Abstract
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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Notes
Instituto Nacional de Estadística, INE. Contabilidad Nacional Trimestral de España base 2000. http://www.ine.es/dyngs/IOE/es/operacion.htm?numinv=30024.
The list of indicators includes premature mortality by 13 causes (all causes; cancer; cardiovascular disease; respiratory disease; digestive disease; genitourinary disease; HIV disease; rest of infectious diseases; road traffic injury; rest of unintentional injuries; illicit drug-induced death; suicide; homicide), prevalence of poor perceived health and HIV incidence.
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This paper forms part of the research funded by Grant ECO2013-48217-C2-1 under the “National Programme for Research, Development and Innovation to Address the Challenges of Society: National Plan for Scientific Research and Technical Innovation 2013–2016” funded by the Ministry of Economy and Competitiveness of Spain (http://invesfeps.ulpgc.es/en). The funder had no influence on the conduct of this study or on the drafting of this manuscript.
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Beatriz Gonzalez Lopez-Valcarcel and Patricia Barber do not have any relevant conflicts of interest to disclose.
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Lopez-Valcarcel, B.G., Barber, P. Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain. Appl Health Econ Health Policy 15, 13–21 (2017). https://doi.org/10.1007/s40258-016-0263-0
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DOI: https://doi.org/10.1007/s40258-016-0263-0