Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'

The consolidation of a universal health system coupled with a process of regionaldevolution characterise the institutional reforms of the National Health System(NHS) in Spain in the last two decades. However, scarce empirical evidence hasbeen reported on the effects of both changes in health inputs, outputs andoutcomes, both at the country and at the regional level. This paper examinesthe empirical evidence on regional diversity, efficiency and inequality ofthese changes in the Spanish NHS using cross-correlation, panel data andexpenditure decomposition analysis. Results suggest that besides significantheterogeneity, once we take into account region-specific needs there is evidenceof efficiency improvements whilst inequalities in inputs and outcomes, althoughmore visible , do not appear to have increased in the last decade. Therefore,the devolution process in the Spanish Health System offers an interesting casefor the experimentation of health reforms related to regional diversity butcompatible with the nature of a public NHS, with no sizeable regionalinequalitiest.

TFC SIG - cobertura sanitaria en zonas de catástrofe

Comando para trabajar con Geomedia Professional 6.1, que extiende la funcionalidad de la herramienta para adaptarla a un escenario en el cual se ayuda a la gestión de la cobertura sanitaria en zonas de catástrofe, en nuestro caso Haití.

Prediction of the economic cost of individual long-term care in the Spanish population

Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.

The effects of a universal child benefit

I study the impact of a universal child benefit on fertility and family well-being. I exploitthe unanticipated introduction of a new, sizeable, unconditional child benefit in Spain in2007, granted to all mothers giving birth on or after July 1, 2007. The regressiondiscontinuity-type design allows for a credible identification of the causal effects. I find thatthe benefit did lead to a significant increase in fertility, as intended, part of it coming froman immediate reduction in abortions. On the unintended side, I find that families whoreceived the benefit did not increase their overall expenditure or their consumption ofdirectly child-related goods and services. Instead, eligible mothers stayed out of the laborforce significantly longer after giving birth, which in turn led to their children spending lesstime in formal child care and more time with their mother during their first year of life. Ialso find that couples who received the benefit were less likely to break up the year afterhaving the child, although this effect was only short-term. Taken together, the resultssuggest that child benefits of this kind may successfully increase fertility, as well asaffecting family well-being through their impact on maternal time at home and familystability.

Cost-containment in health care: The case of Spain from the eighties up to 1997

The purpose of this paper is to provide an overview of the evolutionof health care expenditure in Spain during the period 1980-1997, andhenceforth to comment on the cost containment measures put forwardto control its growth. The paper is divided into three separatesections. The first offers a brief description of the Spanish HealthCare System, with emphasis placed on the issue of expenditure controland health planning targets. The second part outlines a set of costcontainment measures that has accompanied the process of extendinguniversal health care coverage which occurred during the mentionedperiod and which has helped keep public expenditure under control.Finally, the third part describes some of the more recent proposalsfor reform of the Spanish Health Care Sector.

The impact of eliminating a child benefit on birth timing and infant health

We study the effects of the cancellation of a sizeable child benefit in Spainon birth timing and neonatal health. In May 2010, the government announced that a2,500-euro universal "baby bonus" would stop being paid to babies born startingJanuary 1, 2011. We use detailed micro data from birth certificates from 2000 to 2011,and find that more than 2,000 families were able to anticipate the date of birth of theirbabies from (early) January 2011 to (late) December 2010 (for a total of about 10,000births a week nationally). This shifting took place in part via an increase as well as ananticipation of pre-programmed c-sections, seemingly mostly in private clinics. We findthat this shifting of birthdates resulted in a significant increase in the number ofborderline low birth weight babies, as well as a peak in neonatal mortality. The resultssuggest that announcement effects are important, and that families and healthprofessionals may face effective trade-offs when deciding on the timing (and method) ofbirth.

Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants.