Structural risk indicators for the Spanish banking sector

Structural risks are long-term non-cyclical risks stemming from the structural characteristics of the financial system and the wider economy. In this respect, the systemic risk buffer (SyRB) is a fairly flexible macroprudential instrument that aims to address such risks. However, the European Union (EU) legislation is still flexible regarding the indicators for activating or releasing this buffer. Although a clear definition of these indicators is key to enabling the early detection of vulnerabilities that may lead to a crisis, in practice, each national authority determines its own set of indicators. This article has a dual aim. First, to select a set of indicators that are relevant for regularly monitoring the Spanish banking sector’s structural risks and, second, to develop a heatmap of structural indicators comparing variables for Spain with those for the EU. The empirical evidence suggests that the Spanish banking sector shares most of its structural features with those of the EU economies. According to the analysis, no structural risks are identified at present that might threaten the Spanish banking sector.Los riesgos estructurales son riesgos a largo plazo de carácter no cíclico, derivados de las características estructurales del sistema financiero y de la economía en general. A este respecto, el colchón contra riesgos sistémicos es una herramienta macroprudencial dotada de bastante flexibilidad que trata de abordar dichos riesgos. Sin embargo, la normativa de la Unión Europea (UE) todavía es flexible con respecto a la activación y la liberación de este colchón. Aunque definir claramente estos indicadores es esencial para la detección temprana de vulnerabilidades que puedan desembocar en una crisis, en la práctica, cada autoridad nacional establece su propio conjunto de indicadores. Este trabajo persigue un doble objetivo. Primero, seleccionar una serie de indicadores relevantes para el seguimiento periódico de los riesgos estructurales del sector bancario español y, segundo, desarrollar un mapa de riesgos estructurales que compare las variables españolas con las de la UE. La evidencia empírica sugiere que el sector bancario español comparte la mayoría de las características estructurales de las economías de la UE. Según el análisis desarrollado, en la actualidad no se identifican riesgos estructurales que puedan constituir una amenaza para el sector bancario español

Structural risk indicators for the Spanish banking sector

Structural risks are long-term non-cyclical risks stemming from the structural characteristics of the financial system and the wider economy. In this respect, the systemic risk buffer (SyRB) is a fairly flexible macroprudential instrument that aims to address such risks. However, the European Union (EU) legislation is still flexible regarding the indicators for activating or releasing this buffer. Although a clear definition of these indicators is key to enabling the early detection of vulnerabilities that may lead to a crisis, in practice, each national authority determines its own set of indicators. This article has a dual aim. First, to select a set of indicators that are relevant for regularly monitoring the Spanish banking sector’s structural risks and, second, to develop a heatmap of structural indicators comparing variables for Spain with those for the EU. The empirical evidence suggests that the Spanish banking sector shares most of its structural features with those of the EU economies. According to the analysis, no structural risks are identified at present that might threaten the Spanish banking sector.Los riesgos estructurales son riesgos a largo plazo de carácter no cíclico, derivados de las características estructurales del sistema financiero y de la economía en general. A este respecto, el colchón contra riesgos sistémicos es una herramienta macroprudencial dotada de bastante flexibilidad que trata de abordar dichos riesgos. Sin embargo, la normativa de la Unión Europea (UE) todavía es flexible con respecto a la activación y la liberación de este colchón. Aunque definir claramente estos indicadores es esencial para la detección temprana de vulnerabilidades que puedan desembocar en una crisis, en la práctica, cada autoridad nacional establece su propio conjunto de indicadores. Este trabajo persigue un doble objetivo. Primero, seleccionar una serie de indicadores relevantes para el seguimiento periódico de los riesgos estructurales del sector bancario español y, segundo, desarrollar un mapa de riesgos estructurales que compare las variables españolas con las de la UE. La evidencia empírica sugiere que el sector bancario español comparte la mayoría de las características estructurales de las economías de la UE. Según el análisis desarrollado, en la actualidad no se identifican riesgos estructurales que puedan constituir una amenaza para el sector bancario español

