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Negrín MA, Ortún V. [Human resource management in health. Consensual paths forward. SESPAS Report 2024]. GACETA SANITARIA 2024; 38 Suppl 1:102394. [PMID: 38719697 DOI: 10.1016/j.gaceta.2024.102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 06/11/2024]
Abstract
Healthcare professionals deserve good management, and Spain, stagnant in its productivity, needs it. Good management is possible, as evidenced during the states of alarm in 2020. None of the lessons learned have been consolidated. Dismissing the term "public management" as an oxymoron is extreme, as there has never been a greater need for a well-functioning state, along with a better market, for reasons beyond the consolidation of the welfare state. The opposite extreme of thinking that salvation lies only within the civil service is also unhelpful. Bureaucratic sclerosis, a sign of deterioration, focused on legality or its appearance, cannot continue to ignore the need for effectiveness. The quality of management, both in general and in the healthcare sector, can be measured, and there is knowledge on how to improve it. More flexible models of labor relations -for selection, recruitment, and retention based on improved criteria of "equality, merit, and capability"- require modifications in institutional architecture, as proposed in this article: competitor benchmarking among autonomous centers and responsible entities that share standardized rules. The healthcare system, the jewel of the country, thanks in large part to the quality of its human resources, not only deserves to have its potential unleashed but can also lead the necessary increase in its resolution capacity, ensuring its impact on social well-being. It can also document its research and innovative capabilities in intellectual property, thereby contributing to the gross domestic product.
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Affiliation(s)
- Miguel Angel Negrín
- Departamento de Métodos Cuantitativos en Economía y Gestión, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - Vicente Ortún
- Centro de Investigación en Economía y Salud (CRES), Departamento de Economía y Empresa, Universitat Pompeu Fabra, Barcelona, España.
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2
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Molina-Oliva M, Martín-Sánchez R, Pastor-Benito E, Soto-Cámara R, Cárdaba-García RM, Thuissard IJ, Fernández-Domínguez JJ, Matellán-Hernández MP, Navalpotro-Pascual S, Morales-Sánchez A. Influence of Previous Mental State on Psychological Outcomes of Spanish Out-of-Hospital Professionals during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3574. [PMID: 36834266 PMCID: PMC9962449 DOI: 10.3390/ijerph20043574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to describe factors relating to the psychological distress of healthcare workers (HCWs) in Spanish out-of-hospital emergency medical services (EMS), according to the previous or non-use of psychotropic drugs or psychotherapy. A multicentre, cross-sectional descriptive study was designed. The study population were all physicians, nurses, and emergency medical technicians (EMTs) working in any Spanish out-of-hospital EMS between February and April 2021. The main outcomes were the levels of stress, anxiety, depression, and self-efficacy, assessed by DASS-21 and G-SES. Differences in levels of stress, anxiety, depression, and self-efficacy, according to sex, age, previous use of psychotropic drug or psychotherapy, work experience, professional category, type of work, and modification of working conditions were measured using the Student's t-test for independent samples, one-way ANOVA, Pearson's correlation, or 2-factor analysis of covariance. A total of 1636 HCWs were included, of whom one in three had severe mental disorders because of the pandemic. The interaction of the previous or non-use of psychotropic drugs or psychotherapy with the rest of the factors considered did not modify the levels of stress, anxiety, depression, and self-efficacy. However, HCWs with a history of psychotropic drug or psychotherapy use had a more intense negative emotional response and lower self-efficacy, regardless of their sex, professional category, type of work, or change in the working conditions. These HCWs are considered particularly vulnerable to the development or recurrence of new disorders or other comorbidities; therefore, the implementation of monitoring and follow-up strategies should be a priority.
