Transparencia en los resultados de la sanidad pública: el ejemplo de la central de resultados del sistema sanitario catalán

La mejora de la calidad y la transparencia del gobierno sanitario tiene un impacto en la salud de la población a través de las políticas, de la gestión de las organizaciones y de la práctica clínica. Además, la comparación entre centros sanitarios y la retroalimentación de los resultados de forma transparente a los profesionales y a la ciudadanía contribuye directamente a la mejora en los resultados. La Central de Resultados del sistema sanitario catalán mide y difunde los resultados alcanzados en el ámbito de la asistencia sanitaria por los diferentes proveedores a fin de facilitar una toma de decisiones corresponsable al servicio de la calidad de la atención sanitaria prestada a la población de Cataluña. Esta es una iniciativa pionera en el Estado español, y está alineada con los países más avanzados en políticas de transparencia y rendición de cuentasImproving the quality and transparency of the healthcare government has an impact on the health of the population through policies, management of organizations, and clinical practice. Moreover, the comparison between healthcare centres and the transparent feedback of results to professionals and to the citizens contributes directly to improved results. The Results Centre of the Catalan healthcare system measures and disseminates the results achieved by the different healthcare centres in order to facilitate a co-responsible decision making process, at the service of the quality of healthcare provided to the population of Catalonia. This is a pioneering initiative in Spain, and is aligned with the most advanced countries in policies of transparency and accountabilit

Measuring health inequalities : a systematic review of widely used indicators and topics

Altres ajuts: Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) I CIBER de Epidemiología y Salud Pública (CIBERESP)Background: According to many conceptual frameworks, the first step in the monitoring cycle of health inequalities is the selection of relevant topics and indicators. However, some difficulties may arise during this selection process due to a high variety of contextual factors that may influence this step. In order to help accomplish this task successfully, a comprehensive review of the most common topics and indicators for measuring and monitoring health inequalities in countries/regions with similar socioeconomic and political status as Catalonia was performed. Methods: We describe the processes and criteria used for selecting health indicators from reports, studies, and databases focusing on health inequalities. We also describe how they were grouped into well-known health topics. The topics were filtered and ranked by the number of indicators they accounted for. Results: We found 691 indicators used in the study of health inequalities. The indicators were grouped into 120 topics, 34 of which were selected for having five indicators or more. Most commonly found topics in the list include "Life expectancy", "Infant mortality", "Obesity and overweight (BMI)", "Mortality rate", "Regular smokers/tobacco consumption", "Self-perceived health", "Unemployment", "Mental well-being", "Cardiovascular disease/hypertension", "Socioeconomic status (SES)/material deprivation". Conclusions: A wide variety of indicators and topics for the study of health inequalities exist across different countries and organisations, although there are some clear commonalities. Reviewing the use of health indicators is a key step to know the current state of the study of health inequalities and may show how to lead the way in understanding how to overcome them

The impact of an easy access drug supply management policy law on the consumption and abuse of opioids in Catalonia : A population-based study

Background: Over the last two decades, the rise in opioid prescription has worsened health outcomes worldwide, increasing both levels of abuse and mortality rates. In order to reduce the scale of this public health problem, new policies have been implemented in many countries. In 2012, Spain adopted new legislation on opioid prescription (the ROE law), which meant that practitioners no longer needed to obtain extra authorisation in order to prescribe strong opioids. The objective of the paper is to assess the impact of this law on opioid use and abuse in Catalonia, Spain. Methods: We established two measures of the use of strong and weak opioids: DDDs, and abuse. We used benzodiazepines and antidepressants as controls, and adjusted for age, sex, drug co-payment level, death or near death, cancer diagnosis, morbidity group, and type of prescription. The data were obtained from administrative and dispensing drug databases in a population of 7.5 million inhabitants. We estimated two-way fixed effects using difference in difference models. Results: The ROE law impacted reducing the monthly use of strong opioids by 0.903 DDDs, representing a 3.15% decrease in the mean monthly use of strong opioids. However, abuse rose 1.86 times compared with the average pre-ROE value, which represents an increase of 11,190 months of opioid abuse (i.e., an 11.33% of all monthly opioids use). Conclusion: The abolition of the duplicate prescription programme for strong opioids led to a reduction in the average monthly use of strong opioids, but an increase in abuse

Living longer in declining health: factors driving healthcare costs among older people

