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This project will apply microeconomic and microeconometric analysis to empirically examine the effects of the recent economic crisis on the equity and efficiency of the Spanish National Health System (SNSE). The empirical evidence obtained will guide public authorities in designing effective public interventions to optimize resource use within the SNSE during this recovery phase (albeit with adjustments) that Spain is currently undergoing. This research project builds upon two previous projects to which many members of the current research team belonged: ECO2012-36150 and SEJ2004-08073/ECON. The research will be carried out through four lines of inquiry: First (line of inquiry 1), based on different waves of the National Health Surveys (ENS) (MSSSI, 2006-2016), the effects of the economic crisis on horizontal equity in healthcare provision within the Spanish National Health System (SNSE) will be analyzed, both by socioeconomic level (approximated by income level, education level, and occupation) and by nationality. The analysis will be conducted at two levels: a) the effect of the economic crisis on equity in healthcare provision within the SNSE for adults; b) the effect of the economic crisis on the health and equity in healthcare provision within the SNSE of two vulnerable groups: children and the elderly. Second (line of inquiry 2), the impact of the economic crisis on obesity and its social gradient in Spain and the Canary Islands will be quantified and explained. The obesity study proposed in this line of research will also be conducted using data from the National Health Surveys (ENS), although, in the case of the Canary Islands, it will be supplemented with data from the questionnaire of the Cardiovascular, Diabetes, and Cancer (CDC) cohort of the Canary Islands (6,729 adults). Thirdly (line of research 3), the distribution of private funding for medications by user groups within the National Health System (SNSE) (employed and pensioners) has been affected by the change in pharmaceutical co-payments (Royal Decree-Law 16/2012). Furthermore, it will be analyzed whether, following this change, the demand for medications has been affected indiscriminately across all medication groups or, conversely, whether it has been maintained for those indicated for the treatment of chronic and/or serious diseases. A representative random sample of the population with individual health cards in the Canary Islands Autonomous Community (64,000 people) is available, stratified by seven health areas and employment status (active or retired), allowing for a before-and-after analysis of the change that occurred in 2012. Fourth (research line 4), an analysis will be carried out on the effect that the economic crisis has had on the efficiency and productivity of hospitals within the Spanish National Health System (SNSE). To this end, a stochastic frontier of multi-product costs will be estimated, using a flexible functional form, which will enable a complete characterization of the production technology of hospital activity. This will utilize information on resources, activity, costs, and investment (both from Spanish hospital units and their associated specialty centers) from the ESCRI and CSDAE Statistics (MSSSI 2002-13).
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In this project, a micro-economic and micro-econometric analysis will be applied to empirically analyze the effects of the recent economic crisis from the viewpoints of equity and efficiency of the Spanish National Health Service (SNHS). With the empirical evidence obtained, the challenge is to guide health authorities to design effective public interventions that will help optimize the use of resources in the SNHS during this stage of recovery (still under fiscal adjustments) facing the Spanish state. This research project continues and completes the work of the two previous projects to which the majority of the projects research team belonged: Project ECO2012-36150 and Project SEJ2004-08073/ECON. The objectives of this research projects follow four main lines of research: First (research line 1), based on the different waves of the Spanish National Health Surveys ENS (MSSSI, 2006-16), the effects of the economic crisis on horizontal equity in health care provision in the SSNS are analyzed, both by socioeconomic levels (approached by income, education and occupation) and by nationality. This analysis will be differentiated at two levels: 1. Effect of economic crisis on equity in health provision for adults; 2. Effect of the economic crisis on health and equity in health care provision in the NHS on two vulnerable groups: children and the elderly. Second, (research line 2), the impact that the economic crisis has had on obesity and its social gradient will be explained and quantified for Spain and the Canary Islands. The study on obesity will also be conducted with data from ENS although for the case of the Canary Islands, data will be supplemented with data taken from the Cardiovascular Cohort, Diabetes and Cancer (CDC) questionnaire (6729 adults). Third (research line 3), an analysis will be made of how distribution of private funding of medicines by SNHS user groups (active users and pensioners) has been affected, following the change in the pharmaceutical copayment (RDL 16/2012). In addition, following the change, there will be an analysis of whether the demand for drugs has suffered equally in all groups of drugs or, on the contrary, the demand for those with treatment of chronic and/or serious illness has been maintained. A representative random sample of the population with individual health cards of the Canary Islands (64,000 people) will be used, stratified into seven areas of health and condition of active users or pensioners, which allow us to undertake a before and after analysis relative to the 2012 copayment change. Fourth (research line 4), an analysis will be conducted of the effect that the economic crisis has had on the efficiency and productivity of hospitals in the Spanish National Health Service. To do this, the estimation of a stochastic multiproduct cost frontier under a flexible functional form will be made. This will allow a complete characterization of the production technology of hospital activity. Resource information, activity and investment costs (both Spanish hospital units and their associated specialist centers) will be used from the following statistics: ESCRI and CSDAE (MSSSI 2002-13).
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