral from the primary or specialized care physician or for reasons of urgency or vital risk that may require exclusive therapeutic measures of the patient. Hospital environment.

Emergency hospital care will include the diagnosis, first care and treatment needed to address the urgency or immediate need, assess the patient's process and circumstances, and refer to the patient's level of care. primary or specialised care deemed appropriate.

5. Other services and services.

Specialist health care shall also include, in accordance with the rules of organisation, operation and regime of health services, the following services and services:

a) Hemotherapy.

b) Diagnosis and treatment of infertility.

c) prenatal diagnosis in risk groups. d) Diagnosis by image: general radiology, ultrasound, mammography, computerized axial tomography (T.A.C.), magnetic resonance imaging, angiography and scintigraphy, as well as bone densitometry according to the health services programs.

e) Laboratory: pathological anatomy, biochemistry, genetics, hematology, immunology, microbiology and parasitology.

f) Renal lithotriy.

g) Family planning: genetic advice in risk groups, vasectomies, and tubal ligatures. Voluntary termination of pregnancy in the cases referred to in Organic Law 9/1985 of 5 July.

h) Interventional Radiology.

i) Radiation Therapy.

j) Transplants of the heart, cornea, liver, bone, bone marrow, skin, lung and kidney, in accordance with special legislation in the field.

4. Supplementary benefits

Complementary capabilities are those that provide an additional and necessary element for the achievement of comprehensive and appropriate healthcare.

Complementary benefits are considered to be ortho-prosthetic, sanitary transport, dietotherapy, and oxygen therapy at home.

1. Orthoprosthetic Prstation.

The orthoprosthetic capability includes the following capabilities:

a) Fixed surgical prostheses and their timely renovation.

b) Permanent or temporary orthopaedic prostheses (external prostheses) and their appropriate renovation.

(c) Vehicles for invalids, whose invalidity so advises.

The prescription of these benefits will be carried out by the doctors of specialized care, adjusting in any case to the established in the catalog duly authorized. The ortheses, dental prostheses and the special ones will be given or will give rise to an economic aid, in the cases and according to the scales that are established in the corresponding catalogue.

2. Health Transportation.

The provision of health transport comprises the special transport of sick or injured persons when one of the following circumstances is present:

(a) An emergency situation involving vital risk or irreparable damage to the health of the person concerned and so ordered or determined by the relevant person.

(b) The physical ability of the person concerned or other medical causes which, in the opinion of the doctor, prevent or incapacitate him for the use of ordinary transport to move to a health centre or to his home after receiving the corresponding health care.

The assessment of the need for the provision of health transport shall be the responsibility of the practitioner providing the assistance and its indication shall be solely for medical reasons which make it impossible to travel by means of transport. Ordinary transport.

3. Complex dietoterapic treatments.

This supplementary benefit includes the dietoterapic treatments indicated by the appropriate specialist physician for those suffering from certain metabolic disorders of carbohydrates (intolerance). Hereditary to galactose and/or galactosemia and transient situations of lactose intolerance in the infant) or amino acids.

4. º Oxigenotherapy at home.

This additional provision will be made by specialized centers or services, with the capacity to perform gas and spirometries, authorized by the health services.

5. Health information and documentation services

Constitute health and care information and documentation services:

1. Information to the patient and to his or her family or relatives, of their rights and duties, in particular, for the proper provision of informed consent and the use of the health system, as well as, where appropriate, other care services, for the benefit of their health, care, care and well-being.

2. The information and, where appropriate, processing of the administrative procedures necessary to ensure the continuity of the care process.

3. Issue of the parts of the discharge, confirmation, discharge and other reports or clinical documents for the assessment of the incapacity or other effects.

4. The discharge report, at the end of the stay in a hospital institution or the external consultation report for specialized care.

5. The medical documentation or certification of birth, death and other ends for the Civil Registry.

6. º The communication or delivery, at the request of the interested party, of a copy of his or her medical history or of certain data contained therein, without prejudice to the obligation of its conservation in the health center.

7. The issue of any other reports or certificates on the state of health arising from the other health benefits of this Annex or are required by law or regulation.

ANNEX II

Health care to be claimed from third parties

are obliged to pay

As provided for in Article 83 of the General Health Law, in the additional provision 22 of the recast text of the General Law on Social Security, adopted by Royal Legislative Decree 1/1994, of 20 June, in the Article 3 of this Royal Decree and other provisions resulting from application, public health services shall require third parties to pay the amount of care or health benefits provided directly to persons, including health transport, emergency care, hospital health care or extrahospitalaria and rehabilitation, in the following assumptions:

1. Health care provided to insured persons or beneficiaries of the Social Security System, belonging to the General Mutuality of Civil Servants of the State, General Judicial Mutuality or the Social Institute of the Armed Forces, which does not have been assigned, through the procedure laid down, to receive health care from the health network of social security.

2. Assistance provided to the insured or beneficiaries, in the cases of collaborating companies in the health care of the Social Security System, in those benefits whose care corresponds to the collaborating company according to the agreement or subscribed concert.

3. Health care provided in the cases of accidents at work or occupational diseases carried out by the Working Accident Mutuals.

4. Compulsory insurance.

a) School insurance.

b) The compulsory insurance of professional and federal athletes.

c) Mandatory motor vehicle insurance.

d) Mandatory passenger insurance.

e) Mandatory hunting insurance.

5. Conventions or concerts with other bodies or entities.

The amount of the assistance provided will be claimed, in accordance with the terms of the corresponding agreement or concert.

6. Others required to pay.

Any other case in which, by virtue of laws or regulations, other public or private insurance or third party liability for injuries or illnesses caused to the assisted person, the amount of the care or health benefits must be borne by the entities or third parties concerned and not by the common funds of the Social Security or the General Budget of the State attached to the health.

ANNEX III

Benefits that are not bankable by charge

to Social Security or State Funds Intended

to healthcare

1. The issue of health status reports or certificates other than those provided for in Annex I.

2. The examinations and examinations or biological tests voluntarily requested or carried out by third parties.

3. Cosmetic surgery that does not relate to accident, disease or congenital malformation.

4. Treatments in spas and rest cures.

5. Sex change surgery, except for the repair in pathological intersex states.

6. Psychoanalysis and hypnosis.