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Affiliation(s)
- María Molina-Oliva
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
| | - Rafael Martín-Sánchez
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Department of Nursing, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
| | - Elena Pastor-Benito
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Emergency Medical Service of Madrid–SUMMA 112, 28045 Madrid, Spain
| | - Raúl Soto-Cámara
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain
| | - Rosa M. Cárdaba-García
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Department of Nursing, Faculty of Nursing, University of Valladolid, 47005 Valladolid, Spain
| | - Israel John Thuissard
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, European University of Madrid, 28670 Madrid, Spain
| | - Juan José Fernández-Domínguez
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Emergency Medical Service of Madrid–SUMMA 112, 28045 Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, European University of Madrid, 28670 Madrid, Spain
- Emergency Service, HLA Moncloa University Hospital, 28080 Madrid, Spain
| | - María Paz Matellán-Hernández
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
| | - Susana Navalpotro-Pascual
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
- Emergency Medical Service of Madrid–SUMMA 112, 28045 Madrid, Spain
- Department of Nursing, Faculty of Medicine, Autonomous University of Madrid, 2029 Madrid, Spain
| | - Almudena Morales-Sánchez
- Emergency Medical Service of Castilla y León–Sacyl, 47007 Valladolid, Spain
- Red de Investigación de Emergencias Prehospitalarias (RINVEMER), Sociedad Española de Urgencias y Emergencias (SEMES), 28020 Madrid, Spain
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Ayuso-Álvarez A, Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Fernández-Navarro P, González-Palacios J, Damián J, Galán I. Rural-urban gradients and all-cause, cardiovascular and cancer mortality in Spain using individual data. SSM Popul Health 2022; 19:101232. [PMID: 36188419 PMCID: PMC9516441 DOI: 10.1016/j.ssmph.2022.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
The literature reporting on rural-urban health status disparities remains inconclusive. We analyzed data from a longitudinal population-based study using individual observations. Our results show that the risks of all-cause and cancer mortality are greater in large cities than in other municipalities, with no clear urban-rural gradient. Not differences were found among territories in cardiovascular mortality.
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Affiliation(s)
- Ana Ayuso-Álvarez
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Sociology Department, Faculty of Economic and Business Sciences, Autonomous University of Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Pablo Fernández-Navarro
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier González-Palacios
- Bioinformatics and Data Management Group (BIODAMA), National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Javier Damián
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
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Manchon-Walsh P, Aliste L, Borràs JM, Coll-Ortega C, Casacuberta J, Casanovas-Guitart C, Clèries M, Cruz S, Guarga À, Mompart A, Planella A, Pozuelo A, Ticó I, Vela E, Prades J. Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8814. [PMID: 35886665 PMCID: PMC9322195 DOI: 10.3390/ijerph19148814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.
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Affiliation(s)
- Paula Manchon-Walsh
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Luisa Aliste
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Josep M. Borràs
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Cristina Coll-Ortega
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
| | - Joan Casacuberta
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Cristina Casanovas-Guitart
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Montse Clèries
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Sergi Cruz
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Àlex Guarga
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Anna Mompart
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Antoni Planella
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Alfonso Pozuelo
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Isabel Ticó
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Joan Prades
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
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Pérez-Ardanaz B, Peláez-Cantero MJ, González-Cano-Caballero M, Gutiérrez-Rodríguez L, Gómez-González AJ, Lupiáñez-Pérez I, Morales-Asencio JM, Canca-Sánchez JC. Utilization of Parallel Resources and Sociodemographic Factors in Treating Children with Complex Chronic Diseases: A Cross-Sectional Study. CHILDREN 2021; 8:children8110973. [PMID: 34828686 PMCID: PMC8624513 DOI: 10.3390/children8110973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022]
Abstract
Background: Children with complex chronic conditions have a high need for health and social care resources. Many parents explore parallel resources such as alternative therapies, associations, psychological support, private medical consultations, and other out-of-pocket expenses for healthcare. The use of these alternative health resources is sometimes unclear and may lead to health inequalities. To characterize the use made of alternative healthcare resources for children with complex chronic conditions. Additionally, we evaluate the influence of sociodemographic factors on the distribution of this utilization of resources; (2) Methods: Cross-sectional study. Children with complex chronic diseases were treated at a tertiary hospital in Granada, Spain in 2016. We analyzed their use of healthcare resources and socioeconomic variables. This research complies with STROBE guidelines for observational studies; (3) Results: In total, 265 children were analyzed (mean age 7.3 years, SD 4.63). A total of 105 children (39.6%) attended private consultations with specialists, and 12.1% (n = 32) of the children had additional private health insurance. One out three parents belonged to a mutual support association (n = 78), and 26% (n = 69) of the children used alternative therapies. Furthermore, 75.4% (n = 199) of the children received no psychological support. Children whose parents had a higher educational level and occupations status made greater use of parallel healthcare resources.; (4) Conclusions: A significant proportion of children used multiple health resources in addition to the public healthcare system depending on sociodemographic determinants. Studies are needed to determine whether the use of these alternative services achieves better levels of health.