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Discusses primary health care reform in Spain to explore the influence of medical professionals in the state's attempts to reform the health care system. Both professional & private provider associations have worked through demonstrations, strikes, judicial appeals, & personal political connections to delay government control of medical services, & a large number of public physicians have chosen to remain outside the new network of care. Spain's autonomous regions have had varying results, with Navarra a high performer in the primary care field, & Galicia & Catalonia blocking policy implementation. The dangers of open confrontation with interest groups at the macropolitical level in the early stages of a reform effort were recognized. The government eliminated compulsory integration of doctors & did not force implementation by each region. Political visibility was reduced at the microlevel by narrowing the groups receiving selective negative incentives. On an institutional developmental level, the size & quality of public primary care manpower & infrastructure was progressively increased. The Spanish experience demonstrates circumstances where the federalist form of government faces difficulties in achieving welfare state development. 3 Tables, 1 Figure. L. A. Hoffman