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Pulido-Fuentes M, González LA, Reneo IA, Cipriano-Crespo C, Flores-Martos JA, Santos AP. Towards a liquid healthcare: primary care organisational and management strategies during the COVID-19 pandemic - a qualitative study. BMC Health Serv Res 2022; 22:665. [PMID: 35581581 PMCID: PMC9112637 DOI: 10.1186/s12913-022-07855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has changed the organisational and management strategies of healthcare institutions such as primary care centres. Organisational culture as well as leadership style are key issues for the success of these institutions. Due to the multidimensional nature of identity processes, it is necessary to explore the changes experienced by health professionals from these perspectives. This study explores health professionals' organisational and management strategies in primary care settings during the COVID-19 pandemic. DESIGN Qualitative, exploratory study based on the analysis of participants' accounts within a hermeneutic phenomenologicaly approach. METHODS Research was conducted in primary care settings in two neighbouring Spanish healthcare regions. The sample included participants with different demographics (gender, age), professional roles (practice managers, general practitioners, paediatricians), employment status (permanent, temporary, zero-hours), and years of experience (under or over ten years' experience). Data were collected between July and December 2020 through focus groups and in-depth, semi-structured individual interviews. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed and 15 participated in three focus groups. Of these, 78.4% were healthcare professionals, 49% were female nurses, and 70.5% had more than 10 years of work experience in primary care. Two main themes emerged: "liquid" healthcare and "the best healthcare system in the world". During the first wave of the COVID-19 pandemic, new, more fluid organisational and management models were implemented in primary care settings, which have remained in place since. Primary care workers' perceived a lack of appreciation and inclusion in decision-making that risked their alienation and disengagement. CONCLUSION Primary care workers' professional identity became gradually blurred due to shifting perceptions of their professional roles in a context of increasing improvisation and flexible working practices. This affected their professional performance. TRIAL REGISTRATION The study was approved by the Clinical Research Ethical Committee of the Talavera de la Reina Integrated Management Area (CEIm del AGI de Talavera de la Reina in Spain, Hospital Nuestra Señora del Prado, ref: 23/2020).
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Toledo Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - Isaac Aranda Reneo
- Faculty of Social Sciences, University of Castilla -La Mancha, 45600 Talavera de la Reina, Toledo Spain
| | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Avenida Real Fábrica de Sedas s/n, 45600 Talavera de la Reina, Toledo Spain
| | | | - Ana Palmar Santos
- Faculty of Medicine, Autonomous University of Madrid, Calle Arzobispo Morcillo n° 4, 28029 Madrid, Spain
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Cernadas A, Fernández Á. Healthcare inequities and barriers to access for homeless individuals: a qualitative study in Barcelona (Spain). Int J Equity Health 2021; 20:84. [PMID: 33743729 PMCID: PMC7980324 DOI: 10.1186/s12939-021-01409-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Spain, homeless individuals have lower perceived quality of health than the rest of the population and their life expectancy is 30 years lower than the national average. While the Spanish health system provides universal access and coverage, homeless individuals do not access or use public care enough to maintain their health. The objective of this study is to determine if homeless individuals can access public health services in conditions of equality with the rest of the population, as established in healthcare legislation, and to better understand the causes of observed inequalities or inequities of access. METHODS A detailed qualitative study was carried out in the city of Barcelona (Spain) from October 2019 to February 2020. A total of nine open and in-depth interviews were done with homeless individuals along with seven semi-structured interviews with key informants and two focus groups. One group was composed of eight individuals who were living on the street at the time and the other consisted of eight individuals working in healthcare and social assistance. RESULTS The participants indicated that homeless individuals tend to only access healthcare services when they are seriously ill or have suffered some kind of injury. Once there, they tend to encounter significant barriers that might be 1) administrative; 2) personal, based on belief that that will be poorly attended, discriminated against, or unable to afford treatment; or 3) medical-professional, when health professionals, who understand the lifestyle of this population and their low follow-through with treatments, tend towards minimalist interventions that lack the dedication they would apply to other groups of patients. CONCLUSIONS The conclusions derived from this study convey the infrequent use of health services by homeless individuals for reasons attributable to the population itself, to healthcare workers and to the entire healthcare system. Accordingly, to reduce inequities of access to these services, recommendations to healthcare service providers include adapting facilities to provide more adequate care for this population; increasing sensitivity/awareness among healthcare workers; developing in situ care systems in places where the homeless population is most concentrated; and establishing healthcare collaboration agreements with entities that work with this population.
