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The author comments in this paper on the recent literature on reforms in hospital reimbursement systems. Instead of taking a theoretical approach to this topic, the article adopts a "middle of the road" view, by looking at the consistency of applying some of these reforms (mainly on contract management and DRGs) in Public Health Systems. After recognising some of the existing problems in the management of public hospitals in Spain, the author advocates for a common sense strategy to health reforms in terms of the following: (i) at the time of implementing changes in the hospital sector keep targets defined as simple as possible, (ii) go to reforms through a step-by-step procedure, and (iii) whenever things look complex, use basic "house-keeping" economics, instead of just importing additional economic literature from abroad.

The aim of this paper is to review the current state of breast cancer screening in our country, as well as to discuss the most appropriate approaches for its development. Firstly, the impact of breast cancer in Spain is presented, as well as the current evidence about the efficacy of the screening. The major programs and initiatives addressed to promote screening are described. Finally, a few recommendations are given in order to achieve that breast cancer screening be, not only efficacious, but also effective. It is concluded that it is necessary that health and professional authorities coordinate and monitor breast cancer screening programs.