Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to

Abstract

BackgroundIn Spain, hospital expenditure represents the biggest share of overall public healthcare expenditure, the most important welfare system directly run by the Autonomous Communities (ACs). Since 2001, public healthcare expenditure has increased well above the GDP growth, and public hospital expenditure increased at an even faster rate. This paper aims at assessing the evolution of need-adjusted public hospital expenditure at healthcare area level (HCA) and its association with utilisation and ‘price’ factors, identifying the relative contribution of ACs, as the main locus of health policy decisions.MethodsEcological study on public hospital expenditure incurred in 198 (HCAs) in 16 Spanish ACs, between 2003 and 2015. Aggregated and annual log-log multilevel models, considering ACs as a cluster, were modelled using administrative data. HCA expenditure was analysed according to differences in population need, utilization and price factors. Standardised coefficients were also estimated, as well as the variance partition coefficients.ResultsBetween 2003 and 2015, over 59 million hospital episodes were produced in Spain for an overall expenditure of €384,200 million. Need-adjusted public hospital expenditure, at HCA level, was mainly associated to medical and surgical hospitalizations (standardized coefficients 0.32 and 0.28, respectively). The ACs explained 42% of the variance not explained by HCA utilization and ‘price’ factors.ConclusionsUtilization, rather than ‘price’ factors, may be explaining the difference in need-adjusted public hospital expenditure at HCA level in Spain. ACs, third-payers in the fully devolved Spanish National Health System, are responsible for a great deal of the variation in hospital expenditure.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3445-7) contains supplementary material, which is available to authorized users.

Lifetime risk, life expectancy, and years of life lost to type 2 diabetes in 23 high-income jurisdictions: a multinational, population-based study

“…The observation of decreased life expectancies in those with and without T2DM in Spain between 2010-11 and 2015-16 aligns with the decrease in Spanish public healthcare expenditure from 2009 following the global financial crisis. 16 The lowest life expectancies observed in Latvian and Lithuanian males are consistent with evidence showing a high prevalence of smoking and other highrisk behaviours among males of young and middle age in these countries, increasing the risk of fatal accidents and injuries. 17 Regarding years of life lost due to diabetes, the greatest values were observed in Israel's Clalit Health Services population, which may be in part explained by the fact that the Clalit health insurance database includes a high proportion of individuals of lower socioeconomic status (SES).…”

La atención especilizada del Sistema Nacional de Salud durante la Gran Recesión. Gasto, utilización y variabilidad en el periodo 2004-2015

“…Frente a la posibilidad de que durante el periodo 2010-2015, las áreas con mayor gasto hubieran atenuado su crecimiento en mayor proporción que las áreas con menos recursos, el gasto hospitalario creció -o decreció-en la misma proporción en ambos tipos de áreas, manteniéndose las desigualdades en niveles muy similares durante todo el periodo estudiado. En general, estos resultados serían coincidentes con otros trabajos recientes que han analizado la utilización y el gasto en el SNS (Ridao-López et al, 2018;Gorgemans et al, 2018).…”

Regional well-being inequalities arising from healthcare expenditure public policies in Spain

“…Compared to 2010, the budgets of the regions decreased by an average of 4.11%. In 2012, the health budget was cut by 14% ( 55 ) and 12% in 2013, albeit unevenly between regions ( 56 ). This research line claims that these reductions in public health spending may have been the cause of the poor outcome in the current health crisis caused by the SARS-CoV-2 virus ( 57 ).…”

“…Healthcare expenditure is affected by the cost of increasingly advanced technology and by the price of services, but fundamentally by the level of use of the system; for example, by the propensity to hospitalize or the induced demand ( 56 ). Therefore, strategies to reduce hospital stays, increase outpatient surgeries or even eliminate preoperative tests for those patients without a history of risk are some of the proposals made by researchers in this regard ( 56 , 67 ). However, physicians should not be prevented by the system from prescribing expensive diagnostic tests or treatments, as long as they are necessary for the patient's health.…”