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Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain

Author

Listed:
  • Juan Antonio Córdoba-Doña
  • Antonio Escolar-Pujolar
  • Miguel San Sebastián
  • Per E Gustafsson
Abstract
Scant research is available on the impact of the current economic crisis and austerity policies on inequality in health services utilisation in Europe. This study aimed to describe the trends in horizontal inequity in the use of health services in Andalusia, Spain, during the early years of the Great Recession, and the contribution of demographic, economic and social factors. Consultation with a general practitioner (GP) and specialist, hospitalisation and emergency care were studied through the Andalusian Health Survey 2007 (pre-crisis) and 2011–2012 (crisis), using a composite income index as socioeconomic status (SES) indicator. Horizontal inequity indices (HII) were calculated to take differential healthcare needs into account, and a decomposition analysis of change in inequality between periods was performed. Results showed that before the crisis, the HII was positive (greater access for people with higher SES) for specialist visits but negative (greater access for people with lower SES) in the other three utilisation models. During the crisis no change was observed in inequalities in GP visits, but a pro-poor development was seen for the other types of utilisation, with hospital and emergency care showing significant inequality in favour of low income groups. Overall, the main contributors to pro-poor changes in utilisation were socio-economic variables and poor mental health, due to changes in their elasticities. Our findings show that inequalities in healthcare utilisation largely remained in favour of the less well-off, despite the cuts in welfare benefits and health services provision during the early years of the recession in Andalusia. Further research is needed to monitor the potential impact of such measures in subsequent years.

Suggested Citation

  • Juan Antonio Córdoba-Doña & Antonio Escolar-Pujolar & Miguel San Sebastián & Per E Gustafsson, 2018. "Withstanding austerity: Equity in health services utilisation in the first stage of the economic recession in Southern Spain," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-21, March.
    • Handle: RePEc:plo:pone00:0195293
    DOI: 10.1371/journal.pone.0195293
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    References listed on IDEAS

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    1. Elena Villalba Mora & Jose A. Valverde Albacete, 2013. "Integrated Healthcare in Andalusia - Analysis of primary care, specialised care, emergency care, social care and citizen support platforms," JRC Research Reports JRC81838, Joint Research Centre.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    3. Cavagnero, Eleonora & Bilger, Marcel, 2010. "Equity during an economic crisis: Financing of the Argentine health system," Journal of Health Economics, Elsevier, vol. 29(4), pages 479-488, July.
    4. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    5. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    6. David M. Cutler & Adriana Lleras-Muney, 2006. "Education and Health: Evaluating Theories and Evidence," NBER Working Papers 12352, National Bureau of Economic Research, Inc.
    7. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    8. Kees van Gool & Mark Pearson, 2014. "Health, Austerity and Economic Crisis: Assessing the Short-term Impact in OECD countries," OECD Health Working Papers 76, OECD Publishing.
    9. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    10. Amelia Maika & Murthy N Mittinty & Sally Brinkman & Sam Harper & Elan Satriawan & John W Lynch, 2013. "Changes in Socioeconomic Inequality in Indonesian Children’s Cognitive Function from 2000 to 2007: A Decomposition Analysis," PLOS ONE, Public Library of Science, vol. 8(10), pages 1-9, October.
    11. Reeves, Aaron & McKee, Martin & Basu, Sanjay & Stuckler, David, 2014. "The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011," Health Policy, Elsevier, vol. 115(1), pages 1-8.
    12. van Doorslaer, Eddy & Wagstaff, Adam & van der Burg, Hattem & Christiansen, Terkel & De Graeve, Diana & Duchesne, Inge & Gerdtham, Ulf-G & Gerfin, Michael & Geurts, Jose & Gross, Lorna, 2000. "Equity in the delivery of health care in Europe and the US," Journal of Health Economics, Elsevier, vol. 19(5), pages 553-583, September.
    13. Crespo-Cebada, Eva & Urbanos-Garrido, Rosa M., 2012. "Equity and equality in the use of GP services for elderly people: The Spanish case," Health Policy, Elsevier, vol. 104(2), pages 193-199.
    14. Kentikelenis, Alexander E., 2017. "Structural adjustment and health: A conceptual framework and evidence on pathways," Social Science & Medicine, Elsevier, vol. 187(C), pages 296-305.
    15. Max Coveney & Pilar García‐Gómez & Eddy Van Doorslaer & Tom Van Ourti, 2016. "Health Disparities by Income in Spain Before and After the Economic Crisis," Health Economics, John Wiley & Sons, Ltd., vol. 25(S2), pages 141-158, November.
    16. de Belvis, Antonio Giulio & Ferrè, Francesca & Specchia, Maria Lucia & Valerio, Luca & Fattore, Giovanni & Ricciardi, Walter, 2012. "The financial crisis in Italy: Implications for the healthcare sector," Health Policy, Elsevier, vol. 106(1), pages 10-16.
    17. repec:wly:hlthec:v:25:y:2016:i::p:141-158 is not listed on IDEAS
    18. Siegel, Martin & Vogt, Verena & Sundmacher, Leonie, 2014. "From a conservative to a liberal welfare state: Decomposing changes in income-related health inequalities in Germany, 1994–2011," Social Science & Medicine, Elsevier, vol. 108(C), pages 10-19.
    19. Adam Wagstaff & Naoko Watanabe, 2003. "What difference does the choice of SES make in health inequality measurement?," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 885-890, October.
    20. Cervero-Liceras, Francisco & McKee, Martin & Legido-Quigley, Helena, 2015. "The effects of the financial crisis and austerity measures on the Spanish health care system: A qualitative analysis of health professionals’ perceptions in the region of Valencia," Health Policy, Elsevier, vol. 119(1), pages 100-106.
    21. Simou, Effie & Koutsogeorgou, Eleni, 2014. "Effects of the economic crisis on health and healthcare in Greece in the literature from 2009 to 2013: A systematic review," Health Policy, Elsevier, vol. 115(2), pages 111-119.
    22. Keramidou, Ioanna & Triantafyllopoulos, Loukas, 2018. "The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece," Health Policy, Elsevier, vol. 122(4), pages 352-358.
    23. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    24. Laia Palència & Albert Espelt & Maica Rodríguez-Sanz & Katia B. Rocha & M. Isabel Pasarín & Carme Borrell, 2013. "Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 211-219, April.
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