José J. Martín

Review of the literature on the determinants of healthcare expenditure

This study reviews the literature on determinants of healthcare expenditure for the period 1998 to 2007. The methodology combines searches in the MesH database of PubMed with the search in the principal journals of Health Economics. 20 primary studies were found that met the criteria for inclusion. No single pattern of results is clearly identified. Among the 20 articles, four consider income to be the principal determinant of healthcare expenditure, two of them jointly with population ageing. Six highlight population ageing, as against six others that emphasize the proximity to death. The remaining six do not focus on a specific variable, or focus on another variable, e.g. technological progress or territorial decentralization. 11 of the 20 articles calculate the income elasticity of demand, only two of them obtaining a value greater than 1, thus cataloguing healthcare expenditure as a luxury good. There is, therefore, no unanimity in the variables and econometric regressions of healthcare expenditure in Organization for Economic Cooperation and Development (OECD) countries. No solid empirical evidence exists that population ageing is one of the principal determinants of healthcare expenditure, and factors such as technological progress, closeness to death and territorial decentralization of healthcare are increasingly seen as important in the development of explanatory models of healthcare expenditure.

Problemas de salud relacionados con los medicamentos en un servicio de urgencias hospitalario

Fundamento y objetivo Los problemas relacionados con los medicamentos (PRM) son problemas de salud que se producen como consecuencia de fallos de la farmacoterapia del paciente y que interfieren con los resultados esperados de salud. El objetivo de este trabajo es conocer los problemas de salud mas frecuentes que constituyen PRM. Pacientes y metodo La entrevista con el paciente junto con la evaluacion de la historia clinica son las principales fuentes de informacion para evaluar e identificar PRM. Se utilizo un cuestionario validado como instrumento para la entrevista y la CIE-9 para la clasificacion de los problemas de salud encontrados. Resultados Se entrevisto a un total de 2.556 pacientes durante 1 ano en el servicio de urgencies hospitalario, de los que se estudiaron 2.261 tras las exclusiones. Las enfermedades osteoarticulares, los signos y sintomas mal definidos y las lesiones y envenenamientos son los problemas mas relacionados con la aparicion de PRM. Los PRM de necesidad y efectividad mantienen un perfil similar. Los PRM de seguridad se asociaron mas a signos y sintomas mal definidos y lesiones y envenenamientos asi como a alteraciones nerviosas, digestivas y sanguineas. Conclusiones Los PRM mas frecuentes que son causa de consulta en un servicio de urgencies hospitalario son los osteoarticulares, seguidos de los signos y sintomas mal definidos. Se observan diferencias en los diagnosticos entre las distintas dimensiones de PRM y sus tipos.

Multilevel analysis of income, income inequalities and health in Spain.

The aim of this study is to test the influence of personal income (absolute income hypothesis), income inequalities and welfare (relative income hypothesis) on health. A multilevel cross-sectional logit model is used with two alternative specifications of the dependent variable: self-perceived health and chronic illnesses, and six specifications of the income inequality: three positive and three normative. This study incorporates lagged values of the regional variables and interactions between the individual and the regional variables. The data is drawn from the Spanish Life Conditions Survey for 2007 and consists of 28,023 individuals over 16 from 17 autonomous communities. The results support the absolute income hypothesis that a higher level of personal income is correlated with a lower probability of negative health outcomes. The relative income hypothesis results are mixed with only some indicators showing a significant relationship with health. The results also indicate that being a man, being married, working and having a high level of education are related to improved health. This study emphasizes the importance both of the health variable and of the specification of income inequality, and contributes to augmenting the limited empirical evidence available in Spain on the influence of income and income inequalities on the health of the population.

Cost–utility analysis of a pharmacotherapy follow-up for elderly nursing home residents in Spain

To compare the cost‐effectiveness of a pharmacotherapy follow‐up for elderly nursing home (NH) residents with that of usual care.