Sectoral indicators for applying the Banco de España’s new macroprudential tools

Since December 2021 the Banco de España has three new macroprudential tools (Circular 5/2021): the sectoral component of the countercyclical capital buffer, limits on sectoral concentration, and limits and conditions on loan origination. The new sectoral instruments will allow it to address the risks that are concentrated in specific sectors, for which the aggregate macroprudential tools would be less effective, as they are applied equally across all sectors. In order to apply these tools, any potential vulnerabilities building up in the different sectors must be previously identified by means of adequate indicators. This article analyses the battery of sectoral indicators proposed in the circular, which may be useful for activating these new macroprudential tools. Their calculation methodology is similar to that used for the general countercyclical capital buffer indicators. In addition, a study of their predictive power is conducted, which shows their efficiency in identifying risks early. According to these indicators, on data up to 2021 Q3, no warning signals have been observed suggesting that these new tools should be activated

The effect of a change in co-payment on prescription drug demand in a National Health System: The case of 15 drug families by price elasticity of demand.

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase

Indicadores sectoriales para la aplicación de las nuevas herramientas macroprudenciales del Banco de España

El Banco de España cuenta desde diciembre de 2021 con tres nuevas herramientas macroprudenciales (Circular 5/2021): el componente sectorial del colchón de capital anticíclico, los límites a la concentración sectorial, y los límites y condiciones a la concesión de préstamos. Los nuevos instrumentos sectoriales permitirán abordar riesgos que estén concentrados en sectores concretos, para los que las herramientas macroprudenciales agregadas serían menos efectivas, al aplicarse a todos los sectores por igual. Para la aplicación de estas herramientas, es necesario identificar previamente las potenciales vulnerabilidades que se pudieran estar acumulando en los diferentes sectores mediante unos indicadores adecuados. En este artículo se desarrolla la batería de indicadores sectoriales propuesta en la circular, que puede ser de utilidad para la activación de estas nuevas herramientas macroprudenciales. Su metodología de cálculo es análoga a la ya empleada para los indicadores del colchón de capital anticíclico general. Además, se realiza un estudio de su capacidad predictiva, que muestra su eficacia para identificar riesgos de forma temprana. Según estos indicadores, con datos hasta el tercer trimestre de 2021, no se observan señales de alerta que sugieran la activación de las nuevas herramientas

Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services.

OBJECTIVE: To investigate variations in quality of acute stroke care and outcomes by day and time of admission in London hyperacute stroke units compared with the rest of England. DESIGN: Prospective cohort study using anonymised patient-level data from the Sentinel Stroke National Audit Programme. SETTING: Acute stroke services in London hyperacute stroke units and the rest of England. PARTICIPANTS: 68 239 patients with a primary diagnosis of stroke admitted between January and December 2014. INTERVENTIONS: Hub-and-spoke model for care of suspected acute stroke patients in London with performance standards designed to deliver uniform access to high-quality hyperacute stroke unit care across the week. MAIN OUTCOME MEASURES: 16 indicators of quality of acute stroke care, mortality at 3 days after admission to the hospital, disability at the end of the inpatient spell, length of stay. RESULTS: There was no variation in quality of care by day and time of admission to the hospital across the week in terms of stroke nursing assessment, brain scanning and thrombolysis in London hyperacute stroke units, nor was there variation in 3-day mortality or disability at hospital discharge (all p values>0.05). Other quality of care measures significantly varied by day and time of admission across the week in London (all p values0.05). CONCLUSIONS: The London hyperacute stroke unit model achieved performance standards for 'front door' stroke care across the week. The same benefits were not achieved by other models of care in the rest of England. There was no weekend effect for mortality in London or the rest of the England. Other aspects of care were not constant across the week in London hyperacute stroke units, indicating some performance standards were perceived to be more important than others

What does it take to provide clinical interventions with temporal consistency? A qualitative study of London hyperacute stroke units.

OBJECTIVES: Seven-day working in hospitals is a current priority of international health research and policy. Previous research has shown variability in delivering evidence-based clinical interventions across different times of day and week. We aimed to identify factors influencing such variations in London hyperacute stroke units (HASUs). DESIGN: Interview and observation study to explain patterns of variation in delivery and outcomes of care described in a quantitative partner paper (Melnychuk et al). SETTING: Eight HASUs in London. PARTICIPANTS: We interviewed HASU staff (n=76), including doctors, nurses, therapists and administrators. We also conducted non-participant observations of delivery of care at different times of the day and week (n=45; ~102 hours). We analysed the data for thematic content relating to the ability of staff to provide evidence-based interventions consistently at different times of the day and week. RESULTS: Staff were able to deliver 'front door' interventions consistently by taking on additional responsibilities out of hours (eg, deciding eligibility for thrombolysis); creating continuities between day and night (through, eg, governance processes and staggering rotas); building trusting relationships with, eg, Radiology and Emergency Departments and staff prioritisation of 'front door' interventions. Variations by time of day resulted from reduced staffing in HASUs and elsewhere in hospitals in the evenings and at the weekend. Variations by day of week (eg, weekend effect) resulted from lack of therapy input and difficulties repatriating patients at weekends, and associated increases in pressure on Fridays and Mondays. CONCLUSIONS: Evidence-based service standards can facilitate 7-day working in acute stroke services. Standards should ensure that the capacity and capabilities required for 'front door' interventions are available 24/7, while other services, for example, therapies are available every day of the week. The impact of standards is influenced by interdependencies between HASUs, other hospital services and social services

