[Lessons from abroad. Current and previous crisis in other countries. SESPAS report 2014]

Sexually Transmitted Infections in 2000-2018 in a Specialised Centre: Comparison between Pre-Crisis, Crisis, and Post-Crisis Period

(1) Background: Sexually Transmitted Infections (STIs) are a major public health problem due to their consequences in sexual and reproductive health. There is a close link between the crisis and the increase in communicable diseases. The objective of this study was to analyse the evolution of Sexually Transmitted Infections during the period 2000-2018 in the population attending the Centre for Sexually Transmitted Diseases and Sexual Orientation in Granada (Spain), specifically comparing the pre-crisis, crisis, and post-crisis periods. (2) Methods: A retrospective, observational, and analytical study was conducted by reviewing medical records. The sample analysed comprised 1666 cases. (3) Results: During the pre-crisis period (2000-2007), the percentage of diagnoses was 41.6% (n = 126) compared to 58.4% (n = 177) of negative results; during the crisis, the percentages were 63.5% (n = 183) and 36.5% (n = 105), respectively; and during the post-crisis period, the percentages were 42.9% (n = 157) and 57.1% (n = 209), respectively. The variables that were significantly associated with STI diagnosis were the time periods analysed, sexual orientation, occupation, and age at first intercourse. The evolution of the number of positive diagnoses during the entire study period showed a trend of progressive increase in Sexually Transmitted Infections from 2000 to 2018. (4) Conclusions: The period of economic crisis presented a higher risk of infection, although this is a finding with certain limitations due to the lack of homogeneity between the periods analysed.

Políticas de austeridade fiscal: tentativa de desmantelamento do Sistema Nacional de Salud da Espanha e resistência cidadã

Resumo Este ensaio de natureza teórica analisa os ajustes fiscais colocados em marcha na Espanha como resposta à crise financeira de 2008, suas implicações para o Sistema Nacional de Salud (SNS) e a consequente resistência cidadã. Elaboramos um estudo de caso tendo como fonte primária a narrativa de um ator social que participou da reforma espanhola. Utilizamos também fontes secundárias para coleta de dados socioeconômicos e a análise de 20 artigos publicados pelo Relatório Sespas 2014. O SNS formou-se por aumento progressivo da cobertura populacional, financiamento total por impostos e organização da rede por meio da Atenção Primária em Saúde (APS). As medidas de austeridade fiscal impuseram limitações de ordem orçamentária, reduziram a provisão de serviços, introduziram copagamentos e retrocederam o direito à saúde à meritocracia. A corrente crítica da economia política sinaliza que o propósito dos ajustes econômicos é a transferência regressiva de renda e riqueza. As Mareas Ciudadanas constituíram-se numa resposta cidadã com êxito em muitas lutas sociais contra a austeridade fiscal. A alternativa de resistência e superação pela via política se fez presente com vigor na Espanha e tem resistido ao desmantelamento do SNS.

Socioeconomic inequalities in health and the use of healthcare services in Catalonia: analysis of the individual data of 7.5 million residents

Background

The aim of this study is to analyse the health status, the use of public healthcare services and the consumption of prescription drugs in the population of Catalonia, taking into consideration the socioeconomic level of individuals and paying special attention to vulnerable groups.

Methods

Cross-sectional study of the entire population resident in Catalonia in 2015 (7.5 million people) using administrative records. Twenty indicators are analysed related to health, the use of healthcare services and consumption of prescription drugs. Rates, frequencies and averages are obtained for the different variables stratified by age groups (under 15 years, 15–64 years and 65 years or older), gender and socioeconomic status (calculated on the basis of pharmacy copayment levels and Social Security benefits received).

Results

A socioeconomic gradient was observed in all the indicators analysed, in both sexes and in all age groups. Morbidity, use of mental healthcare centres, hospitalisation rates and probability of drug consumption among children is 3–7 times higher for those with low socioeconomic level respect to those with a higher one. In children and adults, the steepest gradient was found in the use of mental health services. Moreover, there are gender inequalities.

Conclusion

There are significant socioeconomic inequalities in health status and in the use of healthcare services in the population of Catalonia. To respond to this situation, new policies on health and other areas, such as education and employment, are required, especially those that have an impact on early years.

Health Care Austerity Measures in Times of Crisis

The current financial crisis has seen severe austerity measures imposed on the Spanish health care system, including reduced public spending, copayments, salary reductions, and reduced services for undocumented migrants. However, the impacts have not been well-documented. We present findings from a qualitative study that explores the perceptions of primary health care physicians in Madrid, Spain. This article discusses the effects of austerity measures implemented in the public health care system and their potential impacts on access and utilization of primary health care services. This is the first study, to our knowledge, exploring the health care experiences during the financial crisis of general practitioners in Madrid, Spain. The majority of participating physicians disapproved of austerity measures implemented in Spain. The findings of this study suggest that undocumented migrants should regain access to health care services; copayments should be minimized and removed for patients with low incomes; and health care professionals should receive additional help to avoid burnout. Failure to implement these measures could result in the quality of health care further deteriorating and could potentially have long-term negative consequences on population health.

[How is the implementation of the new legal framework for health care affecting HIV-infected immigrants in an irregular situation in Spain?]

INTRODUCTION

The entry into force of Royal Decree (RD) 16/2012 in Spain in September 2012 led to the exclusion of the group of irregular immigrants from the National Healthcare System. With this work, GESIDA attempts to measure the impact of the entry into force of the RD in relation to its application by the Autonomous Communities (CCAA), and how it has affected the health care of irregular immigrants infected with HIV.

METHODS

Information was requested from the 17 CCAA of the existence of measures to ensure the care and treatment of people with HIV infection that were left unprotected because of the implementation of the RD. Likewise, a survey was conducted on health professionals and NGOs involved in the care of these people, to find out how it has affected the implementation of the RD to their daily healthcare work and the availability of information on regulations to implement it.

RESULTS

The response of the CCAA was variable, hardly contributing, in some cases, to mitigate the negative effect of the RD. To this is added a complex bureaucracy to access the benefits offered by some regions, often inaccessible to the most vulnerable subjects. Lack of information for health-care professionals and NGOs involved in the care of immigrants, hinders access of this population to health care and the establishment of control measures for diseases with an impact on the public health.

CONCLUSIONS

The RD 16/2012 has had a negative impact on daily healthcare working, generating the appearance of deep inequities throughout the country.