Background Developed countries are facing challenges in caring for people who are living longer but with a greater morbidity burden. Such people are likely to be regular users of healthcare. Objectives Our analytical aim is to identify factors that explain healthcare costs among: (1) people over 55 years old; (2) the top 5% and 1% high-cost users among this population; (3) those that transition into the top 5% and 1% from one year to the next; (4) those that appear in the top 5% and 1% over multiple years; and (5) those that remain in the top 5% and 1% over consecutive years. Methods The data covered 2011 to 2017 and comprised 1,485,170 observations for a random sample of 224,249 people aged over 55 years in the Catalan region of Spain. We analysed each person's annual healthcare costs across all public healthcare settings related to their age, gender, socio-economic status (SES), whether or not and when they died, and morbidity status, through Adjusted Morbidity Groups. Results After controlling for morbidity status, the oldest people did not have the highest costs and were less likely to be among the most costly patients. There was also only a modest impact on costs associated with SES and with dying. Healthcare costs were substantially higher for those with a neoplasm or four or more long term conditions (LTCs), costs rising with the complexity of their conditions. These morbidity indicators were also the most important factors associated with being and remaining in the top 5% or top 1% of costs. Conclusion Our results suggest that age and proximity to death are poor predictors of higher costs. Rather, healthcare costs are explained mainly by morbidity status, particularly whether someone has neoplasms or multiple LTCs. Morbidity measures should be included in future studies of healthcare costs

Salut i pobresa infantil: què ens diuen les dades?

Salut dels infants; Crisi econòmica; Indicadors de salutSalud de los niños; Crisis económica; Indicadores de saludChild health; Economic crisis; Health indicatorsAnàlisi de les desigualtats en salut de la població infantil segons el seu nivell socioeconòmic a conseqüència de la situació de crisi econòmica viscuda els darrers anys. Es presenten un conjunt d'indicadors estadístics de l'any 2015.Análisis de las desigualdades en salud de la población infantil según su nivel socioeconómico como consecuencia de la situación de crisis económica vivida en los últimos años. Se presentan un conjunto de indicadores estadísticos del año 2015.Analysis of health inequalities in the child population according to their socioeconomic level as a result of the economic crisis experienced in the last years. It offers a set of statistical indicators for the year 2015

Do governments care about socioeconomic inequalities in health? Narrative review of reports of EU-15 countries

Altres ajuts: Fundació "La Caixa"Socioeconomic inequalities in health have been an issue in all European countries since the publication of the "Black Report" in the United Kingdom in 1980. However, data show that nowadays there are important socioeconomic health inequalities within EU countries. The purpose of this paper is to review EU-15 government reports that address socioeconomic inequalities in health. We reviewed 101 reports. The pioneer countries in analyzing this topic have a Beveridge-type health system, and they are the leaders over time. The top socioeconomic indicators used are education level, social class, deprivation level of the area, and nationality. Given the current COVID-19 pandemic situation and its economic consequences, EU governments need to continue monitoring the existing inequalities in health and to act transversely in all public policies

Sistemas de clasificación de pacientes en centros de media y larga estancia: evolución y perspectivas de futuro

ResumenLa atención de media y larga estancia es un sector cada vez más importante de la prestación de cuidados sanitarios. La utilización de sistemas de clasificación de pacientes se contempla cada vez más como un elemento necesario tanto en la planificación como en la gestión de servicios en el sector de atención a enfermos crónicos y geriátricos.Aunque mucho menos conocidos, los sistemas de clasificación de pacientes han tenido en el sector de la atención de media y larga estancia un desarrollo mucho más rico y precoz que en el sector hospitalario. De este modo, puede verse la evolución desde clasificaciones basadas exclusivamente en la valoración de la capacidad funcional de los residentes, hacia clasificaciones que incluyen progresivamente variables de complejidad asistencial, hasta sistemas elaborados como la clasificación RUG-III.Los sistemas de clasificación de pacientes se utilizaron inicialmente como instrumentos para soportar los sistemas de financiación de los centros de media y larga estancia basándose en las características de paciente. Posteriormente, sus aplicaciones se han ido extendiendo hacia otros objetivos relacionados con la gestión de los centros, la evaluación de la calidad asistencial, la determinación de niveles de dotación de personal, el control del acceso a la atención y la formulación de políticas gubernamentales. En España, la única experiencia de utilización de un sistema de clasificación de pacientes es la del Programa Vida Als Anys en Cataluña, que desde 1990 utiliza una clasificación para la financiación de los centros acogidos al mismo.SummaryThe importance of long term care sector is increasingly growing. Actually, the use of patient classification systems is a useful tool for the planning and management of health services for chronic and geriatric patients.Despite being much less known, patient classification systems have had a richer and earlier development in the long term care sector than in the acute care sector. Thus, one could see the evolution from classifications based on the assessment of functional dependency to classifications progressively including variables corresponding to clinical complexity, and finally to complex systems such as RUG-III.Patient classification systems were first utilised as tools for the financing of long term centres, based on the patients' characteristics. Later, their applications have spread out to objectives related to the management of centres, assessment of quality of care, staff allocation level, control of access and national policies. In Spain, the only experience in the use of a patient classification system is the one used by the Catalan Health Care Administration which uses a classification for the financing of their centres

Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study

Desigualtats socioeconòmiques; Infància; SalutDesigualdades socioeconómicas; Infancia; SaludSocioeconomic inequalities; Childhood; HealthL'objectiu d’aquest estudi ha estat triple: 1) calcular la desigualtat socioeconòmica per a una àmplia gama de malalties en tota una població infantil, 2) determinar les diferències de gènere en les desigualtats en cada malaltia i 3) estimar la càrrega de patologia atribuïble a l’NSE mitjançant mesures de desigualtat i impacte en el camp de l’epidemiologia