A Goal Programming Scheme to Determine the Budget Assignment among the Hospitals of a Sanitary System

We develop a model in order to assign resources to public hospitals when the decision center has multiple objectives. This way, it will be possible to quantify the potential existing conflicts among the objectives of the decision center, and to determine the optimal activity vector for each one of the hospitals. The model is designed and applied for the special case of the Andalusian Health Service that is the decision center of the net of public hospitals in Andalusia (Spain). We identify the characteristics and priorities of the Central Services in terms of budget, optimum settings for action implementation, and risk transfer to the health care providers. First, a set of feasible actions is identified by using the so-called “technical-restrictions”. Second, the problem identified is solved according to the alternative options identified in the multicriteria programming, by using pondered goals and lexicographic goals package

Cost effectiveness of using moxibustion to correct non-vertex presentation

Aims To analyse the cost effectiveness of using the moxibustion technique to correct non-vertex presentation and to reduce the number of caesarean sections performed at term. Method A deterministic model of decision analysis has been developed to analyse the cost of treatment in which heat is applied by moxibustion (the combustion of Artemisia vulgaris) at acupuncture point BL67 for pregnant women with non-vertex fetal position at 33–35 weeks’ gestation. This approach was compared with conventional treatment recommendations based on the knee-chest posture technique. The costs were obtained mainly from data provided by the Andalusian Public Health System. Effectiveness data for the baseline analysis were taken from a previous clinical study. A secondary analysis was performed based on a meta-analysis conducted using random effects analysis, by reference to studies published in recent systematic reviews of moxibustion versus conventional treatment, in order to make the results generalisable to other healthcare settings. Deterministic and probabilistic sensitivity analyses were performed under diverse assumptions to assess the uncertainty of the result. Results The baseline analysis shows that the application of moxibustion prevents 8.92% of deliveries with non-vertex presentation compared with conventional treatment, with an average cost saving of ¢107.11 per delivery, mainly due to the cost saving from avoiding the need for caesarean section. The meta-analysis revealed a relative risk of the version of non-vertex presentation at term of 0.34 (95% CI 0.16 to 0.76). The sensitivity analysis showed that moxibustion can avoid 0.34 caesarean sections, with an incremental cost per delivery ranging from ¢68 to −¢640 for moxibustion versus conventional treatment. Conclusions Moxibustion treatment applied at acupuncture point BL67 can avoid the need for caesarean section and achieve cost savings for the healthcare system in comparison with conventional treatment.

Using Interactive Multiple Objective Methods to Determine the Budget Assignment to the Hospitals of a Sanitary System

One of the main problems that the decision centers of public sanitary systems must face is the budget distribution among the different hospitals of the system. Sanitary, economical, and political criteria must be combined to take the final decision. In this paper, a combined procedure, which uses several interactive multiple objective methods, is applied to the specific problem of the Andalusian Public Health Service. The performance of the system is studied, and the final results are commented by the decision-makers.

Influence of changes in the Spanish labor market during the economic crisis (2007–2011) on perceived health

PurposeWe analyze the influence of the dramatic changes in the Spanish labor market during the crisis on the perceived health of the Spanish population.MethodsWe use the longitudinal Living Conditions Survey database and multilevel longitudinal logistic models between 2007 and 2011, before and during the economic crisis in one of the European countries most affected by its consequences.ResultsUnemployment (OR 1.75; p < 0.001), job insecurity (OR 1.38; p < 0.001), and being part of a household with severe material deprivation (OR 1.87; p = 0.004) increase the risk of having worsened perceived health. Available income, on the other hand, is a protective factor (OR 0.72; p < 0.001). Public expenditure policies have little impact on the perceived health. Labor market reforms reducing the degree of job insecurity and unemployment, together with income transfers to those at greater risk of social deprivation, can be more effective in improving the health of the population than the increase of aggregated social or health care expenditure.ConclusionsThis study provides evidence of the influence that unemployment, job insecurity, and poverty exert on the perceived health of individuals, with data collected in Spain after the onset of the financial crisis. In addition, after analyzing public social expenditure, only expenditure on FPS seems to influence self-reported health, although to a very limited degree.