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Affiliation(s)
- Andrés Cernadas
- Department of Political Science and Administration, Faculty of Political Science, Universidad de Santiago de Compostela, Campus Vida, S/N, 15782, Santiago de Compostela, Spain
| | - Ángela Fernández
- Department of Political Science and Administration, Faculty of Political Science, Universidad de Santiago de Compostela, Campus Vida, S/N, 15782, Santiago de Compostela, Spain. .,Graduate in Political Science and Master in Equality, Gender and Education, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
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Lostao L, Ronda E, Pascual C, Cea-Soriano L, Moreno A, Regidor E. Erosion of universal health coverage and trend in the frequency of physician consultations in Spain. Int J Equity Health 2020; 19:121. [PMID: 32660616 PMCID: PMC7359494 DOI: 10.1186/s12939-020-01234-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/02/2020] [Indexed: 11/15/2022] Open
Abstract
Background We studied the frequency of physician visits in the native and immigrant populations in Spain before and after implementation of a governmental measure to restrict the use of public healthcare services by undocumented immigrants beginning in 2012. Methods Data were taken from the 2009 and 2014 European Health Surveys carried out in Spain. We investigated any physician consultation in the last 4 weeks before the interview, as well as visits to a family physician, public specialist physician and private specialist physician. We estimated the frequency of visits in 2009 and in 2014 in the native and immigrant populations and the difference in the frequency between the two populations, by calculating the percentage ratio estimated by binomial regression and adjusted for different confounders that are indicators of the need for assistance. Results The percentage of persons who consulted any physician in 2009 and 2014 was 31.7 and 32.9% in the native population, and 25.6 and 30.1% in the immigrant population, respectively. In the immigrant population, the frequency of visits to the general practitioner and public specialist physician increased, whereas in the native population only public specialist physician visits increased. The frequency of private specialist visits remained stable in both populations. After adjusting for the indicators of need for healthcare, no significant differences between the immigrant and native populations were seen in the frequency of visits, except for private specialist consultations, which were less frequent among immigrants. Conclusion The restriction of universal healthcare coverage in Spain did not reduce the frequency of physician visits between 2009 and 2014, as the frequency of these consultations was seen to increase in both the native and immigrant populations.
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Affiliation(s)
- Lourdes Lostao
- Department of Sociology, Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain. .,I-COMMUNITAS-Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain.
| | - Elena Ronda
- Department of Preventive Medicine and Public Health, Universidad de Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cruz Pascual
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Lucía Cea-Soriano
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Almudena Moreno
- Department of Sociology, Medical Sociology, Universidad Pública de Navarra, Pamplona, Spain.,I-COMMUNITAS-Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Stoyanova A, Pinilla J. The Evolution of Mental Health in the Context of Transitory Economic Changes. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:203-221. [PMID: 31761976 DOI: 10.1007/s40258-019-00537-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Mental health disorders are highly prevalent across countries. They increase over time and impose a severe burden on individuals and societies. OBJECTIVE This paper examines the evolution of mental health over a period of 15 years, paying special attention on the impact of the most recent economic downturn and subsequent recovery, in Spain. METHOD We use data coming from the National Health Surveys of 2006/2007, 2011/2012 and 2016/2017. Mental health is proxied by two measures, doctor-diagnosed mental disorder and psychological distress (based on the 12-item General Health Questionnaire). To account for the relationship between the two mental health indicators, we estimate a bivariate probit model. The potential endogeneity of unemployment status is considered. RESULTS We observe different patterns of the two mental health indicators over time. Psychological distress in men increased during recession years, but slightly decreased among women. Diagnosed mental disorders declined during the peak years of the crisis. Unemployment is a major risk factor for mental distress. Irrespective of the economic conditions, belonging to a higher social class acts as a buffer against psychological distress for women, but not for men. The remaining determinants acted as expected. Women declared worse psychological health than men, and were also more often diagnosed with mental disorders. Having a partner had a protective impact, while providing intensive care to a dependent relative exerted the opposite effect. Education acted as buffer against the onset of psychological distress in women. CONCLUSION Even though the need for mental healthcare increased during the recession, the fact that fewer people were diagnosed suggests that barriers to accessing mental healthcare may be aggravated during the crisis. Policies aiming to tackle the challenges posed by the high prevalence of mental disorders have to be particularly attentive to changes in individuals' socioeconomic situation, including education, unemployment and social class.
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Affiliation(s)
- Alexandrina Stoyanova
- Department of Economics, Faculty of Economics and Business Administration, Universitat de Barcelona, BEAT and CAEPS, 08034, Barcelona, Spain.
| | - Jaime Pinilla
- Department of Quantitative Methods in Economics, Universidad de Las Palmas de Gran Canaria, 35017, Las Palmas de Gran Canaria, Spain
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Pinilla J, Negrín MA, Abásolo I. Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006-2017). Int J Equity Health 2019; 18:185. [PMID: 31783864 PMCID: PMC6883664 DOI: 10.1186/s12939-019-1092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/12/2019] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Methods Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Results Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. Conclusions The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.
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Affiliation(s)
- Jaime Pinilla
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Miguel A Negrín
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Ignacio Abásolo
- Departamento de Economía Aplicada y Métodos Cuantitativos, Instituto Universitario de Desarrollo Regional, Universidad de La Laguna, La Laguna, Santa Cruz de Tenerife, Spain. .,Facultad de Economía, Empresa y Turismo, Campus de Guajara, 38071, La Laguna, Santa Cruz de Tenerife, Spain.
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Alvarez-Galvez J, Suarez-Lledo V, Martinez-Cousinou G, Muniategui-Azkona E, Gonzalez-Portillo A. The impact of financial crisis and austerity policies in Andalusia, Spain: disentangling the mechanisms of social inequalities in health through the perceptions and experiences of experts and the general population. Int J Equity Health 2019; 18:108. [PMID: 31311553 PMCID: PMC6636099 DOI: 10.1186/s12939-019-1013-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/04/2019] [Indexed: 11/15/2022] Open
Abstract
Background Andalusia has been one of the regions most damaged by the economic crisis in Spain. A qualitative study of the effects of the economic crisis and austerity policies in this region has been conducted within the framework of the IMPACT-A project. This research seeks to analyse the perceived impact of the crisis upon the health of the Andalusian population through the first-hand discourses of professionals from the health and social sectors on the one hand, and citizens of different socioeconomic status (SES) on the other. Methods A total of five focus groups and ten semi-structured interviews were conducted and analysed following an inductive process based on Grounded Theory (GT). Results Our results show a general perception among professionals: the financial crisis has either directly or indirectly affected population health in Andalusia, though mostly impacting low-income individuals who were already at risk of social exclusion. Professionals’ perceptions have been confirmed through the discourses of citizens of a lower SES, which differ from those of middle and upper SES. Conclusion Findings reveal some of the most salient consequences on the socially vulnerable groups and people at risk of social exclusion. In particular, our study highlights the importance of addressing three areas of priority action: mental health, unmet (basic and medical) needs, and decline in the health system.
