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

Author

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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.

Suggested Citation

  • 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 221-235.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s221-s235
    DOI: 10.1002/hec.1038
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    File URL: http://hdl.handle.net/10.1002/hec.1038
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    References listed on IDEAS

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    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. 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.
    3. 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.
    4. 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.
    5. 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.
    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. 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.
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