spanish health system

  • 文章类型: Journal Article
    公共卫生由政府从税收中筹集的资金资助,无论是国家,省或市。因此,在经济危机期间,卫生系统受到影响。无论是由于撤资,医疗保健人员购买力的丧失或专业人员数量的减少。这使情况恶化,因为有必要满足越来越多的老年人口和出生时预期寿命更长的需求。本研究旨在显示一个模型,该模型可以解释在特定时期内西班牙的“公共卫生人员支出”的确定。对包括1980-2021年在内的这一时期应用了多元线性回归模型。分析了宏观经济和人口变量来解释因变量。卫生人员支出的变化:“我们包括了那些在r>0.6以上表现出高或非常高相关性的变量。解释卫生人员支出变化行为的变量\“。认为对卫生政策影响最大的变量主要是宏观经济变量而不是人口变量,唯一具有特定权重低于宏观经济变量的重要人口变量是“出生率”。在这个意义上,对科学文献的贡献是建立一个解释模型,以便公共政策管理者和特别是各州可以在其公共支出政策中考虑它,考虑到贝弗里奇式卫生系统的卫生支出,就像西班牙一样,是用从税收收入中提取的资金支付的。
    Public health is funded with government funds gathered from tax revenues, whether national, provincial or municipal. The health system therefore suffers during economic crisis periods, whether due to disinvestment, loss of purchasing power among health care personnel or the decrease in the number of professionals. This worsens the situation, as it is necessary to cover the needs of an increasingly elderly population and with a longer life expectancy at birth. The present study intends to show a model which explains the determination of the \"Public Health Personnel Expenditure\" in Spain for a determined period. A multiple linear regression model was applied to the period including the years 1980-2021. Macroeconomic and demographic variables were analyzed to explain the dependent variable. Variation in health personnel expenditure: \"We included those variables which presented a high or very high correlation above r > 0.6. The variables which explain the behavior of Variation in health personnel expenditure\". It was a determining factor in the present study to consider that the variables with the greatest repercussions on health policy were mainly macroeconomic variables rather than demographic variables, with the only significant demographic variable that had a specific weight lower than macroeconomic variables being \"Birth Rate\". In this sense, the contribution made to the scientific literature is to establish an explanatory model so that public policy managers and states in particular can consider it in their public spending policies, bearing in mind that health expenditures in a Beveridge-style health system, as Spain has, are paid with funds drawn from tax revenues.
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  • 文章类型: Journal Article
    由不同的医疗支出公共政策引起的福祉不平等目前是全国范围内的热门话题,但尤其是在国家以下一级,因为有问题的不平等是在同一个国家的公民之间。西班牙是开展这一主题研究的最佳研究地区,因为它被认为是世界上最好的卫生系统之一,它是预期寿命率(我们用来衡量福祉的指标)排名最高的国家之一,它有一个分散的公共卫生系统,具有明显不同的区域医疗支出公共政策。鉴于复杂直接涉及的因素,间接,幸福感和医疗支出之间的二阶关系本质上是潜在的,关于这些关系,有更多的假设而不是确定性,我们提出了偏最小二乘结构方程建模规范来检验研究假设并估计相应的影响。这些结构由一组26个指标代表,2005-2018年期间使用区域范围的年度值。根据这个模型的估计,可以得出结论,死亡率,支出和资源是对福祉影响最大的因素。此外,对这项研究中包含的结构的指标进行的聚类分析表明,存在三个明显不同的自治社区群体:该国北部加上埃斯特雷马杜拉(以最低的福祉和最高的死亡率为特征),马德里(在福祉和死亡率方面效果最好,人均最低的公共卫生支出和药品支出百分比,以及专科护理服务和医务人员支出的最高百分比),和该国其他地区(东南部地区,与第一组的福祉值相似,但医疗支出较少)。最后,主成分分析表明,“健康”和“基本支出”是绘制西班牙福祉和卫生支出的最佳因素。
    Well-being inequalities arising from different healthcare expenditure public policies is currently a hot topic at a national scale, but especially so at a sub-national level because the inequalities in question are among citizens of the same country. Spain is an optimal study area to carry out research on this topic because it is considered to have one of the best health systems in the world, it is one of the top-ranking countries in terms of life expectancy rates (the indicators we use for well-being), and it has a decentralized public health system with significantly different regional healthcare expenditure public policies. Given that the factors involved in the complex direct, indirect, and second-order relationships between well-being and health spending are latent in nature, and that there are more hypotheses than certainties regarding these relationships, we propose a partial least squares structural equation modeling specification to test the research hypotheses and to estimate the corresponding impacts. These constructs are proxied by a set of 26 indicators, for which annual values at a regional scale were used for the period 2005-2018. From the estimation of this model, it can be concluded that mortality, expenditure and resources are the factors that have the greatest impact on well-being. In addition, a cluster analysis of the indicators for the constructs included in this research reveals the existence of three clearly differentiated groups of autonomous communities: the northern part of the country plus Extremadura (characterized by the lowest well-being and the highest mortality rates), Madrid (with the best results in well-being and mortality, the lowest public health expenditure per inhabitant and percentage of pharmaceutical spending, and the highest percentage in specialty care services and medical staff spending), and the rest of the country (south-eastern regions, with similar well-being values to those of the first group but with less health expenditure). Finally, a principal component analysis reveals that \"healthiness\" and \"basic spending\" are the optimal factors for mapping well-being and health spending in Spain.