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Affiliation(s)
- Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain.
| | - Victor Suarez-Lledo
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cadiz, Spain
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Rodriguez-Alvarez E, Lanborena N, Borrell LN. Place of Birth Inequalities in Dental Care Use before and after the Economic Crisis in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101691. [PMID: 31091780 PMCID: PMC6572320 DOI: 10.3390/ijerph16101691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022]
Abstract
This study evaluates inequalities in the use of dental services according to place of birth before and after the economic crisis in Spain. A cross-sectional study was performed in adults aged 18 to 65 years in Spain. We used data from three Spanish National Health Surveys for the years 2006 (before the crisis), 2014, and 2017 (after the crisis). Log-binomial regression was used to quantify the association between place of birth and use of dental care services before and after controlling for the selected covariates. In 2006, we found a greater probability of not using dental care services in immigrants from Asia (PR: 1.36, 95% CI: 1.10-1.67) and Africa (PR: 1.16, 95% CI: 1.05-1.28) compared to the natives. For 2014, the probability of not using dental care services was greater for all immigrants relative to natives, with the greatest probability for those from Africa (PR: 1.71, 95% CI: 1.46-2.01) and Asia (PR: 1.3, 95% CI: 1.23-1.47). The associations for 2017 were weaker in magnitude than the ones observed for 2014, although stronger than for 2006. This study suggests that the economic recovery did not have the same impact for natives and immigrants regardless of regions of origin, given the observed inequalities in use of dental services.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), 48940 Leioa, Bizkaia, Spain.
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
| | - Luisa N Borrell
- OPIK-Research Group for Social Determinants of Health and Demographic Change, University of the Basque Country (UPV/EHU) 48940 Leioa, Bizkaia, Spain.
- Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY 10027, USA.
- Department of Surgery, Medical and Social Science. University of Alcalá, 28871 Madrid, Spain.
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Pérez-Morente MÁ, Sánchez-Ocón MT, Martínez-García E, Martín-Salvador A, Hueso-Montoro C, García-García I. Differences in Sexually Transmitted Infections between the Precrisis Period (2000⁻2007) and the Crisis Period (2008⁻2014) in Granada, Spain. J Clin Med 2019; 8:jcm8020277. [PMID: 30823520 PMCID: PMC6406728 DOI: 10.3390/jcm8020277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: To analyze the difference in the prevalence of sexually transmitted infections (STIs) between two time periods (2000–2007 and 2008–2014, with the latter period characterized by the economic crisis), as well as determine differences in sociodemographic factors, clinical care, and risk indicators. Methods: This was a retrospective, observational, and analytical study, reviewing 1437 medical records of subjects attending a specialized center in the province of Granada (Spain) for consultation associated with the presence or suspicion of an STI between 2000–2014. Data were collected on variables relating to the research objective. A descriptive and bivariate statistical analysis was performed by multiple logistic regression. Results: In the analysis comparing the presence of STIs between the crisis and non-crisis periods, the percentage of positive diagnoses reached 56.6% compared to 43.4% negative diagnoses during the non-crisis period, while the percentages were 75.2% and 24.8%, respectively, during the crisis period. This difference was statistically significant (p < 0.001) with an odds ratio (OR) of 2.21 after adjusting for age, sex, days since last unprotected sexual intercourse, and partners in the last year. Conclusions: There are significant differences in the prevalence of STIs between the study periods, which is consistent with the reports of some authors regarding the effect of the financial crisis on these conditions; however, it is worth considering other aspects that might explain the differences.
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Merino-Ventosa M, Urbanos-Garrido RM. Changes in income-related inequalities in cervical cancer screening during the Spanish economic crisis: a decomposition analysis. Int J Equity Health 2018; 17:184. [PMID: 30545425 PMCID: PMC6293596 DOI: 10.1186/s12939-018-0894-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/20/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cervical cancer is one of the most prevalent cancers, but it may be prevented by early detection. Social inequalities in the use of cytology testing have been identified in the literature. However, the degree of income-related inequality has not been quantified and determinants of inequality changes during the economic crisis remain unknown. METHODS Using the Spanish National Health Surveys (2006-07 / 2011-12), we analyzed how income-related inequalities in the use of cervical cancer screening for women aged 25-64 changed across the economic crisis. We used corrected concentration indices (CCI) which were further decomposed in order to compute the contribution of the explanatory variables. An Oaxaca-type approach was employed to investigate the origin of changes over time. RESULTS Our final sample consisted of 10,743 observations in 2006-07 and 6587 in 2011-12. Despite the higher prevalence of screening over time (from 73.9 to 77.9%), pro-rich inequality significantly increased (from CCI = 0.1726 to CCI = 0.1880, p < 0.001). Income was the main determinant of inequality in cervical screening, although its contribution decreased over time, as well as the contribution of the type of health insurance, mainly due to changes in elasticity. Other factors, such as nationality or the educational level, seem to have played an important role in the increase of pro-rich inequality of cytology testing. CONCLUSIONS Reducing cervical screening inequalities would require actions focused on most vulnerable groups such as migrants, low income and low educated population. The implementation of population-based screening programs would also help to cope with income-related inequalities in cytology testing.
