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

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  • Guillem López

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  • Joan Costa-Font
  • Ivan Planas

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 both changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines the empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS using cross-correlation, panel data and expenditure decomposition analysis. Results suggest that besides significant heterogeneity, once we take into account region-specific needs 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 inequalitiest.

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Bibliographic Info

Paper provided by Department of Economics and Business, Universitat Pompeu Fabra in its series Economics Working Papers with number 745.

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Date of creation: Apr 2004
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Handle: RePEc:upf:upfgen:745

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Web page: http://www.econ.upf.edu/

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Keywords: Health expenditure; devolution; National Health System; regional inequalities; Spain;

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  1. Eulália Dalmau-Atarrodona & Jaume Puig-Junoy, 1998. "Market Structure and Hospital Efficiency: Evaluating Potential Effects of Deregulation in a National Health Service," Review of Industrial Organization, Springer, vol. 13(4), pages 447-466, August.
  2. Esther Martínez, 1998. "Las deducciones en el IRPF por gasto sanitario privado: situación actual y posibilidades de reforma," Economics Working Papers 307, Department of Economics and Business, Universitat Pompeu Fabra.
  3. 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.
  4. 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.
  5. Diego Prior & Magda Solà, 2000. "Technical efficiency and economies of diversification in health care," Health Care Management Science, Springer, vol. 3(4), pages 299-307, September.
  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. Guillem López-Casasnovas & Marc Saez, 1999. "The impact of teaching status on average costs in Spanish hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 8(7), pages 641-651.
  8. Esther Martínez, 1998. "Las deducciones en el IRPF por gasto sanitario privado: situación actual y posibilidades de reforma," Working Papers, Research Center on Health and Economics 307, Department of Economics and Business, Universitat Pompeu Fabra.
  9. Margherita Giannoni & Theodore Hitiris, . "The Regional Impact of Health Care Expenditure: the Case of Italy," Discussion Papers 99/20, Department of Economics, University of York.
  10. 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.
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Cited by:
  1. Joan Costa & Jaume Puig, 2004. "Regulatory ambivalence and the limitations of pharmaceutical policy in Spain," Working Papers, Research Center on Health and Economics 762, Department of Economics and Business, Universitat Pompeu Fabra.
  2. Joan Costa Font & Joan Gil Trasfi, 2007. "Generational Effects on Adult Height in Contemporary Spain: Exploring Gender and Individual Heterogeneity," Working Papers in Economics 169, Universitat de Barcelona. Espai de Recerca en Economia.
  3. Joan Costa Font & Jordi Pons Novell, 2005. "Public Health Expenditure and Spatial Interactions in a Decentralized National Health System," Working Papers in Economics 139, Universitat de Barcelona. Espai de Recerca en Economia.
  4. Joan Costa-Font & Ana Rico, 2006. "Vertical Competition in the Spanish National Health System (NHS)," Public Choice, Springer, vol. 128(3), pages 477-498, September.
  5. Guillem Lopez-Casasnovas & Joan Costa-Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish 'system of health care services'," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S221-S235.
  6. Izabela Karpowicz, 2012. "Narrowing Vertical Fiscal Imbalances in Four European Countries," IMF Working Papers 12/91, International Monetary Fund.
  7. Joan Costa-Font & Ana Rico, 2006. "Devolution and the Interregional Inequalities in Health and Healthcare in Spain," Regional Studies, Taylor & Francis Journals, vol. 40(8), pages 875-887.
  8. Costa-Font, Joan & Gil, Joan, 2008. "Generational effects and gender height dimorphism in contemporary Spain," Economics & Human Biology, Elsevier, vol. 6(1), pages 1-18, March.
  9. Joan Costa-Font & Francesco Moscone, 2008. "The impact of decentralization and inter-territorial interactions on Spanish health expenditure," Empirical Economics, Springer, vol. 34(1), pages 167-184, February.
  10. Hai Zhong, 2010. "The impact of decentralization of health care administration on equity in health and health care in Canada," International Journal of Health Care Finance and Economics, Springer, vol. 10(3), pages 219-237, September.

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