An estimation of the social cost of illicit drug consumption in Catalonia

Drogas ilegales; Coste de la enfermedad; Costes sociales; Planes nacionalesDrogues il·legals; Cost de la malaltia; Costos socials; Plans nacionalsIllegal drugs; Cost of illness; Social costs; National plansWorldwide, as well as in Spain, the use of illegal drugs is among the major contributors to the global burden of disease. Quantifying the costs that illegal drugs impose on society is key in terms of decision-making. The objective of this paper is to estimate the social cost of illicit drug consumption in Catalonia for a specific year, and to establish a methodology to be able to replicate such estimations regularly and monitor properly the impact of national plans. To do that, a cost of illness study was performed. For the estimation of mortality and morbidity costs, we relied on the Attributable Fraction approach. Only public sector costs were included: healthcare and non-healthcare costs. The cost of illegal drug consumption in Catalonia in 2011 was estimated at €326.39 million (0.16% of the Catalan GDP in 2011; 0.15% in 2018). Of the total cost, 82% corresponded to direct costs. Among direct costs, 30.32% corresponded to the penal system, 15.99% to hospitalizations, 13.48% to the police force, 17.19% to pharmacy, 8.34% to treatment in specialized centres, and 5.74% to therapeutic communities, among others. Indirect costs represented 18% of total costs, mostly lost income due to drug-related death. This study has been an opportunity to systematically collect data and think about the potential economic returns that could be achieved from effective policies and programs aimed at reducing the consumption of illegal drugs.Mundialmente, así como en España, el consumo de drogas ilegales es uno los principales contribuyentes a la carga mundial de morbilidad. Cuantificar los costes que las drogas ilegales imponen a la sociedad es clave para la toma de decisiones. El objetivo de este trabajo es estimar el coste social del consumo de drogas ilegales en Cataluña para un año específico y establecer una metodología para poder replicar dichas estimaciones regularmente y monitorear el impacto de los planes nacionales. Se ha realizado un estudio de coste de la enfermedad. Para la estimación de los costes de mortalidad y morbilidad se ha utilizado el enfoque de la fracción atribuible. Solo se incluyeron los costes del sector público, sanitarios y no sanitarios. El coste del consumo de drogas ilegales en Cataluña en 2011 se estimó en € 326,39 millones (0,16 % del PIB catalán en 2011; 0,15 % en 2018). El 82 % del coste total correspondió a costes directos; de estos, el 30,32 % correspondió al sistema penal, 15,99 % a hospitalizaciones, 13,48 % a la policía, 17,19 % a farmacia, 8,34 % a tratamiento en centros especializados y 5,74 % a comunidades terapéuticas, entre otros. Los costes indirectos representaron el 18 % de los costes totales, principalmente pérdidas de productividad debidas a muertes por el consumo de drogas. Este estudio ha sido una oportunidad para recopilar datos de forma sistemática y pensar en los posibles rendimientos económicos que podrían obtenerse de políticas y programas efectivos destinados a reducir el consumo de drogas ilegales

Comorbidity patterns and socioeconomic inequalities in children under 15 with medical complexity : A population-based study

Children with medical complexity (CMC) denotes the profile of a child with diverse acute and chronic conditions, making intensive use of the healthcare services and with special health and social needs. Previous studies show that CMC are also affected by the socioeconomic position (SEP) of their family. The aim of this study is to describe the pathologic patterns of CMC and their socioeconomic inequalities in order to better manage their needs, plan healthcare services accordingly, and improve the care models in place. Cross-sectional study with latent class analysis (LCA) of the CMC population under the age of 15 in Catalonia in 2016, using administrative data. LCA was used to define multimorbidity classes based on the presence/absence of 57 conditions. All individuals were assigned to a best-fit class. Each comorbidity class was described and its association with SEP tested. The Adjusted Morbidity Groups classification system (Catalan acronym GMA) was used to identify the CMC. The main outcome measures were SEP, GMA score, sex, and age distribution, in both populations (CMC and non-CMC) and in each of the classes identified. 71% of the CMC population had at least one parent with no employment or an annual income of less than €18,000. Four comorbidity classes were identified in the CMC: oncology (36.0%), neurodevelopment (13.7%), congenital and perinatal (19.8%), and respiratory (30.5%). SEP associations were: oncology OR 1.9 in boys and 2.0 in girls; neurodevelopment OR 2.3 in boys and 1.8 in girls; congenital and perinatal OR 1.7 in boys and 2.1 in girls; and respiratory OR 2.0 in boys and 2.0 in girls. Our findings show the existence of four different patterns of comorbidities in CMC and a significantly high proportion of lower SEP children in all classes. These results could benefit CMC management by creating more efficient multidisciplinary medical teams according to each comorbidity class and a holistic perspective taking into account its socioeconomic vulnerability