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Affiliation(s)
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, School of Economics, Complutense University of Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Madrid, Spain
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10
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Soriano JB, Rojas-Rueda D, Alonso J, Antó JM, Cardona PJ, Fernández E, Garcia-Basteiro AL, Benavides FG, Glenn SD, Krish V, Lazarus JV, Martínez-Raga J, Masana MF, Nieuwenhuijsen MJ, Ortiz A, Sánchez-Niño MD, Serrano-Blanco A, Tortajada-Girbés M, Tyrovolas S, Haro JM, Naghavi M, Murray CJL. The burden of disease in Spain: Results from the Global Burden of Disease 2016. Med Clin (Barc) 2018; 151:171-190. [PMID: 30037695 DOI: 10.1016/j.medcle.2018.05.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 05/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. MATERIAL AND METHODS GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: 1) communicable, maternal, neonatal, and nutritional diseases; 2) non-communicable diseases (NCDs), and 3) injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. RESULTS There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959-402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902-17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208-16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. CONCLUSION Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.
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Affiliation(s)
- Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España; SEPAR, Barcelona, España.
| | - David Rojas-Rueda
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Josep M Antó
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Pere-Joan Cardona
- Institut Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Esteve Fernández
- Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Países Bajos; Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Fernando G Benavides
- Center for Research in Occupational Health, Universitat Pompeu Fabra (UPF), Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Varsha Krish
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - José Martínez-Raga
- Hospital Universitario Doctor Peset, Valencia, España; Universitat de Valencia, Valencia, España; University Cardenal Herrera CEU, Valencia, España
| | - Maria F Masana
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Miguel Tortajada-Girbés
- Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, España
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Christopher J L Murray
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
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Tolosana ES. Crisis, austeridad y áreas rurales: estudio cualitativo de las percepciones sobre los impactos en el sistema sanitario y la salud en Navarra, España. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018170745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumen La crisis financiera ha impulsado severas medidas de austeridad al sistema español de atención a la salud, entre las que se destacan la reducción del gasto público, la modificación del principio básico de cobertura universal, el copago y las reformas laborales. En este artículo se presentan los resultados de un estudio cualitativo sobre la percepción del personal sanitario y de la población de los impactos de la crisis en el sistema sanitario y de la salud en las áreas rurales. Se consideró la metodología cualitativa como la opción idónea para el estudio de un fenómeno complejo, en el que se buscó profundidad en su comprensión, teniendo en cuenta los significados y el contexto. El estudio se realizó en tres valles del Pirineo navarro. Se llevaron a cabo 22 entrevistas semiestructuradas a informantes clave y de perfiles no expertos, que fueron analizadas según el análisis sociológico del discurso. La desigual accesibilidad a los servicios de salud por parte de la población rural fue el factor identificado de forma unánime como la mayor amenaza y desafío para estos territorios. Una desigualdad que se consideró agravada en la población más envejecida. Las personas entrevistadas no refirieron un impacto negativo en la calidad del servicio de atención primaria, sino que lo localizaron en el entorno urbano y en la asistencia especializada. Los impactos diferenciados de las políticas en las zonas rurales exigen más investigación atendiendo a sus particularidades y de esta forma comprender el impacto específico de la crisis en estos territorios.
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12
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Borges FT, Fernández LAL, Campos GWDS. Políticas de austeridade fiscal: tentativa de desmantelamento do Sistema Nacional de Salud da Espanha e resistência cidadã. SAUDE E SOCIEDADE 2018. [DOI: 10.1590/s0104-12902018180043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este ensaio de natureza teórica analisa os ajustes fiscais colocados em marcha na Espanha como resposta à crise financeira de 2008, suas implicações para o Sistema Nacional de Salud (SNS) e a consequente resistência cidadã. Elaboramos um estudo de caso tendo como fonte primária a narrativa de um ator social que participou da reforma espanhola. Utilizamos também fontes secundárias para coleta de dados socioeconômicos e a análise de 20 artigos publicados pelo Relatório Sespas 2014. O SNS formou-se por aumento progressivo da cobertura populacional, financiamento total por impostos e organização da rede por meio da Atenção Primária em Saúde (APS). As medidas de austeridade fiscal impuseram limitações de ordem orçamentária, reduziram a provisão de serviços, introduziram copagamentos e retrocederam o direito à saúde à meritocracia. A corrente crítica da economia política sinaliza que o propósito dos ajustes econômicos é a transferência regressiva de renda e riqueza. As Mareas Ciudadanas constituíram-se numa resposta cidadã com êxito em muitas lutas sociais contra a austeridade fiscal. A alternativa de resistência e superação pela via política se fez presente com vigor na Espanha e tem resistido ao desmantelamento do SNS.
