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Alvarez-Galvez J, Ortega-Martin E, Ramos-Fiol B, Suarez-Lledo V, Carretero-Bravo J. Epidemiology, mortality, and health service use of local-level multimorbidity patterns in South Spain. Nat Commun 2023; 14:7689. [PMID: 38001107 PMCID: PMC10673852 DOI: 10.1038/s41467-023-43569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Multimorbidity -understood as the occurrence of chronic diseases together- represents a major challenge for healthcare systems due to its impact on disability, quality of life, increased use of services and mortality. However, despite the global need to address this health problem, evidence is still needed to advance our understanding of its clinical and social implications. Our study aims to characterise multimorbidity patterns in a dataset of 1,375,068 patients residing in southern Spain. Combining LCA techniques and geographic information, together with service use, mortality, and socioeconomic data, 25 chronicity profiles were identified and subsequently characterised by sex and age. The present study has led us to several findings that take a step forward in this field of knowledge. Specifically, we contribute to the identification of an extensive range of at-risk groups. Moreover, our study reveals that the complexity of multimorbidity patterns escalates at a faster rate and is associated with a poorer prognosis in local areas characterised by lower socioeconomic status. These results emphasize the persistence of social inequalities in multimorbidity, highlighting the need for targeted interventions to mitigate the impact on patients' quality of life, healthcare utilisation, and mortality rates.
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Affiliation(s)
- Javier Alvarez-Galvez
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain.
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain.
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), Hospital Puerta del Mar, Cadiz, Spain.
| | - Esther Ortega-Martin
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
| | - Begoña Ramos-Fiol
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
| | - Victor Suarez-Lledo
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
- Department of Sociology, University of Granada, Granada, Spain
| | - Jesus Carretero-Bravo
- Department of General Economy (Health Sociology area), Faculty of Nursing and Physiotherapy, University of Cadiz, Cadiz, Spain
- Computational Social Science DataLab, University Institute for Sustainable Social Development, University of Cádiz, Jerez de la Frontera, Spain
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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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Discovery and classification of complex multimorbidity patterns: unravelling chronicity networks and their social profiles. Sci Rep 2022; 12:20004. [PMID: 36411299 PMCID: PMC9678882 DOI: 10.1038/s41598-022-23617-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022] Open
Abstract
Multimorbidity can be defined as the presence of two or more chronic diseases in an individual. This condition is associated with reduced quality of life, increased disability, greater functional impairment, increased health care utilisation, greater fragmentation of care and complexity of treatment, and increased mortality. Thus, understanding its epidemiology and inherent complexity is essential to improve the quality of life of patients and to reduce the costs associated with multi-pathology. In this paper, using data from the European Health Survey, we explore the application of Mixed Graphical Models and its combination with social network analysis techniques for the discovery and classification of complex multimorbidity patterns. The results obtained show the usefulness and versatility of this approach for the study of multimorbidity based on the use of graphs, which offer the researcher a holistic view of the relational structure of data with variables of different types and high dimensionality.
