María del Puerto López del Amo González

Influencia de la renta, la desigualdad de renta y el capital social en la salud de los mayores de 65 años en España en 2007

The aim of this study is to evaluate the influence of personal income [absolute income hypothesis (AIH)], income inequality and welfare [relative income hypothesis (RIH)], and social capital on the health of older people. Multi-level, cross-sectional logit models are calculated separately for women and men. The database employed was the Spanish Life Conditions Survey for 2007. The population consists of 6,259 persons aged over 65 years living in the 17 autonomous regions of Spain. The results confirm the AIH hypothesis: higher personal income is associated with better health. Education is also associated with better self-perceived health. The RIH hypothesis is partially confirmed due to the association between the Gini coefficient, regional per capita welfare and self-perceived health in older people, but only for women. Two different measures of social capital are used: the value of services of social capital and the percentage of people aged over 65 belonging to an association. Both factors are statistically associated with better self-perceived health in women. This study is the first to contrast the associations among income, income inequalities, social capital and the health of elders in Spain.

Cost-effectiveness of percent free PSA for prostate cancer detection in men with a total PSA of 4-10 ng/ml.

Objective: To assess the cost-effectiveness of two diagnostic strategies for prostate cancer in men with prostate-specific antigen (PSA) levels of 4–10 ng/ml and normal digital rectal examination (DRE). Design: Cost-effectiveness analysis was performed using a decision tree model. Data collection and a systematic review of patients at the Urology Department (Carlos Haya Hospital) were made. 101 patients over the age of 40 with PSA levels of 4–10 ng/ml and normal DRE were selected. Transrectal ultrasound-guided prostate biopsy (TRUS-Bx) and percent free PSA testing prior to TRUS-Bx were performed. The outcome measures used were the incremental cost-effectiveness ratio, and costs were calculated through activity-based costing. The effectiveness was measured by means of the number of detected cases, test utility and actual cases (detected cases minus lost cases). Results: Using base-case analysis, the strategy of percent free PSA + TRUS-Bx was found to be the most cost-effective. The incremental cost-effectiveness ratio for free PSA + TRUS-Bx compared with TRUS-Bx was EUR 2,277.40. Strategy 2 (TRUS-Bx) would be more cost-effective if the cost of percent free PSA increased to EUR 21.64 or if prostate cancer prevalence increased to 26%. Conclusions: The use of percent free PSA prior to TRUS-Bx is the most cost-effective diagnostic strategy. However, this result is very sensitive and strategy 2 (TRUS-Bx) would be more cost-effective if the cost of the percent free PSA increased to EUR 21.64 or if the prevalence of prostate cancer increased to above 26%.

Eficiencia técnica de los hospitales públicos y de las empresas públicas hospitalarias de Andalucía

OBJECTIVE To assess the technical efficiency of traditional public hospitals without their own legal identity and subject to administrative law, and that of public enterprise hospitals, with their own legal identities and partly governed by private law, all of them belonging to the taxypayer-funded health system of Andalusia during the period 2005 -2008. METHODS The study included the 32 publicly-owned hospitals in Andalusia during the period 2005-2008. The method consisted of two stages. In the first stage, the indices of technical efficiency of the hospitals were calculated using Data Envelopment Analysis, and the change in total factor productivity was estimated using the Malmquist index. The results were compared according to perceived quality, and a sensitivity analysis was conducted through an auxiliary model and bootstrapping. In the second stage, a bivariate analysis was performed between hospital efficiency and organization type. RESULTS Public enterprises were more efficient than traditional hospitals (on average by over 10%) in each of the study years. Nevertheless, a process of convergence was observed between the two types of organizations because, while the efficiency of traditional hospitals increased slightly (by 0.50%) over the study period, the performance of public enterprises declined by over 2%. DISCUSSION The possible reasons for the greater efficiency of public enterprises include their greater budgetary and employment flexibility. However, the convergence process observed points to a process of mutual learning that is not necessarily efficient.

La sostenibilidad del Sistema Nacional de Salud en España

El Sistema Nacional de Salud (SNS) espanol presenta problemas de sostenibilidad derivados de deficiencias en su diseno institucional y de gobierno, agravadas por la crisis economica que padece. La crisis economica mundial ha tenido una repercusion especialmente virulenta en Espana, caracterizada por altos niveles de desempleo y de deuda publica y privada. Las politicas de ajuste fiscal emprendidas pueden deteriorar el SNS significativamente. Junto a problemas de financiacion general, la fuerte descentralizacion territorial de competencias sanitarias en las Comunidades Autonomas no ha sido acompanada de un marco eficaz de coordinacion sanitaria a nivel de Estado. El SNS adolece de problemas en sus reglas de gobierno, su sistema de financiacion autonomica, las politicas de recursos humanos y la diversidad de formas de gestion directa e indirecta que funcionan en las distintas Comunidades Autonomas. Una estrategia de reformas en el gobierno de la sanidad espanola debe articularse en el marco de una revision mas amplia de las politicas publicas que permita estabilizar las lineas de defensa del Estado del Bienestar. En el ambito del sector sanitario se debe mejorar su sistema de financiacion y desarrollar cambios institucionales para aumentar la eficiencia.