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13
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Peralta-Gallego L, Gené-Badia J, Gallo P. Effects of undocumented immigrants exclusion from health care coverage in Spain. Health Policy 2018; 122:1155-1160. [PMID: 30193979 DOI: 10.1016/j.healthpol.2018.08.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 08/02/2018] [Accepted: 08/22/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2012 the Spanish government passed Royal Decree-Law 16/2012 (RDL) aimed at containing public expenditure in response to the economic crisis. This RDL redefined just who would be entitled to public health care. As a result, a large proportion of undocumented immigrants in Spain were excluded from basic publicly financed health care with access only being granted under particular circumstances (emergency care, maternal care, children under 18, asylum seekers and victims of human trafficking). AIM The aims of this paper are to identify the specific traits of this policy, review its impact on health and health care access, and to evaluate its economic impact. RESULTS Most political parties and health professional groups opposed the RDL, and a large number of Spanish regions either declined to apply it or opted to apply it partially. To date, the RDL has had a considerable impact on the access of undocumented immigrants to public health care, with evidence suggesting that approximately 870,000 people have been excluded. A slight increase in infectious diseases has been reported, albeit not as high as originally predicted, and recent evidence points to an increase in mortality among this population subgroup. CONCLUSIONS Regional legislation favouring the coverage of undocumented immigrants might have acted as a counterweight and thus contained the negative health effects in this population subgroup. But the Constitutional Court invalidated all regional arrangements obliging regions to comply with the RDL.
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Affiliation(s)
| | | | - Pedro Gallo
- Department of Sociology, University of Barcelona, Spain
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14
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Soriano JB, Rojas-Rueda D, Alonso J, Antó JM, Cardona PJ, Fernández E, Garcia-Basteiro AL, Benavides FG, Glenn SD, Krish V, Lazarus JV, Martínez-Raga J, Masana MF, Nieuwenhuijsen MJ, Ortiz A, Sánchez-Niño MD, Serrano-Blanco A, Tortajada-Girbés M, Tyrovolas S, Haro JM, Naghavi M, Murray CJL. The burden of disease in Spain: Results from the Global Burden of Disease 2016. Med Clin (Barc) 2018; 151:171-190. [PMID: 30037695 DOI: 10.1016/j.medcli.2018.05.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/27/2018] [Accepted: 05/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The global burden of disease (GBD) project measures the health of populations worldwide on an annual basis, and results are available by country. We used the estimates of the GBD to summarise the state of health in Spain in 2016 and report trends in mortality and morbidity from 1990 to 2016. MATERIAL AND METHODS GBD 2016 estimated disease burden due to 333 diseases and injuries, and 84 risk factors. The GBD list of causes is hierarchical and includes 3 top level categories, namely: 1) communicable, maternal, neonatal, and nutritional diseases; 2) non-communicable diseases (NCDs), and 3) injuries. Mortality and disability-adjusted life-years (DALYs), risk factors, and progress towards the sustainable development goals (SDGs) are presented based on the GBD 2016 data in Spain. RESULTS There were 418,516 deaths in Spain in 2016, from a total population of 46.5 million, and 80.5% of them occurred in those aged 70 years and older. Overall, NCDs were the main cause of death: 388,617 (95% uncertainty interval 374,959-402,486), corresponding to 92.8% of all deaths. They were followed by 3.6% due to injuries with 15,052 (13,902-17,107) deaths, and 3.5% communicable diseases with 14,847 (13,208-16,482) deaths. The 5 leading specific causes of death were ischaemic heart disease (IHD, 14.6% of all deaths), Alzheimer disease and other dementias (13.6%), stroke (7.1%), chronic obstructive pulmonary disease (6.9%), and lung cancer (5.0%). Remarkable increases in mortality from 1990 to 2016 were observed in other cancers, lower respiratory infections, chronic kidney disease, and other cardiovascular disease, among others. On the contrary, road injuries moved down from 8th to 32nd position, and diabetes from 6th to 10th. Low back and neck pain became the number one cause of DALYs in Spain in 2016, just surpassing IHD, while Alzheimer disease moved from 9th to 3rd position. The greatest changes in DALYs were observed for road injuries dropping from 4th to 16th position, and congenital disorders from 17th to 35th; conversely, oral disorders rose from 25th to 17th. Overall, smoking is by far the most relevant risk factor in Spain, followed by high blood pressure, high body mass index, alcohol use, and high fasting plasma glucose. Finally, Spain scored 74.3 of 100 points in the SDG index classification in 2016, and the main national drivers of detrimental health in SDGs were alcohol consumption, smoking and child obesity. An increase to 80.3 points is projected in 2030. CONCLUSION Low back and neck pain was the most important contributor of disability in Spain in 2016. There has seen a remarkable increase in the burden due to Alzheimer disease and other dementias. Tobacco remains the most important health issue to address in Spain.
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Affiliation(s)
- Joan B Soriano
- Instituto de Investigación Hospital Universitario de la Princesa, Universidad Autónoma de Madrid, Madrid, España; SEPAR, Barcelona, España.
