El gasto sanitario en España en comparación con el de la Europa desarrollada, 1985–2001. La atención primaria española, Cenicienta europea

ObjetivoDescribir la evolución de la distribución de fondos en nuestro sistema sanitario desde el inicio de la reforma de atención primaria hasta 2001, en comparación con la de los países europeos de la Organización para la Cooperación y el Desarrollo Económico (OCDE)DiseñoEstudio descriptivo longitudinal y retrospectivoEmplazamientoPaíses de la OCDEParticipantesPaíses europeos de la OCDEMedicionesSe utilizan datos de la base Health Data 2003 (OCDE) referidos al período 1985–2001 respecto a variables de gasto sanitario por sectores y de renta. Se comparan los datos españoles con los del conjunto de los 22 países europeos de la OCDEResultadosEuropa aumentó el gasto ambulatorio público, tanto como porcentaje del gasto sanitario público como del producto interior bruto (PIB). España redujo el gasto ambulatorio público en ambos sentidos. Nuestro gasto hospitalario público recuperó gran parte del retraso respecto a Europa y desde 1995 se encuentra, como parte del PIB, en la media europea y, en términos per cápita, acorde con nuestra renta. Sin embargo, nuestro gasto ambulatorio público como parte del PIB es muy inferior al promedio europeo y, per capita, muy inferior a nuestra renta. Nuestro gasto ambulatorio privado es de los más altos de Europa y, en relación con ella, muy superior a nuestra renta, al contrario que su homónimo público. Nuestro gasto privado hospitalario es de los más bajos de Europa y, en relación con ella, muy inferior a nuestra rentaConclusionesRespecto a los recursos públicos comprometidos, la reforma de la atención primaria española no ha servido para aproximarla a Europa, tal y como sí lo ha hecho nuestro nivel hospitalario. La distancia entre España y Europa en el esfuerzo público ambulatorio es incluso mayor que la que había al inicio de la reformaObjetiveTo describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation andDevelopment (OECD)DesignA longitudinal descriptive and retrospective studyParticipantsEuropean countries members of the OECDSettingCountries members of the OECDMethodsThe data come from the OECD database Health Data 2003. The data refer to period 1985–2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECDResultsEurope increased public expenditure on outpatient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on outpatient care in both senses. Spanish publicexpenditure on in-patient care reduced a great partof its difference with Europe so that since 1995 it isfound, as a percentage of GDP, in the Europeanaverage and, as per capita, it is according with theSpanish income. In contrast, public expenditure onout-patient care as a percentage of GDP in Spain isvery much lower than the European average and, asper capita, is very much lower than the Spanishincome. The Spanish private expenditure on outpatient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income levelConclusionsWith respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care starte

Public views of the uk media and government reaction to the 2009 swine flu pandemic

<p>Abstract</p> <p>Background</p> <p>The first cases of influenza A/H1N1 (swine flu) were confirmed in the UK on 27th April 2009, after a novel virus first identified in Mexico rapidly evolved into a pandemic. The swine flu outbreak was the first pandemic in more than 40 years and for many, their first encounter with a major influenza outbreak. This study examines public understandings of the pandemic, exploring how people deciphered the threat and perceived they could control the risks.</p> <p>Methods</p> <p>Purposive sampling was used to recruit seventy three people (61 women and 12 men) to take part in 14 focus group discussions around the time of the second wave in swine flu cases.</p> <p>Results</p> <p>These discussions showed that there was little evidence of the public over-reacting, that people believed the threat of contracting swine flu was inevitable, and that they assessed their own self-efficacy for protecting against it to be low. Respondents assessed a greater risk to their health from the vaccine than from the disease. Such findings could have led to apathy about following the UK Governments recommended health protective behaviours, and a sub-optimal level of vaccine uptake. More generally, people were confused about the difference between seasonal influenza and swine flu and their vaccines.</p> <p>Conclusions</p> <p>This research suggests a gap in public understandings which could hinder attempts to communicate about novel flu viruses in the future. There was general support for the government's handling of the pandemic, although its public awareness campaign was deemed ineffectual as few people changed their current hand hygiene practices. There was less support for the media who were deemed to have over-reported the swine flu pandemic.</p

Pharmaceutical cost control in primary care: opinion and contributions by healthcare professionals

<p>Abstract</p> <p>Background</p> <p>Strategies adopted by health administrations and directed towards drug cost control in primary care (PC) can, according to earlier studies, generate tension between health administrators and healthcare professionals. This study collects and analyzes the opinions of general practitioners (GPs) regarding current cost control measures as well as their proposals for improving the effectiveness of these measures.</p> <p>Methods</p> <p>A qualitative exploratory study was carried out using 11 focus groups composed of GPs from the Spanish regions of Aragon, Catalonia and the Balearic Islands. A semi-structured guide was applied in obtaining the GPs' opinions. The transcripts of the dialogues were analyzed by two investigators who independently considered categorical and thematic content. The results were supervised by other members of the team, with overall responsibility assigned to the team leader.</p> <p>Results</p> <p>GPs are conscious of their public responsibility with respect to pharmaceutical cost, but highlight the need to spread responsibility for cost control among the different actors of the health system. They insist on implementing measures to improve the quality of prescriptions, avoiding mere quantitative evaluations of prescription costs. They also suggest moving towards the self-management of the pharmaceutical budget by each health centre itself, as a means to design personalized incentives to improve their outcomes. These proposals need to be considered by the health administration in order to pre-empt the feelings of injustice, impotence, frustration and lack of motivation that currently exist among GPs as a result of the implemented measures.</p> <p>Conclusion</p> <p>Future investigations should be oriented toward strategies that involve GPs in the planning and management of drug cost control mechanisms. The proposals in this study may be considered by the health administration as a means to move toward the rational use of drugs while avoiding concerns about injustice and feelings of impotence on the part of the GPs, which can lead to lack of interest in and disaffection with the current measures.</p