Strengthening health systems through nursing: Evidence from 14 European countries. Spain.

CAPÍTULO 12 Spain‘Who is a nurse?’ and ‘What is nursing?’ seem to be simple questions yet the answers are strangely elusive. This book explores the variations in structure and organization of the nursing workforce across fourteen different countries in Europe. This diversity, and the reasons for it, are of more than academic interest. The work of nurses has always had a critical impact on patient outcomes. As health systems shift radically in response to rising demand, the role of nurses becomes even more important. The lessons learned from comparative case-study analysis demonstrate wide variation in every dimension of the workforce. It examines what a nurse is; nurse-to-doctor and nurse-to-population ratios; the education, regulation and issuing of credentials to nurses; and the planning of the workforce. While comparative analysis across countries brings these differences into sharp relief, it also reveals how the EU functions as an important ‘binding agent’, drawing these diverse elements together into a more coherent whole. This book is part of a two-volume study on the contributions that nurses make to strengthening health systems. This is the first time that the topic of nursing has been dealt with at length within the Observatory Health Policy Series. The aim is to raise the profile of nursing within health policy and draw the attention of decision-makers. Volume 1 is a series of national case studies drawn from Belgium, England, Finland, Germany, Greece, Ireland, the Netherlands, Norway, Poland, Spain, Sweden, and Switzerland. The countries were chosen as the subject of a large EU-funded study of nursing (RN4Cast). Lithuania and Slovenia were added to provide broader geographical and policy reach. Volume 2 will provide thematic analysis of important policy issues such as quality of care, workforce planning, education and training, regulation and migration

A health 'Kuznets' curve'? Cross-section and longitudinal evidence on concentration indices

The distribution of income related health inequalities appears to exhibit changing patterns when both developing countries and developed countries are examined. This paper tests for the existence of a health Kuznets' curve, that is an inverse U-shape pattern between economic developments measured by GDP per capita) and income-related health inequalities (as measured by concentration indices). We draw upon both cross section (the World Health Survey) and a long longitudinal (the European Community Household Panel survey) dataset. Our results suggest evidence of a health Kuznets' curve on per capita income. Our findings point towards the existence of a polynomial association where inequalities decline when GDP per capita reaches a magnitude ranging between $26,000 and$38,700.That is, income-related health inequalities rise with GDP per capita, but tail off once a threshold level of economic development has been attained

Romania: health system review

This analysis of the Romanian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The Romanian health care system is a social health insurance system that has remained highly centralized despite recent efforts to decentralize some regulatory functions. It provides a comprehensive benefits package to the 85% of the population that is covered, with the remaining population having access to a minimum package of benefits. While every insured person has access to the same health care benefits regardless of their socioeconomic situation, there are inequities in access to health care across many dimensions, such as rural versus urban, and health outcomes also differ across these dimensions. The Romanian population has seen increasing life expectancy and declining mortality rates but both remain among the worst in the European Union (EU). Some unfavourable trends have been observed, including increasing numbers of new HIV/AIDS diagnoses and falling immunization rates. Public sources account for over 80% of total health financing. However, that leaves considerable out-of-pocket payments covering almost a fifth of total expenditure. The share of informal payments also seems to be substantial, but precise figures are unknown. In 2014, Romania had the lowest health expenditure as a share of gross domestic product (GDP) among the EU Member States

Ten Years since the 2006 Creation of the Portuguese National Network for Long-Term Care:Achievements and Challenges

The Portuguese National Network for Long-term Integrated Care (Rede Nacional de Cuidados Continuados, RNCCI) was created in 2006 as a partnership between the Ministry of Health and the Ministry of Labour and Social Solidarity. The formal provision of care within the RNCCI is made up of non-profit and non-public institutions called Private Institutions of Social Solidarity, public institutions belonging to the National Health Service, and for-profit-institutions. These institutions are organized by type of care in two main settings: (i) Home and Community-Based Services, and (ii) four types of Nursing Homes to account for different care needs. This is the first study that assess the RNCCI reform in Portugal since 2006 and takes into account several core dimensions: coordination, ownership, organizational structure, financing system and main features, as well as the challenges ahead. Evidence suggests that despite providing universal access, Portuguese policymakers face the following challenges: multiple sources of financing, the existence of several care settings and the sustained increase of admissions at the RNCCI, the dominance of institutionalization, the existence of waiting lists, regional asymmetries, the absence of a financing model based on dependence levels, or the difficulty to use the instrument of needs assessment for international comparison

