1,519 research outputs found
La evaluación de políticas públicas. Informe SESPAS 2010
No full textResumenLa evaluación de políticas públicas no siempre resulta una tarea obligatoria para las administraciones. A priori, los instrumentos de intervención por parte del estado se eligen y calculan para maximizar la función de bienestar social, la cual debe estar implícita en las políticas llevadas a cabo o en el programa electoral del gobierno. Sin embargo, sorprende que en ocasiones el estado actúa sin cuestionarse si el funcionamiento de las instituciones y las políticas públicas correspondientes pueden lograr de manera efectiva y eficiente ese objetivo. La ausencia de evaluación lleva a que programas inefectivos e ineficientes provoquen el drenaje de los escasos recursos disponibles, que podrían utilizarse en otras iniciativas de mayor efecto sobre el bienestar de la población.AbstractPublic policy evaluation is not always a mandatory task for administrations. A priori, the instruments for government intervention are chosen and calculated to maximize the social welfare function that should be implicit in the policies undertaken, or in the government’s electoral program. However, it is surprising how the government sometimes acts without questioning whether institutional functioning and the corresponding public policies can effectively and efficiently achieve this objective. The absence of evaluation drains the scarce available resources towards ineffective and inefficient programs, which could be otherwise used in other initiatives with a greater impact on the population’s welfare
The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition
No full textAbstract Background The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Methods Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. Results Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. Conclusions The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.</p
Why are some Spanish regions so much more efficient than others?
No full textWe investigate the main sources of heterogeneity in regional efficiency. We estimate a translog stochastic-frontier production function in the analysis of Spanish regions in the period 1964-96, to attempt to measure and explain changes in technical efficiency. Our results confirm that regional inefficiency is significantly and positively correlated with the ratio of public capital to private capital. The proportion of service industries in private capital, the proportion of public capital devoted to transport infrastructures, the industrial specialization, and spatial spillovers from transport infrastructures in neighbouring regions significantly contributed to improving regional efficiency.114211290,727Q
Equity in children's utilization of dental services: effect of a children's dental care programme
No full textObjectives: To evaluate the long term impact on fairness of children's dental care programmes. Methods: Data were taken from the Health Module of the Spanish Disability Interview Survey in 1999 (n=8,049). The probability of visit to a dentist and the number of visits are estimated with binary logistic models and count data models in order to compare the regions with consolidated dental care programmes, PADI regions, with the rest of Spanish regions. The effects of family income, residential status and living in small village settings on dental care access for both regions are investigated and compared. Results: The scope of the dental care programme (PADI) makes a very significant difference. Regions with consolidated PADI are by far more equitable than the rest. Once the other explanatory factors have been controlled, the percentage of users is by far larger in PADI regions, odds ratio 3.47 (95% CI 2.38 to 5.07). In PADI regions family income doesn't have any significance in the probability of visits to the dentist, odds ratio 1.9 (95% confidence interval 0.92 to 1.81). In non PADI regions poorer families have less probability of visiting a dentist, odds ratio 1.68 (95% CI 1.50 to 1.88). In addition, in each region, inequalities discriminating against those children that live in small villages cannot be found in PADI regions. Conclusions: PADI regions have more equity in access to dental care. The PADI programme managed to drop any income base discrimination in access and succeeded in equalizing access in small villages and in urban areas. The use of dental services is very unequal among the population. Public dental care programmes for children equalize utilization and strongly contribute to improving children's oral health.157152SCI
The impact of medical technology on health: a longitudinal analysis of ischemic heart disease
No full textObjectives: This article estimates the costs and benefits of changes in ischemic heart disease (IHD) care in Spain from 1980 to 2003. Methods: We use joinpoint regression to identify trends in the standardized rates of mortality and hospitalization for IHD in general and acute myocardial infarction (AMI) in particular. We estimate also logistic regression models for the probability of in-hospital death of patients admitted for AMI. To measure costs and benefits between 1980 and 2003 we use the microdata from Spanish Hospital Morbidity Survey, and the reports of the Cardiac Catheterization and Coronary Intervention Registry of the Spanish Society of Cardiology. Results: Mortality from IHD in Spain has been substantially reduced in the past 25 years. Medical advances have saved lives of many patients admitted to hospitals. If the patients with AMI admitted in 2003 had been treated with 1980 procedures the rate of hospital mortality for AMI would have doubled. The estimated benefits in 2003 are the lives of the 5326 patients saved. The unit real costs have increased from €2143 to €4550 per AMI admission. If this cost increase is applied to the 57,842 Spanish AMI inpatients admitted in 2003, one could say that advances in medical technology from 1980 to 2003 carry a cost of €26,140 per life saved. Conclusions: In Spain advances in hospital technology for the treatment of IHD since 1980 are well worth the cost.96883,009Q1SCIESSC
