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Cirulli V, Marini G. Are austerity measures really distressing? Evidence from Italy. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101217. [PMID: 36701929 DOI: 10.1016/j.ehb.2022.101217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 05/08/2023]
Abstract
Since 2007 financial recovery plans have been adopted by some Italian regions to contain the costs of the healthcare sector. It is legitimate to ask whether spending cuts associated with the austerity policy have had any effect on the health of the citizens. We examine the indirect impact of financial recovery plans on a broad set of health indicators, accounting for several dimensions of both physical and psychological diseases. We use an instrumental variable fixed-effects model to control for time-varying heterogeneity and to deal with the potential endogeneity of the enrolment in the austerity programme. We find that the Italian austerity policy Piano di Rientro resulted in unintended negative effects on several dimensions of health, hurting and potentially jeopardising the health of citizens.
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Otero-García L, Mateos JT, Esperato A, Llubes-Arrià L, Regulez-Campo V, Muntaner C, Legido-Quigley H. Austerity Measures and Underfunding of the Spanish Health System during the COVID-19 Pandemic-Perception of Healthcare Staff in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2594. [PMID: 36767958 PMCID: PMC9914961 DOI: 10.3390/ijerph20032594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Insufficient pandemic preparedness and underfunding of human and economic resources have conditioned the response to COVID-19 in Spain. This underfunding has continued since the austerity measures introduced during the 2008 financial crisis. This study aims to understand the perceptions of healthcare staff in Spain on the relationship between the funding of the health system and its capacity to respond to the COVID-19 pandemic. To this end, we carried out a thematic content analysis, based on 79 online semi-structured interviews with healthcare staff across the regions most affected by the COVID-19 first wave. Participants reported a lack of material resources, which had compromised the capacity of the health system before the pandemic. The lack of human resources was to be addressed by staff reorganisation, such as reinforcing hospital units to the detriment of primary health care. Staff shortages continued straining the COVID-19 response, even after material scarcities were later partially alleviated. Personnel shortages need to be adequately addressed in order to adequately respond to future health crises.
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Affiliation(s)
- Laura Otero-García
- CIBER Epidemiology and Public Health (CIBERESP-ISCIII), 28029 Madrid, Spain
- Nursing Department, Faculty of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - José Tomás Mateos
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRB Lleida), 25198 Lleida, Spain
| | | | - Laia Llubes-Arrià
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, 25199 Lleida, Spain
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRB Lleida), 25198 Lleida, Spain
| | - Vanesa Regulez-Campo
- Osakidetza, Nursing Teaching Unit, Cruces University Hospital, 48903 Baracaldo, Spain
| | - Carles Muntaner
- Faculty of Nursing, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore
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Fleming P, Caffrey L, Belle SV, Barry S, Burke S, Conway J, Siersbaek R, Mockler D, Thomas S. How International Health System Austerity Responses to the 2008 Financial Crisis Impacted Health System and Workforce Resilience - A Realist Review. Int J Health Policy Manag 2022; 12:7420. [PMID: 37579453 PMCID: PMC10125082 DOI: 10.34172/ijhpm.2022.7420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/19/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND The Great Recession, following the 2008 financial crisis, led many governments to adopt programmes of austerity. This had a lasting impact on health system functionality, resources, staff (numbers, motivation and morale) and patient outcomes. This study aimed to understand how health system resilience was impacted and how this affects readiness for subsequent shocks. METHODS A realist review identified legacies associated with austerity (proximal outcomes) and how these impact the distal outcome of health system resilience. EMBASE, CINAHL, MEDLINE, EconLit and Web of Science were searched (2007-May 2021), resulting in 1081 articles. Further theory-driven searches resulted in an additional 60 studies. Descriptive, inductive, deductive and retroductive realist analysis (utilising excel and Nvivo) aided the development of context-mechanism-outcome configurations (CMOCs), alongside stakeholder engagement to confirm or refute emerging results. Causal pathways, and the interplay between context and mechanisms that led to proximal and distal outcomes, were revealed. The refined CMOCs and policy recommendations focused primarily on workforce resilience. RESULTS Five CMOCs demonstrated how austerity-driven policy decisions can impact health systems when driven by the priorities of external agents. This created a real or perceived shift away from the values and interests of health professionals, a distrust in decision-making processes and resistance to change. Their values were at odds with the realities of implementing such policy decisions within sustained restrictive working conditions (rationing of staff, consumables, treatment options). A diminished view of the profession and an inability to provide high-quality, equitable, and needs-led care, alongside stagnant or degraded working conditions, led to moral distress. This can forge legacies that may adversely impact resilience when faced with future shocks. CONCLUSION This review reveals the importance of transparent, open communication, in addition to co-produced policies in order to avoid scenarios that can be detrimental to workforce and health system resilience.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland
| | | | - Sarah Barry
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Jacki Conway
- Everlake, 5 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - David Mockler
- Library Reader Services, Trinity College Dublin, The University of Dublin, St James Hospital, Dublin 8, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
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Bartoll-Roca X, Rodríguez-Sanz M, Sánchez-Ledesma E, Pérez K, Borrell C. Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018. GACETA SANITARIA 2022; 36:520-525. [PMID: 35337685 DOI: 10.1016/j.gaceta.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death. METHOD We computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes. RESULTS The life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes. CONCLUSIONS The stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels.