Centralisation of specialist cancer surgery services in two areas of England: the RESPECT-21 mixed-methods evaluation

Background: Centralising specialist cancer surgical services is an example of major system change. High-volume centres are recommended to improve specialist cancer surgery care and outcomes. Objective: Our aim was to use a mixed-methods approach to evaluate the centralisation of specialist surgery for prostate, bladder, renal and oesophago-gastric cancers in two areas of England [i.e. London Cancer (London, UK), which covers north-central London, north-east London and west Essex, and Greater Manchester Cancer (Manchester, UK), which covers Greater Manchester]. Design: Stakeholder preferences for centralising specialist cancer surgery were analysed using a discrete choice experiment, surveying cancer patients (n = 206), health-care professionals (n = 111) and the general public (n = 127). Quantitative analysis of impact on care, outcomes and cost-effectiveness used a controlled before-and-after design. Qualitative analysis of implementation and outcomes of change used a multisite case study design, analysing documents (n = 873), interviews (n = 212) and non-participant observations (n = 182). To understand how lessons apply in other contexts, we conducted an online workshop with stakeholders from a range of settings. A theory-based framework was used to synthesise these approaches. Results: Stakeholder preferences – patients, health-care professionals and the public had similar preferences, prioritising reduced risk of complications and death, and better access to specialist teams. Travel time was considered least important. Quantitative analysis (impact of change) – only London Cancer’s centralisations happened soon enough for analysis. These changes were associated with fewer surgeons doing more operations and reduced length of stay [prostate –0.44 (95% confidence interval –0.55 to –0.34) days; bladder –0.563 (95% confidence interval –4.30 to –0.83) days; renal –1.20 (95% confidence interval –1.57 to –0.82) days]. The centralisation meant that renal patients had an increased probability of receiving non-invasive surgery (0.05, 95% confidence interval 0.02 to 0.08). We found no evidence of impact on mortality or re-admissions, possibly because risk was already low pre-centralisation. London Cancer’s prostate, oesophago-gastric and bladder centralisations had medium probabilities (79%, 62% and 49%, respectively) of being cost-effective, and centralising renal services was not cost-effective (12% probability), at the £30,000/quality-adjusted life-year threshold. Qualitative analysis, implementation and outcomes – London Cancer’s provider-led network overcame local resistance by distributing leadership throughout the system. Important facilitators included consistent clinical leadership and transparent governance processes. Greater Manchester Cancer’s change leaders learned from history to deliver the oesophago-gastric centralisation. Greater Manchester Cancer’s urology centralisations were not implemented because of local concerns about the service model and local clinician disengagement. London Cancer’s network continued to develop post implementation. Consistent clinical leadership helped to build shared priorities and collaboration. Information technology difficulties had implications for interorganisational communication and how reliably data follow the patient. London Cancer’s bidding processes and hierarchical service model meant that staff reported feelings of loss and a perceived ‘us and them’ culture. Workshop – our findings resonated with workshop attendees, highlighting issues about change leadership, stakeholder collaboration and implications for future change and evaluation. Limitations: The discrete choice experiment used a convenience sample, limiting generalisability. Greater Manchester Cancer implementation delays meant that we could study the impact of only London Cancer changes. We could not analyse patient experience, quality of life or functional outcomes that were important to patients (e.g. continence). Future research: Future research may focus on impact of change on care options offered, patient experience, functional outcomes and long-term sustainability. Studying other approaches to achieving high-volume services would be valuable. Study registration: ational Institute for Health and Care Research (NIHR) Clinical Research Network Portfolio reference 19761