Regional well-being inequalities arising from healthcare expenditure public policies in Spain
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 resea...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2022.953827/full |
| _version_ | 1828733645846740992 |
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| author | María del Carmen Valls Martínez Mayra Soledad Grasso José-María Montero |
| author_facet | María del Carmen Valls Martínez Mayra Soledad Grasso José-María Montero |
| author_sort | María del Carmen Valls Martínez |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-12T22:34:30Z |
| format | Article |
| id | doaj.art-f1e58a1d614e4566b24fd611bb5bef02 |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-12T22:34:30Z |
| publishDate | 2022-09-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-f1e58a1d614e4566b24fd611bb5bef022022-12-22T03:13:54ZengFrontiers Media S.A.Frontiers in Public Health2296-25652022-09-011010.3389/fpubh.2022.953827953827Regional well-being inequalities arising from healthcare expenditure public policies in SpainMaría del Carmen Valls Martínez0Mayra Soledad Grasso1José-María Montero2European Research Center on Economics and Sustainable Development, Economics and Business Department, University of Almería, Almería, SpainEuropean Research Center on Economics and Sustainable Development, Economics and Business Department, University of Almería, Almería, SpainDepartment of Political Economy and Public Finance, Economic and Business Statistics, and Economic Policy, University of Castilla-La Mancha, Toledo, SpainWell-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.https://www.frontiersin.org/articles/10.3389/fpubh.2022.953827/fullSpanish health systemlife expectancywell-being inequalitieshealthcare expenditure public policiespartial least squares structural equation modelingcluster analysis |
| spellingShingle | María del Carmen Valls Martínez Mayra Soledad Grasso José-María Montero Regional well-being inequalities arising from healthcare expenditure public policies in Spain Frontiers in Public Health Spanish health system life expectancy well-being inequalities healthcare expenditure public policies partial least squares structural equation modeling cluster analysis |
| title | Regional well-being inequalities arising from healthcare expenditure public policies in Spain |
| title_full | Regional well-being inequalities arising from healthcare expenditure public policies in Spain |
| title_fullStr | Regional well-being inequalities arising from healthcare expenditure public policies in Spain |
| title_full_unstemmed | Regional well-being inequalities arising from healthcare expenditure public policies in Spain |
| title_short | Regional well-being inequalities arising from healthcare expenditure public policies in Spain |
| title_sort | regional well being inequalities arising from healthcare expenditure public policies in spain |
| topic | Spanish health system life expectancy well-being inequalities healthcare expenditure public policies partial least squares structural equation modeling cluster analysis |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2022.953827/full |
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