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Fleming P, Thomas S, Williams D, Kennedy J, Burke S. Implications for health system reform, workforce recovery and rebuilding in the context of the Great Recession and COVID-19: a case study of workforce trends in Ireland 2008-2021. HUMAN RESOURCES FOR HEALTH 2022; 20:48. [PMID: 35619111 PMCID: PMC9134726 DOI: 10.1186/s12960-022-00747-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Workforce is a fundamental health systems building block, with unprecedented measures taken to meet extra demand and facilitate surge capacity during the COVID-19 pandemic, following a prolonged period of austerity. This case study examines trends in Ireland's publicly funded health service workforce, from the global financial crisis, through the Recovery period and into the COVID-19 pandemic, to understand resource allocation across community and acute settings. Specifically, this paper aims to uncover whether skill-mix and staff capacity are aligned with policy intent and the broader reform agenda to achieve universal access to integrated healthcare, in part, by shifting free care into primary and community settings. METHODS Secondary analysis of anonymised aggregated national human resources data was conducted over a period of almost 14 years, from December 31st 2008 to August 31st 2021. Comparative analysis was conducted, by professional cadre, across three keys periods: 'Recession period' December 31st 2008-December 31st 2014; 'Recovery period' December 31st 2014-December 31st 2019; and the 'COVID-19 period' December 31st 2019-August 31st 2021. RESULTS During the Recession period there was an overall decrease of 8.1% (n = 9333) between December 31st 2008 and December 31st 2014, while the Recovery period saw the overall staff levels rebound and increase by 15.2% (n = 16,789) between December 31st 2014 and December 31st 2019. These figures continued to grow, at an accelerated rate during the most recent COVID-19 period, increasing by a further 8.9% (n = 10,716) in under 2 years. However, a notable shift occurred in 2013, when the number of staff in acute services surpassed those employed in community services (n = 50,038 and 49,857, respectively). This gap accelerated during the Recovery and COVID-19 phase. By August 2021, there were 13,645 more whole-time equivalents in acute settings compared to community, a complete reverse of the 2008 situation. This was consistent across all cadres. Workforce absence trends indicate short-term spikes resulting from shocks while COVID-19 redeployment disproportionately impacted negatively on primary care and community services. CONCLUSIONS This paper clearly demonstrates the prioritisation of staff recruitment within acute services-increasing needed capacity, without the same commitment to support government policy to shift care into primary and community settings. Concerted action including the permanent redistribution of personnel is required to ensure progressive and sustainable responses are learned from recent shocks.
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Affiliation(s)
- Padraic Fleming
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, 3-4 Foster Place, Dublin 2, Ireland.
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, 3-4 Foster Place, Dublin 2, Ireland
| | - Des Williams
- National Human Resources Directorate, HSE, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Jack Kennedy
- National Human Resources Directorate, HSE, Dr. Steevens' Hospital, Dublin 8, Ireland
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, The University of Dublin, 3-4 Foster Place, Dublin 2, Ireland
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Easy to Read Health Education Material Improves Oral Health Literacy of Older Adults in Rural Community-Based Care Centers: A Quasi-Experimental Study. Healthcare (Basel) 2021; 9:healthcare9111465. [PMID: 34828511 PMCID: PMC8624561 DOI: 10.3390/healthcare9111465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Health education increases older adults’ health knowledge and affects their health outcomes. Older adults have physical changes with aging, such as blurred vision and cognitive decline. Therefore, health education materials must be legible in their case. This study, following the “easy (EZ) to read” concept, designed oral health education material and tested the learning effectiveness of older adults in rural community-based care centers in central Taiwan. Three of the communities were provided EZ to read health education material (n = 72), while three were given general text material (n = 57) as the control group. We collected pre-test and post-test scores using the Mandarin version of the oral health literacy adult questionnaire (MOHL-AQ). The demographic background of the EZ to read and general text groups showed no significant difference (p > 0.05). Analysis of covariance (ANCOVA) showed that the EZ to read material significantly improved total scores of oral health literacy (p < 0.001). The chi-square test showed a significant improvement in oral health literacy levels (p < 0.001). We suggest applying EZ to read concepts to widen the field of older adult education and to reduce illegibility-induced health knowledge disparities.
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Rosenberg S, Mendoza J, Tabatabaei-Jafari H, Salvador-Carulla L. International experiences of the active period of COVID-19 - Mental health care. HEALTH POLICY AND TECHNOLOGY 2020; 9:503-509. [PMID: 32874855 PMCID: PMC7452826 DOI: 10.1016/j.hlpt.2020.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To summarise commonalities and variations in the mental health response to COVID-19 across different sites and countries, with a view to better understanding key steps not only in crisis management, but for future systemic reform of mental health care. METHOD We conducted a Rapid Synthesis and Translation Process of lessons learned from an international panel of experts, collecting on the ground experiences of the pandemic as it evolved in real time. Digital conferencing and individual interviews were used to rapidly acquire knowledge on the COVID-19 outbreak across 16 locations in Australia, Denmark, Italy, Spain, Taiwan, the UK, and the USA. RESULTS COVID-19 has had massive impacts on mental health care internationally. Most systems were under-resourced and under-prepared, struggling to manage both existing and new clients. There were significant differences between sites, depending on the explosivity the pandemic and the readiness of the mental health system. Integrated, community mental health systems exhibited greater adaptability in contrast to services which depended on face-to-face and hospital-based care. COVID-19 has demonstrated the need for a new approach to rapid response to crisis in mental health. New decision support system tools are necessary to ensure local decision-makers can effectively respond to the enormous practical challenges posed in these circumstances. CONCLUSIONS The process we have undertaken has generated clear lessons for mental health policymakers worldwide, beyond pandemic planning and response to guide next steps in systemic mental health reform. Key here is achieving some balance between national leadership and local context adaptation of evidence.
