Will austerity cuts dismantle the Spanish healthcare system?

Legido‐Quigley, Helena; Otero, Laura Llorca; Parra, Daniel; Álvarez-Dardet, Carlos; Martín-Moreno, José M.; McKee, Martin

doi:10.1136/bmj.f2363

Cited by 158 publications

(132 citation statements)

References 19 publications

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“…According to Navarro 47 , the substantial cuts in public health are accelerating the growth of private spending, with further segmentation of the Spanish health system, including private healthcare for the wealthier social strata and a public system that treats lower-income strata. According to Legido-Quigley et al 48 , the current health system reform hides the underlying interest of siphoning public funds to the private sector.…”

Section: Spainmentioning

confidence: 99%

Crise econômica e desigualdades nos sistemas de saúde dos países do Sul da Europa

Serapioni

2017

Cad. Saúde Pública

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Section: Spainmentioning

confidence: 99%

Crise econômica e desigualdades nos sistemas de saúde dos países do Sul da Europa

Serapioni

2017

Cad. Saúde Pública

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“…However, with observational data alone we cannot establish whether the cause of a deterioration in the population's health, if any, is attributable to markets or governments, and among the latter, whether to those responsible for health or to public policy in general and the welfare state in particular. In these troubled waters, cutbacks in public health spending in developed countries have been associated with increases in mortality [2], and many medical research publications have defended the assertion that "austerity kills" [3,4], an idea which has become established in many sectors of society, including healthcare personnel [5] and in electoral programs. During the crisis, the word austerity (i.e., sobriety, the absence of excess) acquired a pejorative connotation [6].…”

Section: Introductionmentioning

confidence: 99%

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

López-Valcarcel

Pérez

2016

Appl Health Econ Health Policy

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This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambigously detected. The impact of the recession in the general population in diseases associated with mental health is well documented, although the high levels of unemployment are identified as direct causes, and therefore it is social policies rather than measures affecting the healthcare system that would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap. 3 Key points for decision makers Some health problems have a clear social dimension, which seems to have become more acute during the crisis  The public health system has borne a disproportionate share of the burden of spending cuts provoked by the crisis, but it has managed to avoid irreversible deterioration. The most tangible consequences of healthcare spending cuts and austerity measures concern problems of access to health care, both for specific population groups (undocumented immigrants) and for patients in general (longer waiting lists). The studies have common limitations: use of cross-sectional data and no consideration of lags between the cause (economic recession) and its effects (mortality, morbidity). In order to better estimate the effects of the crisis on health population, up-to-date data of cohorts from clinical records and registries would be needed. No attempt has been made in Spain so far to reform the health system with a view to achieving its long-term sustainability, in response to the 2008 recession and for preventing future recessions

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“…It is a term sometimes used by proponents, but more often by opponents and commentators, to describe attempts to cut national debt in relation to Gross Domestic Product (GDP) by decreasing expenditure on welfare and public services whilst increasing some taxes in the wake of the 2008 crisis (Blyth 2013, Konzelmann 2014. Throughout the post-2008 period austerity has been critiqued on multiple grounds, including that it is not achieving its stated aims (Guajardo et al 2014); that it is a fundamentally flawed idea that will necessarily worsen the problems that it is supposed to solve (Konzelmann 2014); that it is having devastating effects on public health (Karanikolos et al 2013, Legido-Quigley et al 2013; that it entrenches gender inequalities and disproportionately affects already disadvantaged groups of women (Griffin 2015, Montgomerie andTepe-Belfrage 2016); and even that it constitutes the end of democratic capitalism because capitalism no longer provides enough for enough people to sustain it democratically (Schäfer and Streeck 2013, Streeck 2014. Political contestation of austerity has taken many forms in this period, including the 15M, or Indignados, protests in Spain in 2011 (Hughes 2011, Castañeda 2012; an increase in various forms of anti-austerity social movement activity across Europe (Della Porta 2015, Giugni and Grasso 2015, Bailey et al 2016Flesher Fominaya 2017, Hayes 2017; the rise of new anti-austerity parties in Greece and Spain (Kioupkiolis 2016, Ramiro andGomez 2016); and the relative success of the Labour Party on an anti-austerity platform in the 2017 UK General Election (Berry 2017).…”

Section: Introductionmentioning

confidence: 99%

Contesting Actually Existing Austerity

Berglund

2017

New Political Economy

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The paper considers what it means to contest austerity and what political contestation of austerity says about how austerity as a political process should be conceived. It does so through separating a narrow view of austerity as fiscal consolidation from actually existing austerity as a broader political economic process ongoing in different ways in different countries. Through a case study of crisis, austerity and contestation as it relates to housing in Spain, the paper argues that to contest actually existing austerity it is necessary to contest both the wealth and power of the actors that have gained from austerity, not least finance capital. Through bank bailouts and the creation of a bad bank, the reforms demanded by the troika have opened up Spanish housing to direct wealth extraction by global finance capital whilst half a million households have been evicted and hundreds of thousands live with insurmountable debt. The Plataforma de Afectados por la Hipoteca (PAH, Platform for the Mortgage-Affected) has contested austerity in Spanish housing by contesting finance capital through civil disobedience whilst campaigning for anti-austerity reforms to housing and mortgage legislation, aiming to limit how housing can be a sphere of wealth extraction for finance capital. ARTICLE HISTORY

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Will austerity cuts dismantle the Spanish healthcare system?

Cited by 158 publications

References 19 publications

Crise econômica e desigualdades nos sistemas de saúde dos países do Sul da Europa

Crise econômica e desigualdades nos sistemas de saúde dos países do Sul da Europa

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

Contesting Actually Existing Austerity

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