| | - David Rojas-Rueda
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Jordi Alonso
- IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Josep M Antó
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Pere-Joan Cardona
- Institut Germans Trias i Pujol, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, España; Universitat Autònoma de Barcelona, Barcelona, España
| | - Esteve Fernández
- Institut Català d'Oncologia (ICO)-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Alberto L Garcia-Basteiro
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Países Bajos; Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Fernando G Benavides
- Center for Research in Occupational Health, Universitat Pompeu Fabra (UPF), Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Scott D Glenn
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Varsha Krish
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Jeffrey V Lazarus
- Instituto de Salud Global de Barcelona, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - José Martínez-Raga
- Hospital Universitario Doctor Peset, Valencia, España; Universitat de Valencia, Valencia, España; University Cardenal Herrera CEU, Valencia, España
| | - Maria F Masana
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España
| | - Mark J Nieuwenhuijsen
- Instituto de Salud Global de Barcelona, Barcelona, España; IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, España; Universitat Pompeu Fabra (UPF), Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, España
| | - Alberto Ortiz
- IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, España
| | | | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Biomedical Research Networking Center in Epidemiology & Public (CIBERESP), Barcelona, España
| | - Miguel Tortajada-Girbés
- Hospital Universitario Doctor Peset, Valencia, España; Departamento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, España
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España; Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, España; Facultat de Medicina, Universitat de Barcelona, Barcelona, España; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, España
| | - Mohsen Naghavi
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
| | - Christopher J L Murray
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, Estados Unidos
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Córdoba-Doña JA, Escolar-Pujolar A, San Sebastián M, Gustafsson PE. Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain. PLoS One 2018; 13:e0195293. [PMID: 29601609 PMCID: PMC5877882 DOI: 10.1371/journal.pone.0195293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 03/20/2018] [Indexed: 12/30/2022] Open
Abstract
Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011–2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.
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Affiliation(s)
- Juan Antonio Córdoba-Doña
- Delegación Territorial de la Consejería de Salud de la Junta de Andalucía, Cádiz, Spain
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | | | - Miguel San Sebastián
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Per E. Gustafsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden
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16
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Fornell B, Correa M, López Del Amo MP, Martín JJ. Influence of changes in the Spanish labor market during the economic crisis (2007-2011) on perceived health. Qual Life Res 2018; 27:2095-2105. [PMID: 29478131 DOI: 10.1007/s11136-018-1824-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE We analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population. METHODS We use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences. RESULTS Unemployment (OR 1.75; p < 0.001), job insecurity (OR 1.38; p < 0.001), and being part of a household with severe material deprivation (OR 1.87; p = 0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p < 0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure. CONCLUSIONS This study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.
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Affiliation(s)
- Beatriz Fornell
- Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - Manuel Correa
- Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain.
| | - M Puerto López Del Amo
- Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
| | - José J Martín
- Applied Economics, University of Granada, Campus Universitario de Cartuja, 18071, Granada, Spain
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17
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Lostao L, Geyer S, Albaladejo R, Moreno-Lostao A, Ronda E, Regidor E. Use of health services according to income before and after elimination of copayment in Germany and restriction of universal health coverage in Spain. Int J Equity Health 2018; 17:11. [PMID: 29374481 PMCID: PMC5787305 DOI: 10.1186/s12939-018-0725-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 01/16/2018] [Indexed: 11/18/2022] Open
Abstract
Background In Germany copayment for medical consultation was eliminated in 2013, and in Spain universal health coverage was partly restricted in 2012. This study shows the relationship between income and the use of health services before and after these measures in each country. Methods Data were taken from the 2009 and 2014 Socio-Economic Panel conducted in Germany, and from the 2009 and 2014 European Health Surveys in Spain. The health services investigated were physician consultations and hospital admissions, and the measure of socioeconomic position used was household income. The magnitude of the relationship between socioeconomic position and the use of each health service in people from 16 to 74 years old was estimated by calculating the percentage ratio using binary regression. Results In Germany, after adjusting for age, sex, and need for care, in the model comparing the two lower income categories to the two higher categories, the percentage ratio for physician consultation was 0.97 (95% CI 0.96–0.99) in 2009 and 0.98 (95% CI 0.97–0.99) in 2014, and the percentage ratio for hospitalization was 1.01 (95% CI 0.93–1.10) in 2009 and 1.16 (95% CI 1.08–1.25) in 2014. In Spain, after adjusting for age, sex, and self-rated health, the percentage ratio for physician consultation was 0.99 (95% CI 0.94–1.05) in 2009 and 1.08 (95% CI 1.03–1.14) in 2014, and the percentage ratio for hospitalization was 1.04 (95% CI 0.92–1.18) in 2009 and 0.99 (95% CI 0.87–1.14) in 2014. Conclusion The results suggest that elimination of the copayment in Germany did not change the frequency of physician consultations, whereas after the restriction of universal health coverage in Spain, subjects with lower incomes had a higher frequency of physician consultations.
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Affiliation(s)
- Lourdes Lostao
- Department of Medical Sociology, Universidad Pública de Navarra, Campus de Arrosadía s/n, 31006, Pamplona, Navarra, Spain.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Romana Albaladejo
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Elena Ronda
- Department of Preventive Medicine and Public Health, Universidad de Alicante, Alicante, Spain
| | - Enrique Regidor
- Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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18
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Abstract
This study aims to analyze the differences in the use of primary care (PC), hospital, and emergency services between people born in Spain and immigrants. Data were obtained from the 2006 Spanish National Health Survey. The sample was composed of individuals aged 16-64 years from Spain and the seven countries with most immigrants in Spain (n = 22,224). Hierarchical multiple logistic regression models were fitted. Romanian men were less likely to use health care at all levels compared to men from other countries. Women from Argentina, Bolivia and Ecuador reported a lower use of PC. Among women, there were no differences in emergency visits or hospitalizations between countries. Bolivian men reported more hospitalizations than Spanish men, whereas Argentinean men reported more emergency visits than their Spanish counterparts. In Spain, most immigrants made less than, or about the same use of health care services as the native Spanish population.
