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La distribución territorial de los recursos sanitarios: Algunas propuestas

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  • Juan de Dios Jiménez Aguilera
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    Abstract

    RESUMEN Este trabajo resume algunas de las desigualdades territoriales en la oferta de servicios sanitarios y, en consecuencia, de las desigualdades en salud, en el caso de las Comunidades Autónomas españolas. Una de las causas de estas diferencias procede de los criterios de asignación de recursos, que cada vez se han ido distanciando del criterio capitativo simple. En concreto, el nuevo modelo de financiación territorial de la sanidad (2002) ha alterado la definición tradicional de necesidad, incorporando dos variables de ajuste al anterior criterio: población mayor de 65 años e insularidad. Un análisis de la convergencia en salud, medida en términos de esperanza de vida al nacer y ratios de mortalidad infantil, demuestra que no sólo no existe convergencia en salud, sino que, durante los últimos años se están abriendo divergencias en salud entre las provincias españolas. Por otro lado, una variable de control poco analizada ha sido la zona geográfica de residencia, de forma que la cuestión que se plantea es analizar en qué medida la residencia determina un distinto uso de los servicios sanitarios públicos. La implicación fundamental, a un nivel de política sanitaria territorial, es la gran cautela que debería seguirse a la hora de realizar ajustes ad hoc en el criterio poblacional para la distribución de recursos sanitarios. Concretamente, en el caso español, se puede recordar la escasa justificación de la actual fórmula de definición de necesidad sanitaria, particularmente, la incorporación de la población mayor de 65 años con mayor valor de ponderación. ABSTRACT This paper summarises some of the territorial inequalities in the delivery of health care services, and consequently inequalities in population’s health, for the Spanish Comunidades Autonomas. One of the causes for these differences comes from the criteria for allocating resources that has increasingly departed from the pure capitative system. In particular, the new health care financing model (2002) has changed the traditional definition of need, incorporating two new adjusting factors to the previous criterion: population older than 65 years old and insularity. An analysis of convergence in health status, proxied as life expectancy at birth and infant mortality rates, shows that health inequalities exist, and that these inequalities are increasing in recent years among Spanish provinces. On the other hand, since the area of residence of an individual has received little attention, this article explores to what extent the territory determines a different pattern of utilisation of the public health care services. The policy implication of these findings is that care should be taken in the selection of adjusting factors to allocate health care resources. This does not seem to be the case for Spain, where the introduction of a higher weight attached to the variable population older than 65 years old has had little justification in the current health care financing model.

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    Bibliographic Info

    Article provided by Universidades Públicas de Andalucía in its journal Revista de Estudios Regionales.

    Volume (Year): 01 (2007)
    Issue (Month): ()
    Pages: 75-107

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    Handle: RePEc:rer:articu:v:01:y:2007:p:75-107

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    Keywords: Financiación autonómica; Salud pública; Oferta sanitaria; Convergencia; Necesidad sanitaria;

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