Exploring changes in dental workforce, dental care utilisation and dental caries levels in Europe, 1990-2004
No full textTo provide a conceptual framework of the relationships between dental health and dental care utilisation with socio-economic factors, human resources and the finance and organisation of dental healthcare systems in European countries from 1990 to 2004. Methods: Bivariate relations and longitudinal analysis using time series cross-sectional regression models. Data were obtained from published papers and official publications. Results: We found no evidence that greater access to dental healthcare professionals has contributed to improving dental health among 12-year-old children. The main parameters influencing oral health and its evolution are income and educational levels within countries. The greater number of dentists and a relatively young adult population have a positive effect on the utilisation of dental services. Conclusions: The improvement in dental health obtained among European children over the last 15 years does not seem to be attributable to policies aimed at improving access to oral health services. What has been achieved is a higher rate of utilisation by adults, due in part to the greater relative numbers of dental healthcare personnel in European countries between 1990 and 2004.95870,632Q4SCI
Equity in the utilisation of public health care services by regions in Spain: a multinivel analysis
No full textIncluye JEL classification: C01, D39, I19, R53El objetivo de esta investigación consiste en analizar si existe equidad horizontal en la utilización de servicios sanitarios públicos por comunidad autónoma de residencia en España. A partir de la Encuesta Nacional de Salud de 2006, se ha realizado un análisis multinivel, utilizando una función de ajuste logístico binaria para cada uno de los servicios sanitarios públicos estudiados (visitas al médico general, visitas al médico especialista y hospitalizaciones).The aim of this paper is to analyse if there is horizontal equity in the utilisation of public health care services by region (comunidad autónoma) of residence in Spain. Data from the 2006 National Health Survey were considered to undertake a multilevel analysis, using a binary logistic function for each of the public health care services analysed (general practitioner -GP- visits, specialist visits and hospitalisations).106870,1Q4Sello FECYTSSC
Time trends in socio-economic inequalities in the lack of access to dental services among children in Spain 1987-2011
No full textAdult oral health is predicted by oral health in childhood. Prevention improves oral health in childhood and, consequently in adulthood, so substantial cost savings can be derived from prevention. The burden of oral disease is particularly high for disadvantaged and poor population groups in both developing and developed countries.1,1822,378Q1Q1SSC
Profile of the population of Spain with respect to the smoking habit, period 1993-1997
No full textThe consumption of tobacco has become by far the main avoidable cause of disease and premature death in Spain. There is a trend towards picking up the tobacco habit at an earlier age for both males and females. The number of women smokers is rising, particularly in the younger age groups (45% of women between the ages of 16 and 22 claim to be smokers) almost equalling male levels, which are remaining constant. The objective of this study is to profile current smokers, former smokers and never smokers among Spanish men and women, based on subject characteristics, and compare the profiles estimated for 1993, 1995 and 1997. We use a two-level nested logistic regression model to model the adoption and cessation processes of the smoking habit. The first level or branch discriminates between persons who have never been smokers and people who have been smokers or who are smokers at present. The second level is to discriminate between present smokers and former smokers (succeeded in the cessation process). The results show that the variables which define the profile of smokers include so-called stress-related factors, if the individual is separated or divorced, whether s/he is unemployed. The cessation process accelerates with age and is stimulated by the diagnosis of chronic disease, particularly heart disease. Our results, which are fairly stable from 1993 to 1997, should provide guidelines in the development of prevention and control of tobacco consumption health policies.3513461,152Q1SCIESSC
Equity in specialist waiting times by socioeconomic groups: Evidence from Spain
No full textIn countries with publicly financed health care systems, waiting time-rather than price-is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.3343230,9661,774Q1Q1SSC
- …