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | | | | | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | - Alberto José Gómez-González
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
| | - Inmaculada Lupiáñez-Pérez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951-952-833
| | - José Carlos Canca-Sánchez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (L.G.-R.); (A.J.G.-G.); (I.L.-P.); (J.C.C.-S.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
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Buceta BB, Lorenzo RB, Ramos AC, Silva ÁFD. Equity policies in health plans: accessibility and something more? Rev Saude Publica 2021; 55:31. [PMID: 34076210 PMCID: PMC8139844 DOI: 10.11606/s1518-8787.2021055002560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/01/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE: To examine the approach adopted by the health plans of the autonomous communities of Spain, verifying the weight given to the concept of equity; to detect referenced communities or situations, as well as to distinguish the perspective of approaching it, from access, equity or equalization. METHODS: Qualitative study, of content analysis using Nvivo12, carried out in 2020 on health plans in force since 2019 in the different regions (autonomous communities) of Spain. Sixteen current regional health plans were compiled to establish base categories (equity, accessibility and equality) and determine associated terms using Nvivo12, from which a content analysis was performed. RESULTS: The concept of equity is not emphasized in the regional health plans and its relevance is surpassed by the concepts of accessibility and equality. The use of these three concepts is associated with various categories indicating circumstances, conditions or groups to which the plans give greater attention. CONCLUSIONS: The results obtained coincide with previous studies on the contents and orientation of health plans, revealing a discrete presence of the concept of equity in the approaches adopted, although this does not undermine the alignment of health policies with the visions emanating from transnational organizations. It is detected the existence of a group to which special attention is given from the accessibility approach, the population with functional diversity.
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Affiliation(s)
- Bran Barral Buceta
- Universidade de Santiago de Compostela. Facultad de Ciencias Políticas y Sociales. Departamento de Ciencia Política e Sociología. Santiago de Compostela, Galicia, España
| | - Ramón Bouzas Lorenzo
- Universidade de Santiago de Compostela. Facultad de Ciencias Políticas y Sociales. Departamento de Ciencia Política e Sociología. Santiago de Compostela, Galicia, España
| | - Andrés Cernadas Ramos
- Universidade de Santiago de Compostela. Facultad de Ciencias Políticas y Sociales. Departamento de Ciencia Política e Sociología. Santiago de Compostela, Galicia, España
| | - Ángela Fernández da Silva
- Universidade de Santiago de Compostela. Facultad de Ciencias Políticas y Sociales. Departamento de Ciencia Política e Sociología. Santiago de Compostela, Galicia, España
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Mehta R, Tsilimigras DI, Pawlik TM. Assessment of Magnet status and Textbook Outcomes among medicare beneficiaries undergoing hepato-pancreatic surgery for cancer. J Surg Oncol 2021; 124:334-342. [PMID: 33961716 DOI: 10.1002/jso.26521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between hospital Magnet status recognition and postoperative outcomes following complex cancer surgery remains ill-defined. We sought to characterize Textbook Outcome (TO) rates among patients undergoing (HP) surgery for cancer in Magnet versus non-Magnet centers. METHODS Medicare beneficiaries undergoing HP surgery between 2015 and 2017 were identified. The association of postoperative TO (no complications/extended length-of-stay/90-day mortality/90-day readmission) with Magnet designation was examined after adjusting for competing risk factors. RESULTS Among 10,997 patients, 21.3% (n = 2337) patients underwent surgery at Magnet hospitals (non-Magnet centers: 78.7%, n = 8660). On multivariable analysis, patients undergoing HP surgery had comparable odds of achieving a TO at Magnet versus non-Magnet hospitals (hepatectomy: odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.94-1.17; pancreatectomy-OR: 0.88, 95% CI: 0.74-1.06). Patients treated at hospitals with a high nurse-to-bed ratio had higher odds of achieving a TO irrespective of whether they received surgery at Magnet (high vs. low nurse-to-bed ratio; OR: 1.38; 95% CI: 1.01-1.89) or non-Magnet centers (OR: 1.26; 95% CI: 1.10-1.45). Similarly, hospital HP volume was strongly associated with higher odds of TO following HP surgery in both Magnet (Leapfrog compliant vs. noncompliant; OR: 1.24, 95% CI: 1.06-1.44) and non-Magnet centers (OR: 1.18; 95% CI: 1.11-1.26). CONCLUSION Hospital Magnet designation was not an independent factor of superior outcomes after HP surgery. Rather, hospital-level factors such as nurse-to-bed ratio and HP procedural volume drove outcomes.
