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

  • 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)

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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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
Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. 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.
  2. Guillem López & Joan Costa-Font & Ivan Planas, 2004. "Diversity and regional inequalities: Assessing the outcomes of the Spanish 'System of Health Care Services'," Economics Working Papers 745, Department of Economics and Business, Universitat Pompeu Fabra.
  3. 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.
  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. 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.
  6. 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.
  7. 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.
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