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Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona (ASPB), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Cièncias Experimentales i de la Salut, Facultat de Ciències de la Salut i de la Vida, Universitat Pompeu Fabra, Barcelona, Spain
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Hospitals during economic crisis: a systematic review based on resilience system capacities framework. BMC Health Serv Res 2022; 22:977. [PMID: 35907833 PMCID: PMC9339182 DOI: 10.1186/s12913-022-08316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08316-4.
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Moreno A, Lostao L, Beller J, Sperlich S, Ronda E, Geyer S, Pulido J, Regidor E. Trends and equity in the use of health services in Spain and Germany around austerity in Europe. Int J Equity Health 2021; 20:120. [PMID: 33985518 PMCID: PMC8117640 DOI: 10.1186/s12939-021-01459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 04/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Following the 2008 economic crisis many countries implemented austerity policies, including reducing public spending on health services. This paper evaluates the trends and equity in the use of health services during and after that period in Spain – a country with austerity policies – and in Germany – a country without restriction on healthcare spending. Methods Data from several National Surveys in Spain and several waves of the Socio-Economic Panel in Germany, carried out between 2009 and 2017, were used. The dependent variables were number of doctor’s consultations and whether or not a hospital admission occurred. The measure of socioeconomic position was education. In each year, the estimates were made for people with and without pre-existing health problems. First, the average number of doctor’s consultations and the percentage of respondents who had had been hospitalized were calculated. Second, the relationship between education and use of those health services was estimated by calculating the difference in consultations using covariance analysis – in the case of number of consultations – and by calculating the percentage ratio using binomial regression – in the case of hospitalization. Results The annual mean number of consultations went down in both countries. In Spain the average was 14.2 in 2009 and 10.4 in 2017 for patients with chronic conditions; 16.6 and 13.5 for those with a mental illness; and 6.4 and 5.9 for those without a defined illness. In Germany, the averages were 13.8 (2009) and 12.9 (2017) for the chronic group; 21.1 and 17.0 for mental illness; and 8.7 and 7.5 with no defined illness. The hospitalization frequency also decreased in both countries. The majority of the analyses presented no significant differences in relation to education. Conclusion In both Spain and Germany, service use decreased between 2009 and 2017. In the first few years, this reduction coincided with a period of austerity in Spain. In general, we did not find socioeconomic differences in health service use.
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Affiliation(s)
- Almudena Moreno
- Department of Sociology, Universidad Pública de Navarra, Campus de Arrosadía s/n, 31006, Pamplona, Spain. .,I-COMMUNITAS - Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain.
| | - Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Campus de Arrosadía s/n, 31006, Pamplona, Spain.,I-COMMUNITAS - Institute for Advanced Social Research, Universidad Pública de Navarra, Pamplona, Spain
| | - Johannes Beller
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | | | - Elena Ronda
- Preventive Medicine and Public Health Unit, Universidad de Alicante, Alicante, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - José Pulido
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Enrique Regidor
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Arcà E, Principe F, Van Doorslaer E. Death by austerity? The impact of cost containment on avoidable mortality in Italy. HEALTH ECONOMICS 2020; 29:1500-1516. [PMID: 32805073 PMCID: PMC7754121 DOI: 10.1002/hec.4147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/09/2020] [Accepted: 07/24/2020] [Indexed: 05/23/2023]
Abstract
Does austerity in health care affect health and healthcare outcomes? We examine the intended and unintended effects of the Italian austerity policy Piano di Rientro aimed at containing the cost of the healthcare sector. Using an instrumental variable strategy that exploits the temporal and geographical variation induced by the policy rollout, we find that the policy was successful in alleviating deficits by reducing expenditure, mainly in the southern regions, but also resulted in a 3% rise in avoidable deaths among both men and women, a reduction in hospital capacity and a rise in south-to-north patient migration. These findings suggest that-even in a high-income country with relatively low avoidable mortality like Italy-spending cuts can hurt survival.
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Affiliation(s)
- Emanuele Arcà
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
| | - Francesco Principe
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
| | - Eddy Van Doorslaer
- Erasmus School of Health Policy & ManagementErasmus University RotterdamRotterdamThe Netherlands
- Erasmus School of EconomicsErasmus University RotterdamRotterdamThe Netherlands
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