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Diversity and regional inequalities in the Spanish 'system of health care services'

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  • Guillem Lopez-Casasnovas

    (Departament d'Economia i Empresa, Universitat Pompeu Fabra, Barcelona, Spain)

  • Joan Costa-Font
  • Ivan Planas

    (Departament d'Economia i Empresa, Universitat Pompeu Fabra, Barcelona, Spain)

Abstract

The consolidation of a universal health system coupled with a process of regional devolution characterise the institutional reforms of the National Health System (NHS) in Spain in the last two decades. However, scarce empirical evidence has been reported on the effects of changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines health care reform in Spain along with empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS. Results suggest that besides significant heterogeneity, once region-specific needs are taken into account, there is evidence of efficiency improvements whilst inequalities in inputs and outcomes, although more 'visible', do not appear to have increased in the last decade. Therefore, the devolution process in the Spanish Health System offers an interesting case for the experimentation of health reforms related to regional diversity but compatible with the nature of a public NHS, with no sizeable regional inequalities. Copyright © 2005 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1038
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 14 (2005)
Issue (Month): S1 ()
Pages: S221-S235

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Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s221-s235

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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References

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  1. Joan Costa & Jaume Puig, 2004. "Regulatory ambivalence and the limitations of pharmaceutical policy in Spain," Economics Working Papers 762, Department of Economics and Business, Universitat Pompeu Fabra.
  2. Joan Costa & Jaume Garcia, 2003. "Demand for private health insurance: how important is the quality gap?," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 587-599.
  3. Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Working Papers, Research Center on Health and Economics 745, Department of Economics and Business, Universitat Pompeu Fabra.
  4. Beatriz Gonzalez Lopez-Valcarcel & Patricia Barber Perez, 1996. "Changes in the efficiency of spanish public hospitals after the introduction of program-contracts," Investigaciones Economicas, Fundación SEPI, vol. 20(3), pages 377-402, September.
  5. Calonge Ramírez Samuel & Manresa Sánchez Antonio, 2001. "Incidencia fiscal y del gasto público social sobre la distribución de la renta en España y sus CC. AA," Books, Fundacion BBVA / BBVA Foundation, edition 1, number 201117.
  6. Mireia Jofre-Bonet, 2000. "Public health care and private insurance demand: The waiting time as a link," Health Care Management Science, Springer, vol. 3(1), pages 51-71, January.
  7. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & Citoni, Guido & Di Biase, Rita & Gerdtham, Ulf-G. & Gerfin, Mike & Gross, Lorna & Hakinnen, Unto, 1999. "The redistributive effect of health care finance in twelve OECD countries," Journal of Health Economics, Elsevier, vol. 18(3), pages 291-313, June.
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Citations

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Cited by:
  1. Angulo, Ana María & Barberán, Ramón & Egea, Pilar & Mur, Jesús, 2011. "An analysis of health expenditure on a microdata population basis," Economic Modelling, Elsevier, vol. 28(1-2), pages 169-180, January.
  2. Guillem López, 2006. "Organisational innovations and health care decentralisation: A perspective from Spain," Economics Working Papers 984, Department of Economics and Business, Universitat Pompeu Fabra.
  3. Galina Besstremyannaya & Jaak Simm, 2012. "The impact of private health insurers on the quality of Russian regional health systems," Working Papers w0177, Center for Economic and Financial Research (CEFIR).
  4. Fernando Sánchez-Martínez & José-María Abellán-Perpiñán & Jorge-Eduardo Martínez-Pérez & Jaume Puig-Junoy, 2006. "Cost accounting and public reimbursement schemes in Spanish hospitals," Health Care Management Science, Springer, vol. 9(3), pages 225-232, August.
  5. José-Ignacio Antón & Rafael Muñoz de Bustillo & Enrique Fernández Macías & Jesús Rivera, 2014. "Effects of health care decentralization in Spain from a citizens’ perspective," The European Journal of Health Economics, Springer, vol. 15(4), pages 411-431, May.
  6. Antón, José-Ignacio & Muñoz de Bustillo, Rafael & Fernández-Macías, Enrique & Rivera, Jesús, 2012. "Effects of health care decentralization in Spain from a citizens’ perspective," MPRA Paper 39423, University Library of Munich, Germany.
  7. Kristian Bolin & Anna Lindgren & Björn Lindgren & Petter Lundborg, 2009. "Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries," International Journal of Health Care Finance and Economics, Springer, vol. 9(1), pages 83-112, March.
  8. Fang, Pengqian & Dong, Siping & Xiao, Jingjing & Liu, Chaojie & Feng, Xianwei & Wang, Yiping, 2010. "Regional inequality in health and its determinants: Evidence from China," Health Policy, Elsevier, vol. 94(1), pages 14-25, January.
  9. Galina Besstremyannaya & Jaak Simm, 2014. "Multi-payer health insurance systems in Central and Eastern Europe: lessons from the Czech Republic, Slovakia, and Russia," Working Papers w0203, Center for Economic and Financial Research (CEFIR).
  10. Jorgen Lauridsen & Mariluz Sánchez & Mickael Bech, 2010. "Public pharmaceutical expenditure: identification of spatial effects," Journal of Geographical Systems, Springer, vol. 12(2), pages 175-188, June.
  11. Guillem López, 2006. "Organisational innovations and health care decentralisation: A perspective from Spain," Working Papers, Research Center on Health and Economics 984, Department of Economics and Business, Universitat Pompeu Fabra.
  12. Galina Besstremyannaya, 2014. "Urban inequity in the performance of social health insurance system: evidence from Russian regions," Working Papers w0204, Center for Economic and Financial Research (CEFIR).
  13. Jorgen Lauridsen & Mickael Bech & Fernando López & Mariluz Sánchez, 2010. "A spatiotemporal analysis of public pharmaceutical expenditure," The Annals of Regional Science, Springer, vol. 44(2), pages 299-314, April.

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