Guillem López

Hospital costs in Catalonia: a stochastic frontier analysis

A multiproduct stochastic hospital cost frontier is estimated on panel data for 43 Catalan hospitals over the period 1988-91 on the assumption that inefficiency remains constant over time. In addition to reporting estimates of inefficiency, the paper reports estimates of economies of scope and economies of scale.

Diversity and Regional Inequalities: Assessing the Outcomes of the Spanish 'System of Health Care Services'

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 both changes in health inputs, outputs and outcomes, both at the country and at the regional level. This paper examines the empirical evidence on regional diversity, efficiency and inequality of these changes in the Spanish NHS using cross-correlation, panel data and expenditure decomposition analysis. Results suggest that besides significant heterogeneity, once we take into account region-specific needs 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 inequalitiest.

Finance Versus Costs for Teaching Hospitals in Spain

In this paper we analyse the observed systematic differences in costs for teaching hospitals (THhenceforth) in Spain. Concern has been voiced regarding the existence of a bias in the financing of TH’s has been raised once prospective budgets are in the arena for hospital finance, and claims for adjusting to take into account the ‘legitimate’ extra costs of teaching on hospital expenditure are well grounded. We focus on the estimation of the impact of teaching status on average cost. We used a version of a multiproduct hospital cost function taking into account some relevant factors from which to derive the observed differences. We assume that the relationship between the explanatory and the dependent variables follows a flexible form for each of the explanatory variables. We also model the underlying covariance structure of the data. We assumed two qualitatively different sources of variation: random effects and serial correlation. Random variation refers to both general level variation (through the random intercept) and the variation specifically related to teaching status. We postulate that the impact of the random effects is predominant over the impact of the serial correlation effects. The model is estimated by restricted maximum likelihood. Our results show that costs are 9% higher (15% in the case of median costs) in teaching than in non-teaching hospitals. That is, teaching status legitimately explains no more than half of the observed difference in actual costs. The impact on costs of the teaching factor depends on the number of residents, with an increase of 51.11% per resident for hospitals with fewer than 204 residents (third quartile of the number of residents) and 41.84% for hospitals with more than 204 residents. In addition, the estimated dispersion is higher among teaching hospitals. As a result, due to the considerable observed heterogeneity, results should be interpreted with caution. From a policy making point of view, we conclude that since a higher relative burden for medical training is under public hospital command, an explicit adjustment to the extra costs that the teaching factor imposes on hospital finance is needed, before hospital competition for inpatient services takes place.

The Effects of Poor Financial Information Systems on the Long Term Sustainability of Local Public Services. Empirical Evidence from the Catalan Municipalities

In this paper we describe the existence of financial illusion in public accounting and we comment on its effects for the future sustainability of local public services. We relate these features to the lack of incentives amongst public managers for improving the financial reporting and thus management of public assets. Financial illusion pays off for politicians and managers since it allows for larger public expenditure increases and managerial slack, these being arguments in their utility functions. This preference is strengthen by the short time perspective of politically appointed public managers. Both factors run against public accountability. This hypothesis is tested for Spain by using an unique sample. We take data from around forty Catalan local authorities with population above 20,000 for the financial years 1993-98. We build this data basis from the Catalan Auditing Office Reports in a way that it can be linked to some other local social and economic variables in order to test our assumptions. The results confirm that there is a statistical relationship between the financial illusion index (FI as constructed in the paper) and higher current expenditure. This reflects on important overruns and increases of the delay in paying suppliers, as well as on a higher difficulties to face capital finance. Mechanisms for FI creation have to do among other factors, with delays in paying suppliers (and thereafter higher future financial costs per unit of service), no adequate provision for bad debts and lack of appropriate capital funding either for reposition or for new equipments. For this, it is crucial to monitor the way in which capital transfers are accounted in local public sheet balances. As a result, for most of the Municipalities we analyse, the funds for guaranteeing continuity and sustainability of public services provision are today at risk. Given managerial incentives at present in public institutions, we conclude that public regulation recently enforced for assuring better information systems in local public management may not be enough to change the current state of affairs.

Hypothesis on Immigration and Welfare

The number of hypothesis trying to explain which are the reasons behind the decision to migrate to work into a developed country are diverse and at the same time, difficult to test due to the multiplicity of factors which affect it. This papers attempts to move forward trying to disentangle which are the socio-economic factors that explain the differences in the figures of immigrants in the OECD countries. We show empirical evidence about the determinants of the migratory flows to 17 OECD countries from 65 countries in the 1980-2000 period. Our results reveal the importance to differentiate the inflows composition by at least income in the origin countries. Thus, regarding inflows from non-high-income countries, the results suggest that there is a pull effect from monetary and not real income, and then, the welfare magnets hypothesis should be rejected. This group reacts more to the migratory policy than the inflows coming from high-income countries, although those policies designed to slow down the inflows have not been able, in the aggregate, to reduce them.

The Drift of Public Spending Towards the Elderly: A Generational Analysis of the Trend of Public Policies in Spain

The tendency for public welfare spending to be increasingly aimed at the elderly has been pointed out for the US and other developed countries. While population ageing is a common trend, it is not obvious why the shift in spending exceeds the trend in ageing, or why per capita spending on the elderly increases. We show that this is the case in Spain, identify the losers from this development, discuss the policies that underlie this trend, and propose adjustments based on Musgrave’s fixed proportions rule as an inter-generationally fair distribution.

A young woman with first-trimester metrorrhagia, fever and skin lesions

Inflammatory bowel disease commonly affects women with child-bearing potential, and clinical activity extent is most relevant at the time of conception. Below, we report on the case of a 19-year-old woman who was admitted for first-trimester metrorrhagia and fever, with various extraintestinal manifestations, mainly including erythema nodosum and episcleritis during the course of disease. The differential diagnosis of these manifestations led to the diagnosis of Crohns disease, which involved the whole colon.