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19
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Lopez-Valcarcel BG, Barber P. Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:13-21. [PMID: 27461007 DOI: 10.1007/s40258-016-0263-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system, but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambiguously detected. The impact of the recession on the general population in terms of diseases associated with mental health is well documented; however, the high levels of unemployment are identified as direct causes. Therefore, social policies rather than measures affecting the healthcare system would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap.
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Affiliation(s)
- Beatriz G Lopez-Valcarcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain.
| | - Patricia Barber
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus Tafira, 35320, Las Palmas de Gran Canaria, Spain
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20
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Urbanos-Garrido R. [Inequality in access to health care services. Policy recommendations aimed at achieving equity]. GACETA SANITARIA 2016; 30 Suppl 1:25-30. [PMID: 27004770 DOI: 10.1016/j.gaceta.2016.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This article reveals the presence of inequalities in access to health care that may be considered unfair and avoidable. These inequalities are related to coverage of clinical needs, to the financial problems faced by families in completing medical treatments, or to disparities in waiting times and the use of services for equal need. A substantial proportion of inequalities appears to have increased as a result of the measures adopted to face the economic crisis. The recommendations aimed at improving equity affect different pillars of the taxpayer-funded health system, including, among others, the definition of the right to public health care coverage, the formulas of cost-sharing, the distribution of powers between primary and specialty care, the reforms of clinical management, and the production and dissemination of information to facilitate the decision-making processes of health authorities, professionals and citizens. Moreover, it is recommended to focus on particularly vulnerable population groups.
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Affiliation(s)
- Rosa Urbanos-Garrido
- Departamento de Economía Aplicada VI, Universidad Complutense de Madrid, Pozuelo de Alarcón, Madrid, España.
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21
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Pereira PL, Casanova AP, Sanz-Barbero B. A "Before and After" in the Use of Emergency Services in Spain? The Impact of the Economic Crisis. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:430-47. [PMID: 26970455 DOI: 10.1177/0020731416636591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this study was to analyse whether variables associated with emergency services (ES) use in Spain have changed in the period 2006-2011 using a comparative analysis of the 2006 and 2011 Spanish National Health Surveys. The measure of association was the prevalence ratio with its 95% confidence interval, obtained by Poisson regression with robust variance. We studied interactions between the explanatory variables for ES use and year and subsequently performed a stratified analysis by year. ES use declined by 2.1% in 2011. Most emergency care (approximately 60% in both surveys) was provided in public hospitals. Between 2006 and 2011, ES use increased by 9% in women (p for interaction = 0.008) [ref. men], 3% in persons with poor mental health (p for interaction = 0.072) [ref. good mental health], and 8% in individuals with limitations on activities of daily living (p for interaction = 0.006) [ref. no limitations]. The change in the effect of the variables sex, mental health, and limitations on activities of daily living on use of ES (2006 and 2011) is not explained by either demographic characteristics or individual socioeconomic indicators. These results could be associated with macroeconomic and structural changes occurring during the period 2006-2011.
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Affiliation(s)
- Patricia López Pereira
- Department of Preventive Medicine and Public Health, University Hospital Ramón y Cajal, Madrid, Spain
| | - Ana Pagá Casanova
- Department of Preventive Medicine and Public Health, University Hospital Doctor Peset, Valencia, Spain
| | - Belén Sanz-Barbero
- Department of Epidemiology and Biostatistics. National School of Public Health, Institute of Health "Carlos III", Madrid, Spain CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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22
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Rodriguez-Alvarez E, Borrell LN, González-Rábago Y, Martín U, Lanborena N. Induced abortion in a Southern European region: examining inequalities between native and immigrant women. Int J Public Health 2016; 61:829-36. [PMID: 26898916 DOI: 10.1007/s00038-016-0799-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 01/29/2016] [Accepted: 02/05/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To examine induced abortion (IA) inequalities between native and immigrant women in a Southern European region and whether these inequalities depend on a 2010 Law facilitating IA. METHODS We conducted two analyses: (1) prevalence of total IAs, repeat and second trimester IA, in native and immigrant women aged 12-49 years for years 2009-2013 according to country of origin; and (2) log-binomial regression was used to quantify the association of place of origin with repeat and second trimester IAs among women with IAs. RESULTS Immigrants were more likely to have an IA than Spanish women, with the highest probability in Sub-Saharan Africa (PR 8.32 95 % CI 3.66-18.92). Immigrant women with an IA from countries other than Maghreb and Asia have higher probabilities of a repeat IA than women from Spain. Women from Europe non-EU/Romania were 50 % (95 % CI 0.30-0.79) less likely to have a second trimester IA, while women from Central America/Caribbean were 45 % (95 % CI 1.11-1.89) more likely than Spanish women. The 2010 Law did not affect these associations. CONCLUSIONS There is a need for parenthood planning programs and more information and access to contraception methods especially in immigrant women to help decrease IAs.
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Affiliation(s)
- Elena Rodriguez-Alvarez
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Spain.
- Social Determinants of Health and Demographic Change, OPIK, Leioa, Spain.
| | - Luisa N Borrell
- Social Determinants of Health and Demographic Change, OPIK, Leioa, Spain
- Department of Health Sciences, Lehman College, City University of New York, Bronx, NY, USA
| | - Yolanda González-Rábago
- Social Determinants of Health and Demographic Change, OPIK, Leioa, Spain
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Unai Martín
- Social Determinants of Health and Demographic Change, OPIK, Leioa, Spain
- Department of Sociology 2, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Nerea Lanborena
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Spain
- Social Determinants of Health and Demographic Change, OPIK, Leioa, Spain
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23
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Health Care Austerity Measures in Times of Crisis. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:283-99. [DOI: 10.1177/0020731415625251] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health.
