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

BACKGROUND: In 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...

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Autores principales: Ridao-López, Manuel, Comendeiro-Maaløe, Micaela, Martínez-Lizaga, Natalia, Bernal-Delgado, Enrique
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131833/
https://www.ncbi.nlm.nih.gov/pubmed/30200956
http://dx.doi.org/10.1186/s12913-018-3445-7
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author Ridao-López, Manuel
Comendeiro-Maaløe, Micaela
Martínez-Lizaga, Natalia
Bernal-Delgado, Enrique
author_facet Ridao-López, Manuel
Comendeiro-Maaløe, Micaela
Martínez-Lizaga, Natalia
Bernal-Delgado, Enrique
author_sort Ridao-López, Manuel
collection PubMed
description BACKGROUND: In 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. METHODS: Ecological 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. RESULTS: Between 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. CONCLUSIONS: Utilization, 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 MATERIAL: The online version of this article (10.1186/s12913-018-3445-7) contains supplementary material, which is available to authorized users.
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spelling pubmed-61318332018-09-13 Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to Ridao-López, Manuel Comendeiro-Maaløe, Micaela Martínez-Lizaga, Natalia Bernal-Delgado, Enrique BMC Health Serv Res Research Article BACKGROUND: In 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. METHODS: Ecological 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. RESULTS: Between 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. CONCLUSIONS: Utilization, 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 MATERIAL: The online version of this article (10.1186/s12913-018-3445-7) contains supplementary material, which is available to authorized users. BioMed Central 2018-09-10 /pmc/articles/PMC6131833/ /pubmed/30200956 http://dx.doi.org/10.1186/s12913-018-3445-7 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ridao-López, Manuel
Comendeiro-Maaløe, Micaela
Martínez-Lizaga, Natalia
Bernal-Delgado, Enrique
Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title_full Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title_fullStr Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title_full_unstemmed Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title_short Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to
title_sort evolution of public hospitals expenditure by healthcare area in the spanish national health system: the determinants to pay attention to
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131833/
https://www.ncbi.nlm.nih.gov/pubmed/30200956
http://dx.doi.org/10.1186/s12913-018-3445-7
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