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The aim of this article is to analyse the roots of the Catalonia health reform, whose first projects on reform have been documented since 1917. This historical process set-up, in Catalonia, a hospital-centric model involving three sets of regenerating and mutually reinforcing institutions: financial resources were being disproportionally distributed to hospitals, high-quality medical professionals were largely concentrated in hospitals and large outpatient departments were incorporated in hospitals, which functioned as a first point of care for many patients. Based on these premises, the intention is to contribute to the understanding of the initiatives that, during much of the 20th century, took place in Catalonia with the aim of bringing access to hospital services to the population. These same organising principles also had decisive influence on hospital planning in the rest of Spain. As such, we develop an historical approach to public policies that have been shaping the current imbalance between hospitals and primary care providers in Catalonia by combining two methodologies. On the one hand, an overview of the existing literature on this topic. On the other, an accumulation of case studies –which does not claim to be exhaustive– the result of this very research and that of other specialists in the object of study. As Catalonia still has a hospital-centric health system seeded throughout the 20th century, these findings can inform the framing of contemporary options for primary care strengthening. Without addressing these deep regenerating causes using a whole-system approach, Catalonia is unlikely to achieve a primary care orientation for health system development.