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Bacigalupe A, Martín U, Font R, González-Rábago Y, Bergantiños N. [Austerity and healthcare privatization in times of crisis: are there any differences among autonomous communities?]. GACETA SANITARIA 2015; 30:47-51. [PMID: 26646086 DOI: 10.1016/j.gaceta.2015.10.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the differences between autonomous communities in Spain according to their policies of austerity and healthcare privatization during the economic crisis. METHODS Changes in the application of legal reforms, healthcare privatization and healthcare financing/resources in the autonomous communities were analysed, and a summary indicator of each dimension was constructed. RESULTS The Basque Country showed the clearest behaviour towards a weak policy of austerity and privatization, as opposed to La Rioja, Madrid, and the Balearic Islands. CONCLUSIONS The three classifications will enable analysis of the mediating effect of policies of austerity and privatization in the relationship between the economic crisis and health in the Spanish context.
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Affiliation(s)
- Amaia Bacigalupe
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España.
| | - Unai Martín
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Raquel Font
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España
| | - Yolanda González-Rábago
- Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, España; Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Leoia, Bizkaia, España
| | - Noemi Bergantiños
- Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Vitoria-Gasteiz, España
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25
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Aguilar-Palacio I, Carrera-Lasfuentes P, Solsona S, Sartolo MT, Rabanaque MJ. [Health-care utilization in elderly (Spain 2006-2012): Influence of health status and social class]. Aten Primaria 2015; 48:235-43. [PMID: 26388467 PMCID: PMC6877833 DOI: 10.1016/j.aprim.2015.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/18/2014] [Accepted: 01/22/2015] [Indexed: 11/30/2022] Open
Abstract
Objetivo Conocer la utilización de servicios sanitarios de Atención Primaria (AP), Atención Especializada (AE), hospitalizaciones, Hospital de Día y Urgencias, y la hiperfrecuentación en ancianos en España, analizando la influencia del estado de salud, sexo, clase social y evolución temporal. Diseño Estudio transversal en 2 fases. Emplazamiento España. Participantes Personas encuestadas en la Encuesta Nacional de Salud 2006 y 2011-12. Mediciones principales Como variables de salud se utilizaron la salud percibida y diagnosticada (número y tipo de diagnósticos). La clase social se obtuvo a partir de la última ocupación del sustentador principal (clases manuales y no manuales). Se realizaron análisis de regresión logística, ajustando por sexo, edad, nivel de salud, clase social y año, calculando su capacidad predictiva. Resultados El porcentaje de población mayor que utiliza consultas médicas descendió en el periodo estudiado. Las mujeres trabajadoras manuales presentaron la mayor prevalencia de mala salud (mala salud percibida en el 2006: 70,6%). La mala salud se asoció a mayor utilización de servicios sanitarios. La salud percibida fue mejor predictor de utilización de servicios y de hiperfrecuentación que la diagnosticada, con la mayor capacidad predictiva para AE (C = 0,676). Los ancianos de clases sociales bajas utilizaron con más frecuencia AP y Urgencias, mientras que la utilización de AE y Hospital de Día fue mayor en clases altas. Conclusiones Existen diferencias en salud y utilización de servicios sanitarios en mayores según clase social. Resulta necesario prestar atención a la salud percibida como predictor de la utilización de servicios sanitarios y revisar la accesibilidad-equidad de nuestros servicios.
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Affiliation(s)
- Isabel Aguilar-Palacio
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Santa Eulalia del Campo, Teruel, España.
| | - Patricia Carrera-Lasfuentes
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España
| | - Sofía Solsona
- Servicio de Geriatría, Hospital San José, Teruel, España
| | | | - M José Rabanaque
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Santa Eulalia del Campo, Teruel, España
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26
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Naranjo-Gil D, Ruiz-Muñoz D. [The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality]. GACETA SANITARIA 2015; 29:118-22. [PMID: 25554198 DOI: 10.1016/j.gaceta.2014.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 10/23/2014] [Accepted: 11/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. METHODS Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. RESULTS The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. CONCLUSIONS The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality.
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Affiliation(s)
- David Naranjo-Gil
- Departamento Economía Financiera y Contabilidad, Facultad de Ciencias Empresariales, Universidad Pablo de Olavide, Sevilla, España.
| | - David Ruiz-Muñoz
- Departamento Economía Financiera y Contabilidad, Facultad de Ciencias Empresariales, Universidad Pablo de Olavide, Sevilla, España
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27
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Garcia-Subirats I, Vargas I, Sanz B, Malmusi D, Ronda E, Ballesta M, Luisa Vázquez M, I M. Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:10182-201. [PMID: 25272078 PMCID: PMC4210974 DOI: 10.3390/ijerph111010182] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/17/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022]
Abstract
AIM To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis. METHODS Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year. RESULTS unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012. CONCLUSION Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.
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Affiliation(s)
- Irene Garcia-Subirats
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain.
| | - Belén Sanz
- National School of Public Health, Instituto de Salud Carlos III, Avda Monforte de Lemos 5, Pabellón 7, Madrid 28029, Spain.
| | - Davide Malmusi
- Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain.
| | - Elena Ronda
- Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain.
| | - Mónica Ballesta
- Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain.
| | - María Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain.
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