The Spanish long-term care system in transition: ten years since the 2006 Dependency Act

At the end of 2006, a new System for Promotion of Personal Autonomy and Assistance for Persons in a Situation of Dependency (SAAD) was established in Spain through the approval of the Act 39/2006 of 14th December (the Dependency Act, DA). The DA acknowledged the universal entitlement of Spanish citizens to social services. The recent economic crisis added degrees of uncertainty to several dimensions of the SAAD implementation process. Firstly, the political consensus on which its foundation rested upon has weakened. Secondly, implementation of the SAAD was hampered by several challenges that emerged in the context of the economic crisis. Thirdly, the so-called “dependency limbo” (i.e. the existence of a large number of people eligible for benefits but who do not receive them) has become a structural feature of the system. Finally, contrary to the spirit of the DA, monetary benefits have become the norm rather than a last resort. High heterogeneity across regions regarding the number of beneficiaries covered and services provided reveal the existence of regional inequity in access to long-term care services in the country. Broadly, the current evidence on the state of the SAAD suggests the need to improve the quality of governance, to enhance coordination between health and social systems, to increase the system's transparency, to foster citizens’ participation in decision-making and to implement a systematic monitoring of the system

France: health system review

The Health Systems in Transition (HiT) series consists of country-based reviews that provide a detailed description of a health system and of reform and policy initiatives in progress or under development in a specific country. Each review is produced by country experts in collaboration with the Observatory’s staff. In order to facilitate comparisons between countries, reviews are based on a template, which is revised periodically. The template provides detailed guidelines and specific questions, definitions and examples needed to compile a report. HiTs seek to provide relevant information to support policy-makers and analysts in the development of health systems in Europe. They are building blocks that can be used to: • learn in detail about different approaches to the organization, financing and delivery of health services and the role of the main actors in health systems; • describe the institutional framework, process, content and implementation of health care reform programmes; • highlight challenges and areas that require more in-depth analysis; • provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policy-makers and analysts in different countries; and • assist other researchers in more in-depth comparative health policy analysis. Compiling the reviews poses a number of methodological problems. In many countries, there is relatively little information available on the health system and the impact of reforms. Due to the lack of a uniform data source, quantitative data on health services are based on a number of different sources, including the World Health Organization (WHO) Regional Office for Europe’s European Health for All database, data from national statistical offices, Eurostat, the Organisation for Economic Co-operation and Development (OECD) Health Data, data from the International Monetary Fund (IMF), the World Bank’s World Development Indicators and any other relevant sources considered useful by the authors. Data collection methods and definitions sometimes vary, but typically are consistent within each separate review. A standardized review has certain disadvantages because the financing and delivery of health care differ across countries. However, it also offers advantages because it raises similar issues and questions. HiTs can be used to inform policy-makers about experiences in other countries that may be relevant to their own national situations. They can also be used to inform comparative analysis of health systems. This series is an ongoing initiative and material is updated at regular intervals. Comments and suggestions for the further development and improvement of the HiT series are most welcome and can be sent to [email protected]. HiTs and HiT summaries are available on the Observatory’s web site (http://www.healthobservatory.eu)

The unexpected outcomes of the closure of 67 inpatient care facilities in 2011 in Romania

One of the main objectives of the National Strategy for Hospitals Rationalization approved by the Romanian Government in 2011 was to resize the hospital sector in order to improve efficiency. To this end, the government decided the closure of 67 inpatient care facilities with low efficiency scores, giving them the opportunity to become nursing homes for elderly under a national programme financed by the Ministry of Labour, Family and Social Protection. The measure faced a tremendous public opposition that put pressure on politicians to re-open some hospitals, while other hospitals were re-opened by the governments that followed in order to consolidate their power. Since only 20 closed institutions have been reorganized as nursing homes for elderly and almost 40 are currently performing medical activities, this decision was generally perceived as a policy failure. Nevertheless, a thorough analysis, shows that the medical facilities that are still functioning - either merged with other hospitals, or re-organized as state or private medical institutions have improved efficiency by reshaping services provided to the population needs, mobilizing communities and local authorities investments and initiating public-private partnerships. Besides revealing the unexpected benefits resulted from the implementation of this policy, the Romanian experience provides some useful insights for other countries that are also facing the challenge of reducing the oversized hospital sector