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Affiliation(s)
- Rittal Mehta
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Influence of Gender Determinants on Informal Care and Health Service Utilization in Spain: Ten Years after the Approval of the Equality Law. ADMINISTRATIVE SCIENCES 2021. [DOI: 10.3390/admsci11020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The existence of gender inequalities in health, in the use of health services, and in the development of informal care has been demonstrated throughout scientific literature. In Spain, a law was passed in 2007 to promote effective equality between men and women. Despite this, different studies have shown that the previous gender inequalities are still present in Spanish society. For all these reasons, the objective of this paper is to study the differences by sex in informal care and in the use of emergency care, and to identify the existence of gender inequalities in Spain 10 years after the adoption of the aforementioned equality law. In this case, we development a cross-sectional study based on the 2017 Spanish National Health Survey of the Spanish population aged 16 and over. To analyze the influence of gender determinants on informal care and emergency care utilization, logistic regressions were performed, model 1 was adjusted for age, and model 2 was further adjusted too by the variables of the Andersen care demand model. The results showed that informal care and the use of the emergency care continues to be higher in women than in men. Informal care in women was related to a higher level of education. In emergency care, the older the age, the lower the probability of utilization, and living in a rural municipality was related to a higher probability of utilization for both sexes. Finally, we concluded that there is still a need for studies that analyze gender inequalities in different contexts, such as the informal care and the use of health services. This is especially relevant in Spain, where economic changes have led to a change in roles, mainly for women, and new management strategies are needed to achieve equity in care and effective equality between men and women.
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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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Gaps in coverage and access in the European Union. Health Policy 2020; 125:341-350. [PMID: 33431257 DOI: 10.1016/j.healthpol.2020.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/04/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022]
Abstract
This study identifies gaps in universal health coverage in the European Union, using a questionnaire sent to the Health Systems and Policy Monitor network of the European Observatory on Health Systems and Policies. The questionnaire was based on a conceptual framework with four access dimensions: population coverage, service coverage, cost coverage, and service access. With respect to population coverage, groups often excluded from statutory coverage include asylum seekers and irregular residents. Some countries exclude certain social-professional groups (e.g. civil servants) from statutory coverage but cover these groups under alternative schemes. In terms of service coverage, excluded or restricted services include optical treatments, dental care, physiotherapy, reproductive health services, and psychotherapy. Early access to new and expensive pharmaceuticals is a concern, especially for rare diseases and cancers. As to cost coverage, some countries introduced protective measures for vulnerable patients in the form of exemptions or ceilings from user chargers, especially for deprived groups or patients with accumulation of out-of-pocket spending. For service access, common issues are low perceived quality and long waiting times, which are exacerbated for rural residents who also face barriers from physical distance. Some groups may lack physical or mental ability to properly formulate their request for care. Currently, available indicators fail to capture the underlying causes of gaps in coverage and access.
