Spain has a decentralized health system that operates as a network of 17 regional health services. It is publicly funded (mainly from taxes), and provides universal, free of charge, needs-based care coverage to the resident population of Spain. The Ministry of Health is responsible for the national health planning, coordination and regulation, but other competences such as the primary jurisdiction over-operational planning, resource acquisition, allocation and provision are devolved to the regional health authorities.1 In practice the regional health services, such as the Navarre Health Service, are organized into Health Departments (each one grouping several primary health care districts of more than 5000–25 000 people each) and are responsible for providing global health access to their reference population in primary, hospital and specialized outpatient care. However, it is worth noting that whereas the health assistance is free of charge, medicines and medical devices (including orthotics and prosthetics such as wheelchairs, hearing aids etc.) are subject to a co-payment,1 which is established on the basis of the economic income and employment status of each individual.