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Austerity, healthcare provision, and health outcomes in Spain

Author

Listed:
  • Cristina Borra

    (Universidad de Sevilla)

  • Jerònia Pons-Pons

    (Universidad de Sevilla)

  • Margarita Vilar-Rodríguez

    (University of A Coruña)

Abstract

The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm’s (Q J Econ 115(2):617–650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees’ pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.

Suggested Citation

  • Cristina Borra & Jerònia Pons-Pons & Margarita Vilar-Rodríguez, 2020. "Austerity, healthcare provision, and health outcomes in Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(3), pages 409-423, April.
  • Handle: RePEc:spr:eujhec:v:21:y:2020:i:3:d:10.1007_s10198-019-01141-3
    DOI: 10.1007/s10198-019-01141-3
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    Cited by:

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    2. Laura Otero-García & José Tomás Mateos & Alexo Esperato & Laia Llubes-Arrià & Vanesa Regulez-Campo & Carles Muntaner & Helena Legido-Quigley, 2023. "Austerity Measures and Underfunding of the Spanish Health System during the COVID-19 Pandemic—Perception of Healthcare Staff in Spain," IJERPH, MDPI, vol. 20(3), pages 1-10, January.
    3. Andrea Ciaccio, 2023. "The Impact of a Cost-containment Measure on the Quality of Regional Health Services in Italy: a Parametric and a Non-parametric Approach," Working Papers 2023: 24, Department of Economics, University of Venice "Ca' Foscari".
    4. Cirulli, Vanessa & Marini, Giorgia, 2023. "Are austerity measures really distressing? Evidence from Italy," Economics & Human Biology, Elsevier, vol. 49(C).
    5. Emanuele Arcà & Francesco Principe & Eddy Van Doorslaer, 2020. "Death by austerity? The impact of cost containment on avoidable mortality in Italy," Health Economics, John Wiley & Sons, Ltd., vol. 29(12), pages 1500-1516, December.

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    More about this item

    Keywords

    Healthcare provision; Mortality; Health cuts;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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