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      Una investigación de caso único sobre el impacto de los recortes en la calidad asistencial de un servicio autonómico de salud Translated title: A single-case research on the impact of spending cuts on the quality of care of a regional health service

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          Abstract

          Resumen Fundamento Aplicar métodos de investigación de caso único para evaluar el impacto de los recortes del gasto de la comunidad autónoma de Galicia en ciertos aspectos de la calidad de la asistencia sanitaria. Material y métodos Se toman indicadores de espera media quirúrgica, un Índice Genérico de Deficiencias Sanitarias (IGDS), de elaboración propia, e índices de mejora percibida basados en el Barómetro Sanitario. El análisis combina aproximaciones de abajo a arriba (inspección visual y medidas de no solapamiento) con otras de arriba a abajo (técnicas paramétricas). Resultados En el quinquenio de los recortes se detectaron algunos impactos adversos en la calidad asistencial. La tendencia a acortar la espera media quirúrgica se invirtió, siendo dicho efecto significativo (p<0,01) según los tres modelos ARIMA estimados. El IGDS aumentó más que antes según el efecto total inferido de los análisis de regresión por mínimos cuadrados generalizados, con procedimiento de Cochran-Orcutt y ajuste de Prais-Winsten (p<0,1), y por mínimos cuadrados no lineales (p<0,05). Los índices de mejora percibida cayeron en atención primaria y especializada, así como en hospitalización, siendo el tamaño de efecto medio (NAP, no solapamiento de todos los pares) o grande (SMD, diferencia tipificada de medias). El estadístico C confirmó un cambio significativo. Conclusiones En esta aplicación empírica con técnicas de investigación de caso único, se aprecia un cierto deterioro en los indicadores analizados, que incide primordialmente en aspectos de la calidad no blindados por la relación médico-paciente y ligados a las condiciones de prestación del servicio y su percepción global.

          Translated abstract

          Abstract Background To apply single-case research methods to evaluate the impact of the Regional Government of Galicia's spending cuts on certain aspects of the quality of healthcare. Material and methods In our study, we consider average surgical wait indicators, a Generic Healthcare Deficiency Index (GHDI) of our own design, and rates of perceived improvement based on the Healthcare Barometer. Our analysis combines bottom-up approaches (both visual inspection and non-overlapping measures) with top-down approaches (parametric techniques). Results In the quinquennial period of cutbacks, we detect several adverse impacts on the quality of healthcare. The tendency to shorten the average surgical wait is reversed and this effect is statistically significant (p<0.01), according to the three estimated ARIMA models. The GHDI increases more than before, with a total effect inferred from regression analyses by both generalized least squares, using the Cochran-Orcutt procedure with the Prais-Winsten adjustment (p<0.1), and non-linear least squares (p<0.05). Indices of perceived improvement fall in primary and specialized care, as well as in hospitalization, with the effect being moderate (NAP, non-overlap of all pairs) or large (SMD, standardized mean difference). The C statistic confirms a significant change. Conclusions In this empirical application with single-case research techniques, we notice a certain deterioration in the analyzed indicators, which primarily affect aspects of quality that are not shielded by the doctor-patient relationship, aspects more connected to the conditions of service provision and its overall perception.

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          Has health in Spain been declining since the economic crisis?

          The economic recession starting in 2008 may be having negative effects on health. We aimed to identify and characterise changes in trends in 15 health indicators in Spain during the recession. Joinpoint regression and average annual percent change (AAPC) were used to compare trends. Premature mortality rates from several causes of death, except from cancer, showed statistically significant downward trends during the recession, as did poor self-reported health. HIV incidence was stable. No indicator declined significantly more slowly during the recession than in the preceding 4-year period, and two declined significantly faster. Health in Spain has continued to improve during the first four years of the economic recession at a rate equal to or higher than in previous years.
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            Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain.

            This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system, but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambiguously detected. The impact of the recession on the general population in terms of diseases associated with mental health is well documented; however, the high levels of unemployment are identified as direct causes. Therefore, social policies rather than measures affecting the healthcare system would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap.
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              Mortality decrease according to socioeconomic groups during the economic crisis in Spain: a cohort study of 36 million people

              Studies of the effect of macroeconomic fluctuations on mortality in different socioeconomic groups are scarce and have yielded mixed findings. We analyse mortality trends in Spain before and during the Great Recession in different socioeconomic groups, quantifying the change within each group.
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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                December 2020
                : 43
                : 3
                : 359-372
                Affiliations
                [2] Santiago de Compostela Galicia orgnameUniversidad de Santiago de Compostela orgdiv1Departamento de Economía Aplicada Spain
                [3] Ourense orgnameGovernance and Economics research Network
                [1] Santiago de Compostela orgnameInstituto de Investigación Sanitaria de Santiago de Compostela
                Article
                S1137-66272020000300007 S1137-6627(20)04300300007
                10.23938/assn.0926
                321d270f-dc4b-496a-bfe8-563a976637c5

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 31 July 2020
                : 12 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 14
                Product

                SciELO Spain

                Categories
                Artículos Originales

                Healthcare quality,Financial crisis,Healthcare cuts,Austerity,Indicadores,Calidad de la atención sanitaria,Crisis financiera,Recortes en salud,Austeridad,Indicators

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