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11
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[Measures to contain gender-based violence during the COVID-19 pandemic]. GACETA SANITARIA 2020; 35:389-394. [PMID: 32404257 PMCID: PMC7181996 DOI: 10.1016/j.gaceta.2020.04.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
Las crisis, las emergencias y las épocas de disturbios se han relacionado con un aumento de la violencia interpersonal, incluida la violencia hacia las mujeres. A raíz de la declaración de estado de alarma y confinamiento se han puesto en marcha nuevas medidas encaminadas a paliar el posible impacto de la violencia de género (Plan de Contingencia contra la violencia de género ante la crisis del coronavirus o Real Decreto-Ley de medidas urgentes). Se revisan en este documento las medidas de contención adoptadas hasta el momento por el gobierno de España y las comunidades autónomas, y las iniciativas formuladas en diferentes países. Ante la ausencia de medidas económicas concretas planteadas hasta la fecha y el escenario de incertidumbre económica concluimos que no es posible prevenir la violencia de género de manera integral sin considerar el aumento del desempleo, la temporalidad y la inestabilidad laboral, la dependencia económica o la sobrecarga de tareas reproductivas, entre otros elementos que la facilitan.
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Moral Torres E, Fernández Fernández Ó, Carrascal Rueda P, Ruiz-Beato E, Estella Pérez E, Manzanares Estrada R, Gómez-García T, Jiménez M, Hidalgo-Vega Á, Merino M. Social value of a set of proposals for the ideal approach of multiple sclerosis within the Spanish National Health System: a social return on investment study. BMC Health Serv Res 2020; 20:84. [PMID: 32019531 PMCID: PMC7001370 DOI: 10.1186/s12913-020-4946-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disease that in many cases produces disability, having a high impact in patients' lives, reducing significantly their quality of life. The aim of this study was to agree on a set of proposals to improve the current management of MS within the Spanish National Health System (SNHS) and apply the Social Return on Investment (SROI) method to measure the potential social impact these proposals would create. METHODS A Multidisciplinary Working Team of nine experts, with representation from the main stakeholders regarding MS, was set up to agree on a set of proposals to improve the management of MS. A forecast SROI analysis was carried out, with a one-year timeframe. Data sources included an expert consultation, a narrative literature review and a survey to 532 MS patients. We estimated the required investment of a hypothetical implementation, as well as the potential social value that it could create. We calculated outcomes in monetary units and we measured intangible outcomes through financial proxies. RESULTS The proposed ideal approach revealed that there are still unmet needs related to MS that can be addressed within the SNHS. Investment would amount to 148 million € and social return to 272 million €, so each euro invested could yield almost €2 of social return. CONCLUSIONS This study could guide health interventions, resulting in money savings for the SNHS and increases in patients' quality of life.
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Affiliation(s)
- Ester Moral Torres
- Neurology Service, Moisès Broggi Hospital - General Hospital of l'Hospitalet, Barcelona, Spain
| | | | | | | | | | | | | | - Margarita Jiménez
- Pharmacoeconomics and Market Access Department, Weber, Madrid, Spain
| | - Álvaro Hidalgo-Vega
- Economy and Health Research Seminar, Universidad de Castilla-La Mancha, Toledo, Spain
| | - María Merino
- Health Outcomes Research Department, Weber, Calle Moreto, 17, 5 Dcha, 28014, Madrid, Madrid, Spain.
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13
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Badanta-Romero B, Lucchetti G, Barrientos-Trigo S. Access to healthcare among Chinese immigrants living in Seville, Spain. GACETA SANITARIA 2020; 35:145-152. [PMID: 32008864 DOI: 10.1016/j.gaceta.2019.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/10/2019] [Accepted: 09/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the use of healthcare services and factors associated with accessing them among Chinese immigrants living in Southern Spain. METHOD A mixed methodology was used. A cross-sectional survey was first administered to Chinese immigrants (n=133), and they were asked about their visits to the doctor, use of emergency services, and hospitalization. A phenomenological approach was then used with key informants (n=7). In the interviews, additional information, such as barriers and facilitators to improving accessibility, was explored. RESULTS In the previous year, 51% had visited a doctor and 34% had visited an Emergency Department. The main reasons for hospitalization were pregnancy (37.5%) and surgery (25%). At least 20% of the sample reported having never visited a doctor. Language difficulties and time constraints were identified as important barriers to accessibility. Sex differences were found among the reasons for lack of time, which, in men, were related to work (odds ratio [OR]=7.7) and, in women, were related to childcare (OR=12). The majority of Chinese immigrants preferred to use Traditional Chinese Medicine as their first treatment rather than visiting a doctor. CONCLUSIONS A lower use of health services was found among Chinese immigrants in Spain compared to the native population. When using health services, they choose acute care settings. Communication and waiting times are highlighted as major barriers. Adapting these demands to the healthcare system may help immigrants to trust their healthcare providers, thus increasing their use of health services and improving their treatment.
