Rafael Bengoa is considered one of the 'fathers' of the Basque Health Service-Osakidetza. For 14 years he led the Directorate of Health Systems at the World Health Organization.

Bengoa believes that the sustainability of the public health system involves eliminating everything that does not provide any clinical value to patients. The option of privatizing health would do so, but it would cause enormous inequalities and would not solve the structural problems that health has such as human resources, primary care and the relationship with social services.