[Healthcare in Prisons: reflections on the inertia of systems and the low effectiveness of health policies in Spain]. / Sanidad Penitenciaria: reflexiones sobre la inercia de los sistemas y la baja efectividad de las políticas sanitarias en España.

The blockage in implementing transfer of prison health care to regional governments is a problematic social and health care issue, and also brings to light major institutional and political weaknesses. This article considers the power dynamics between administrations and levels, highlighting the subordinate nature of the health care agendas with regard to political and economic ones, as well as the sizeable capacity for blockage created by the environment itself. Within this context, some strategies are proposed to improve the future feasibility of the integration of prison health into the National Health System, based on the awareness of the need to accumulate power and influence, promote service improvements to increase the attractiveness and desirability of prison health, and the acceptance of more extended time scales so that cultural changes may take root.

Taxonomía práctica de la «desinversión sanitaria» en lo que no añade valor, para hacer sostenible el Sistema Nacional de Salud / Practical taxonomy of health care containment/disinvestment in non-value-added care in order to have a sustainable NHS

El entorno de severa contención de costes obligará a buscar de forma activa la sostenibilidad interna en los sistemas sanitarios; la desinversión en todos los servicios que no añaden valor es una de las herramientas a utilizar. En este artículo se aporta una taxonomía práctica para identificar los cuidados inefectivos, inseguros, innecesarios, inútiles, inclementes e insensatos, y se analizan las implicaciones en relación a pacientes ordenados por su gravedad y en función a las ganancias de salud esperables por la intervención. Finalmente se analiza la factibilidad de las políticas de desinversión en relación al ámbito macro-meso o micro de la gestión(AU)

The environment of severe cost containment has led to the active search of "internal sustainability" of health systems; the disinvestment in all non-value added services is one of the tools used. This article provides the taxonomy to identify ineffective, unsafe, unnecessary, unsuccessful, unkind and unwise care practices and discusses their implications in relation to patients ordered according to their severity, as well as the expected health gains of the intervention. Finally, the feasibility of those disinvestment policies is analysed according to macro-,middle, and micro-management scenarios(AU)

[Practical taxonomy of health care containment/disinvestment in non-value-added care in order to have a sustainable NHS]. / Taxonomía práctica de la «desinversión sanitaria¼ en lo que no añade valor, para hacer sostenible el Sistema Nacional de Salud.

The environment of severe cost containment has led to the active search of "internal sustainability" of health systems; the disinvestment in all non-value added services is one of the tools used. This article provides the taxonomy to identify ineffective, unsafe, unnecessary, unsuccessful, unkind and unwise care practices and discusses their implications in relation to patients ordered according to their severity, as well as the expected health gains of the intervention. Finally, the feasibility of those disinvestment policies is analysed according to macro-, middle, and micro-management scenarios.