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Affiliation(s)
- Sebastian Rosenberg
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Australia
- Mental Health Policy Unit, Brain & Mind Centre, University of Sydney, Australia
| | - John Mendoza
- Faculty of Medicine, University of Sydney, Australia
- Mental Health Centre, Adelaide Local Health Network, Australia
| | - Hossein Tabatabaei-Jafari
- Centre for Mental Health Research, Research School of Population Health ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd, Acton ACT 2601 Australia
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Australia
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Pereyra-Zamora P, Copete JM, Oliva-Arocas A, Caballero P, Moncho J, Vergara-Hernández C, Nolasco A. Changes in Socioeconomic Inequalities in Amenable Mortality after the Economic Crisis in Cities of the Spanish Mediterranean Coast. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6489. [PMID: 32899994 PMCID: PMC7559182 DOI: 10.3390/ijerph17186489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
Several studies have described a decreasing trend in amenable mortality, as well as the existence of socioeconomic inequalities that affect it. However, their evolution, particularly in small urban areas, has largely been overlooked. The aim of this study is to analyse the socioeconomic inequalities in amenable mortality in three cities of the Valencian Community, namely, Alicante, Castellon, and Valencia, as well as their evolution before and after the start of the economic crisis (2000-2007 and 2008-2015). The units of analysis have been the census tracts and a deprivation index has been calculated to classify them according to their level of socioeconomic deprivation. Deaths and population were also grouped by sex, age group, period, and five levels of deprivation. The specific rates by sex, age group, deprivation level, and period were calculated for the total number of deaths due to all causes and amenable mortality and Poisson regression models were adjusted in order to estimate the relative risk. This study confirms that the inequalities between areas of greater and lesser deprivation in both all-cause mortality and amenable mortality persisted along the two study periods in the three cities. It also shows that these inequalities appear with greater risk of death in the areas of greatest deprivation, although not uniformly. In general, the risks of death from all causes and amenable mortality have decreased significantly from one period to the other, although not in all the groups studied. The evolution of death risks from before the onset of the crisis to the period after presented, overall, a general pro-cyclical trend. However, there are population subgroups for which the trend was counter-cyclical. The use of the deprivation index has made it possible to identify specific geographical areas with vulnerable populations in all three cities and, at the same time, to identify the change in the level of deprivation (ascending or descending) of the geographical areas throughout the two periods. It is precisely these areas where more attention is needed in order to reduce inequalities.
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Affiliation(s)
- Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - José M. Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Pablo Caballero
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Joaquín Moncho
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
| | - Carlos Vergara-Hernández
- Área de Desigualdades en Salud, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46035 Valencia, Spain;
| | - Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.M.C.); (A.O.-A.); (P.C.); (J.M.); (A.N.)
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Salvador-Carulla L, Almeda N, Álvarez-Gálvez J, García-Alonso C. [On the roller coaster: An abridged history of mental health planning in Spain. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:3-10. [PMID: 32843197 DOI: 10.1016/j.gaceta.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/18/2020] [Accepted: 06/02/2020] [Indexed: 01/29/2023]
Abstract
Effective mental health change in Spain started in 1985 with the Report of the Ministerial Commission for the Psychiatric Reform that recommended integrating psychiatric care into the general health system, providing care in the patient's context and for specific diagnoses. The SESPAS 2002 Report carried out an analysis of this reform and recommended the creation of a permanent ministerial commission, the design of a national map of socio-sanitary mental health services, the creation of a coordination and promotion agency for and carrying out a financial analysis of resource provision and research. Since 2004, the Technical Committee for the Mental Health Strategy boosted the elaboration of a theoretical and normative framework that unfortunately did not lead to a road map for the improvement of the system. After 2011, during the financial crisis, the Ministry of Health lost the opportunity to lead a second phase of change of the mental health care, which was evidence-based: no key technical reports were published nor was an action plan based on data developed. Currently, the 1985 community mental health model is still the general framework of mental health care with the addition of aspects related to the recovery model and the balance of care model. Significant progress has been made in developing care systems assessment methods and data-based models that could advance mental health planning. The gap between general health attention and mental health care has increased and the expected reform of the mental health system will not take place in the near future.