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  • 文章类型: Journal Article
    在这个COVID-19时代,我们需要重新考虑衡量以人为本护理策略结果的标准。
    为了确定优先级,以及卫生服务可以用来实际追求实现以人为本护理目标的标准。
    使用德尔菲技术在2020年5月至7月进行了三阶段在线定性研究。
    一个在线平台用于114名与会者的共识会议,包括健康规划专家,医疗机构经理,临床医生和患者。
    实现以人为本护理的标准和指标。
    第一轮以125个提案和11个维度开始。第二轮之后,28个想法在与会者中达成了高度共识。最终,工作组就COVID-19时代实施以人为本护理的20项目标标准和21项相关指标达成了一致.
    确定了9个维度和28个优先事项。这些优先事项也符合四重目标方针,这强调了对医疗保健专业人员的护理的必要性,没有他们,就不可能实现更好的护理质量。
    以人为本的护理仍然是一个关键目标。然而,在恢复COVID-19无法控制的公共卫生服务期间,需要新的指标来确保其持续发展。
    12名专业人员和患者代表自愿参与基线问卷的构建以及使用在线共识会议平台选择标准和指标。
    In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies.
    To identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care.
    Three-phase online qualitative study performed during May-July of 2020 using the Delphi technique.
    An online platform was used for a consensus meeting of 114 participants, including health planning experts, health-care institution managers, clinicians and patients.
    Criteria and indicators for the achievement of person-centred care.
    The first round began with 125 proposals and 11 dimensions. After the second round, 28 ideas reached a high level of consensus among the participants. Ultimately, the workgroup agreed on 20 criteria for goals in the implementation of person-centred care during the COVID-19 era and 21 related indicators to measure goal achievement.
    Nine dimensions and 28 priorities were identified. These priorities are also in accordance with the quadruple aim approach, which emphasizes the need for care for health-care professionals, without whom it is impossible to achieve a better quality of care.
    Person-centred care continues to be a key objective. However, new metrics are needed to ensure its continued development during the restoration of public health services beyond the control of COVID-19.
    Twelve professionals and patient representatives participated voluntarily in the construction of the baseline questionnaire and in the selection of the criteria and indicators using an online platform for consensus meetings.
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  • 文章类型: Journal Article
    与世界上大多数国家不同,西班牙拥有独特而庞大的高度专业化的院外急救服务体系,由训练有素的家庭医生领导,急诊医学专家。当救护车在20号随着警报声和音乐沿着街道行驶时,为伊比沙岛市的人们加油,巴利阿里群岛,西班牙,2020年4月7日,一个男孩不确定地走近,在阳台上人们的支持和同谋的目光下,一句话也没说就通过了救护车卫生工作者,他的画透过窗户。
    Unlike most countries in the world, Spain has a unique and huge system of highly specialized out-of-hospital emergency service, led by the best trained family doctors, specialists in Emergency Medicine. While the ambulance went down the street at 20th with sirens and music to cheer on the people of city Ibiza, Balearic Islands, Spain, on April 7, 2020, a BOY approached unsurely, under the supportive and complicit eyes of the people from the balconies and without saying a word passed the ambulance health workers, his drawing through the window.
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  • 文章类型: English Abstract
    This article offers a brief summary of the factors that the author believes should be considered when analyzing the multiple interrelations between the economic crisis and its effects on public finances, social spending, and the health and welfare of Spaniards. For the sake of brevity, a linear argument is followed, with the basic contents of the message, leaving some of the more controversial issues whose interpretation may be heavily influenced by ideology to the discussion. The core of the argument is that, despite the double dip of the Spanish recession, healthcare has survived the consequences of the crisis fairly well. This is particularly the case when the situation is analyzed in terms of the share of public expenditure to GDP and in per capita terms, given the evolution of these ratios, although the final effect is unknown in terms of the actual and potential beneficiaries. This relatively low incidence so far on the health of Spaniards is basically due to family networks, pooling their incomes, and to the acceptance by Spanish health professionals of budget cuts, which have allowed services and their apparent quality to be maintained, contrasting with private employment and public finances. Obviously, this is not a guarantee of sustainability unless economic growth recovers. Even if the Spanish economy and public finances improve, the composition of health care delivery needs to be reevaluated to achieve a new allocation between public and private responsibilities for healthcare in accordance with the social development of the 21st century.
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