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 1997 to 2014 to provide novel causal evidence on the short-term impact of health care provision on health outcomes. The fact that regional governments have discretionary powers in deciding health care 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 (2000) fixed effects model, we find that staff or hospital bed reductions account for a significant increase in mortality rates from cardiovascular disease and external causes, for 25-34 and 65-74 year-old groups, and in the late foetal mortality rate. Mortality rates, however, do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments. Contrary to expectations, we find some evidence of reduced mortality rates for cancer and female cancer as a result of the 2012 changes in migrants' access restrictions to the Spanish NHS. Overall, our analyses suggest that short-term impacts of decreases in health care provision on mortality are significant but small. However, impacts prove to be economically and quantitatively significant in the case of fatalities due to external causes, especially accidental deaths.
Using new statistical data on financing, coverage and economic and health care provisions, this article analyses how sickness insurance was introduced, managed and extended in Spain, under the Franco dictatorship, between 1939 and 1962. This article highlights how the dictatorship accelerated its implementation for political motives and this resulted in a failure of the system due to the lack of public financing and the high pharmaceutical, medical and infrastructure costs.
SummaryThe main aim of this paper is to analyse the singularity of the Spanish position with regard to coverage of the risk of sickness within the context of the different welfare models described in international literature. This analysis enables us to verify that in Spain, as in other countries, there were initially different forms of sickness coverage which coexisted, created by the market, by workers themselves and, gradually, by the state. Within this so-called mixed economy of welfare, the most extensive health coverage for the Spanish population was a result of the self-organization of workers, and this continued until the Civil War (1936–1939), not so much due to its efficacy and viability, as to the slow development of private insurance companies and the inability of the state to implement compulsory sickness insurance. The installation of the Franco dictatorship meant that the introduction of compulsory sickness insurance was further delayed, and when it was eventually passed, it offered only limited coverage, was enacted more for political than for social ends, and was to result in the virtual disappearance of friendly societies.
Reinsurance allows insurance companies to diversify their risks. However, from this original role, insurance companies have developed various reinsurance strategies in order to expand their market share. From the last decades of the nineteenth century to the 1940s, Spanish insurance companies used reinsurance in a largely unregulated context. This article analyses the reinsurance practices and their adaptation to the singularities of the Spanish market, namely: the difficulties for the consolidation of a core of pure reinsurers; the management of reinsurance in the internationalisation process; and the use of reinsurance by mutual societies to overcome their lack of equity capital.
Throughout history, healthcare, along with diet, has been an essential component of life and a country's welfare. In particular, a country's hospital system is a key indicator for analysing the level of welfare achieved by health coverage. From an economic history perspective, the study of hospital systems is relevant since they stem from public and private investment and produce positive externalities by creating employment and stimulating other economic sectors such as construction and health. Spain provides a significant case study for determining the factors of backwardness in the construction of a modern hospital system in a country on the European periphery. Moreover, it also helps us understand how, despite initial obstacles, this system had attained a significant degree of quality by the end of the twentieth century, as confirmed by its current international hospital rankings and even by the phenomenon of health tourism. The study analyses the creation of the Spanish hospital system during Franco's dictatorship and the transition to democracy. It reveals how the maintenance of a regressive tax system, the use of health policy as political propaganda, and disputes within the political elite of the dictatorship led to an inadequate and fragmented public hospital system, which had to collaborate with the private hospital system, was full of financial holes and tainted by corruption, and remained at the service of privileged groups.
This article analyzes the basic characteristics of the labor and social policies of the Franco dictatorship established in Spain after the Civil War (1936)(1937)(1938)(1939), and the links which existed between them. The offer of support to working families was presented through a paternalistic discourse of 'social justice' which was combined with tough repressive measures in the labor market. Within this context, compulsory social insurances pursued a political end, as they served to mitigate social tensions in a context of worker repression and harsh living conditions. Sickness insurance was a key element in this strategy, and it turned out to be very economical for the dictatorship, as the burden of financing the system was placed on employers and, above all, the workers themselves. This led to financial and management problems within a system providing imperfect coverage, with low benefits and serious inequalities in protection. Consequently, Spain moved away from other advanced countries which, at this time, were establishing their welfare states on the basis of two pillars: the universalization of benefits and the redistributive character of the system from a social point of view.
competencia o cooperación con el sector privado. El estudio pone en evidencia que el debate sanitario ha venido protagonizado por dos modelos diferentes de sanidad que se han enfrentado desde los primeros momentos de la transición hasta el presente. La herida entre estas dos facciones sigue abierta y el consenso global lejos de ser alcanzado.
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