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Affiliation(s)
- Luis Salvador-Carulla
- Asociación Científica Psicost, Sevilla, España; Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, Canberra, Australia
| | - Nerea Almeda
- Asociación Científica Psicost, Sevilla, España; Departamento de Psicología, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España.
| | - Javier Álvarez-Gálvez
- Asociación Científica Psicost, Sevilla, España; Departamento de Biomedicina, Biotecnología y Salud Pública, Universidad de Cádiz, Cádiz, España
| | - Carlos García-Alonso
- Asociación Científica Psicost, Sevilla, España; Departamento de Métodos Cuantitativos, Universidad Loyola Andalucía, Dos Hermanas, Sevilla, España
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Abstract
The 2008 global economic crisis heightened social inequality and drastically reduced equal opportunities for many people. It had negative consequences for social regulation in many European countries, which have dismantled their public social policies. The objective of the study was to describe social workers’ perceptions of their lived experiences in different areas of the public social services system. A qualitative study was developed, based on a hermeneutic approach. Six in-depth interviews and two focus groups were conducted with 20 social workers employed by community social services and the Andalusian public health service (Spain). The professionals agreed that the public social services system has been eroded, that the lack of resources has consequences for workers and the general public alike, and that the public authorities and the administration are responsible for this situation. Social services have become distributors of scarce resources rather than a social protection system that empowers and accompanies the most vulnerable. The system must provide the necessary resources and structures so that they can escape the situation of poverty, exclusion and social injustice.
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Sánchez-Recio R, Alonso JP, Aguilar-Palacio I. The use of health care services in the Great Recession: evaluating inequalities in the Spanish context. GACETA SANITARIA 2020; 34:245-252. [PMID: 32005597 DOI: 10.1016/j.gaceta.2019.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To analyse the effect of the Great Recession (2008) on primary care (PC) and secondary care (SC) inequalities in Spain. METHOD Repeated cross-sectional study using Spanish Health Surveys from 2001 to 2017 (n=139,566). Prevalence of PC and SC utilization were calculated standardized by age. Chi square tests for trend were conducted to explore the evolution. We performed logistic regression analyses adjusted by the Andersen's model of demand for care to explore inequalities prior to, during and following the recession. All the analyses were stratified by sex. RESULTS Healthcare use trends changed from a rapid increase in the pre-recession period to a plateau during the recession and a decrease in the post-recession period. Healthcare use was higher in women (PC: 15.8% to 32.5%; SC: 8.2% to 16.2%) than in men (PC: 11.3% to 24.1%; SC: 5.4% to 11.6%) and the gender gap increased. During the recession the likelihood of PC use was higher in disadvantaged groups, while SC had greater usage amongst more advantaged social groups. Inequalities in SC use increased during the recession and could not be attributed to factors of need. CONCLUSIONS Healthcare use trends changed as a result of the recession. There are socioeconomic inequalities in the use of PC and SC in Spain, which increased in secondary care, during the recession and in the post-recession period. It is necessary to take into account socioeconomic determinants in health planning, in order to achieve equity in healthcare services.
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Affiliation(s)
- Raquel Sánchez-Recio
- Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain
| | - Juan Pablo Alonso
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain; Dirección General de Salud Pública, Gobierno de Aragón, Zaragoza, Spain
| | - Isabel Aguilar-Palacio
- Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA) IIS Aragón, Zaragoza, Spain; Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, Spain; Departamento de Fisiatría y Enfermería, Universidad de Zaragoza, Zaragoza, Spain.
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