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Affiliation(s)
- Bárbara Badanta-Romero
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, Spain.
| | - Giancarlo Lucchetti
- School of Medicine, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Sergio Barrientos-Trigo
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, Seville, 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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15
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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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Ruiz-Azarola A, Escudero Carretero M, López-Fernández LA, Gil García E, March Cerdà JC, López Jaramillo D. [The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. GACETA SANITARIA 2018; 34:261-267. [PMID: 30554737 DOI: 10.1016/j.gaceta.2018.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/13/2018] [Accepted: 09/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.
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Affiliation(s)
- Ainhoa Ruiz-Azarola
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España.
| | - María Escudero Carretero
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biosanitaria de Granada, Granada, España
| | - Luis Andrés López-Fernández
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
| | | | - Joan Carles March Cerdà
- Escuela Andaluza de Salud Pública, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación Biosanitaria de Granada, Granada, España
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17
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March Cerdá JC. [The universalization of health and quality]. J Healthc Qual Res 2018; 33:309-310. [PMID: 30527345 DOI: 10.1016/j.jhqr.2018.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
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García-Altés A, Ruiz-Muñoz D, Colls C, Mias M, Martín Bassols N. Socioeconomic inequalities in health and the use of healthcare services in Catalonia: analysis of the individual data of 7.5 million residents. J Epidemiol Community Health 2018; 72:871-879. [PMID: 30082426 PMCID: PMC6161657 DOI: 10.1136/jech-2018-210817] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/16/2018] [Accepted: 07/18/2018] [Indexed: 12/03/2022]
Abstract
Background The aim of this study is to analyse the health status, the use of public healthcare services and the consumption of prescription drugs in the population of Catalonia, taking into consideration the socioeconomic level of individuals and paying special attention to vulnerable groups. Methods Cross-sectional study of the entire population resident in Catalonia in 2015 (7.5 million people) using administrative records. Twenty indicators are analysed related to health, the use of healthcare services and consumption of prescription drugs. Rates, frequencies and averages are obtained for the different variables stratified by age groups (under 15 years, 15–64 years and 65 years or older), gender and socioeconomic status (calculated on the basis of pharmacy copayment levels and Social Security benefits received). Results A socioeconomic gradient was observed in all the indicators analysed, in both sexes and in all age groups. Morbidity, use of mental healthcare centres, hospitalisation rates and probability of drug consumption among children is 3–7 times higher for those with low socioeconomic level respect to those with a higher one. In children and adults, the steepest gradient was found in the use of mental health services. Moreover, there are gender inequalities. Conclusion There are significant socioeconomic inequalities in health status and in the use of healthcare services in the population of Catalonia. To respond to this situation, new policies on health and other areas, such as education and employment, are required, especially those that have an impact on early years.
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Affiliation(s)
- Anna García-Altés
- Catalan Health System Observatory, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Dolores Ruiz-Muñoz
- Catalan Health System Observatory, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Cristina Colls
- Catalan Health System Observatory, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
| | - Montse Mias
- Catalan Health System Observatory, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
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Nombela-Monterroso K, González-Chordá VM, Roman P. Descriptive study of the Specialized Care of the Spanish Health System. Rev Saude Publica 2018; 52:5. [PMID: 29412372 PMCID: PMC5802722 DOI: 10.11606/s1518-8787.2018052000289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/02/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The objective of this study is to analyze the trend of the Key Indicators of the National Health System of Spain and its autonomous communities, related to Specialized Care, from the publication of the Law of Cohesion and Quality. METHODS This is an ecological study of temporary series of Spain and its autonomous communities from 2003 to 2014. We have analyzed 10 indicators related to Specialized Care (percentage of expenditure, professionals, waiting lists, surgical activity, average duration, infections, and mortality) using the Prais-Winsten regression method. We have obtained data from the health information system of the Spanish Ministry of Health, Social Services, and Equality. RESULTS Specialized care expenditure (APC = 0.059, 95%CI 0.041-0.074), number of medical professionals (APC = 0.0006, 95%CI 0.0003-0.0009) and nursing professionals (APC = 0.001, 95%CI 0.0005-0.0016), hospital infections (APC = 0.0003, 95%CI 0.0002-0.0004), and in-hospital mortality (APC = 0.0008, 95%CI 0.0006-0.001) had an increasing trend in Spain. Average duration presented a decreasing trend (APC = -0.0017, 95%CI -0.002- -0.0014). The trend of waiting lists (specialized appointment and non-urgent surgical interventions) was static. The trend of these indicators varied in the Autonomous Communities. CONCLUSIONS We have observed a non-compliance with the principles of equity and quality of the services offered. Increased aging, technological development, and inadequate strategies taken to reduce health costs may be the main causes.
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Affiliation(s)
| | | | - Pablo Roman
- Universidad Jaume I. Departamento de Enfermería. Castellón, España
- Universidad de Almería. Departamento de Enfermería, Fisioterapia y Medicina. Almería, España
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Inequalities in Health Services Usage in a National Health System Scheme: The Case of a Southern Social European Region. Nurs Res 2017; 67:26-34. [PMID: 29240657 DOI: 10.1097/nnr.0000000000000256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served. OBJECTIVE The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain. METHODS A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women. RESULTS Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]). DISCUSSION There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.
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Porthé V, Vargas I, Ronda E, Malmusi D, Bosch L, Vázquez ML. Has the quality of health care for the immigrant population changed during the economic crisis in Catalonia (Spain)? Opinions of health professionals and immigrant users. GACETA SANITARIA 2017; 32:425-432. [PMID: 28583698 DOI: 10.1016/j.gaceta.2017.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyse changes in health professionals' and immigrant users' perceptions of the quality of care provided to the immigrant population during the crisis. METHODS A qualitative descriptive-interpretative and exploratory study was conducted in two areas of Catalonia. Semi-structured individual interviews were used with a theoretical sample of medical (n=24) and administrative (n=10) professionals in primary care (PC) and secondary care (SC), and immigrant users (n=20). Thematic analysis was conducted and the results were triangulated. RESULTS Problems related to technical and interpersonal quality emerged from the discourse of both professionals and immigrants. These problems were attributed to cutbacks during the economic crisis. Regarding technical quality, respondents reported an increase in erroneous or non-specific diagnoses, inappropriate use of diagnostic tests and non-specific treatments, due to reduction in consultation times as a result of cuts in human resources. With regard to interpersonal quality, professionals reported less empathy, and users also reported worse communication, due to changes in professionals' working conditions and users' attitudes. Finally, a reduction in the resolution capacity of the health services emerged: professionals described unnecessary repeated PC visits and limited responses in SC, while young immigrants reported an insufficient response to their health problems. CONCLUSION The results indicate a deterioration in perceived technical and interpersonal quality during the economic crisis, due to cutbacks mainly in human resources. These changes affect the whole population, but especially immigrants.
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Affiliation(s)
- Victoria Porthé
- Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci de Salut i Social de Catalunya, Barcelona, Spain
| | - Ingrid Vargas
- Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci de Salut i Social de Catalunya, Barcelona, Spain
| | - Elena Ronda
- Departamento de Salud Pública, Universidad de Alicante, Alicante, Spain
| | - Davide Malmusi
- Direcció de Serveis de Salut, Ajuntament de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública, Spain
| | - Lola Bosch
- Unitat de Atenció al Ciutadà i Comunicació, Serveis de Salut Integrats del Baix Empordà, Palamós, Girona, Spain
| | - M Luisa Vázquez
- Grup de Recerca en Polítiques de Salut i Serveis Sanitaris (GRPSS), Servei d'Estudis i Prospectives en Polítiques de Salut, Consorci de Salut i Social de Catalunya, Barcelona, Spain.
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La salud pública y las políticas de salud: del conocimiento a la práctica. Informe SESPAS 2016. GACETA SANITARIA 2016; 30 Suppl 1:1-2. [DOI: 10.1016/j.gaceta.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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