Mortality risk factors in the dependent population of Castilla-La Mancha (Spain) before and during the first COVID-19 wave.

The coronavirus disease pandemic has had an important impact worldwide. The population aged over 65 years and aged dependent persons are the population groups which have suffered in a highest level the consequences of the pandemic in terms of cases and death. In Spain, the situation is similar to other countries, but regional studies are needed because competencies on long-term care depend on regional public administration. Thus, the aim of this work is to analyse social and individual factors associated with the risk of mortality of legally recognised dependent people during the pandemic compared to a non-pandemic period. The data were extracted from the administrative database on individuals included in Castilla-La Mancha's long-term care system and it was merged with the information from the Spanish National Death Index administered by the Ministry of Health, Consumption and Social Welfare. The results show that the risk of mortality between March and June 2020 was positively associated with being male; being older than 65, with an especially high impact in the group aged over 90; having a higher level of dependency; living in a nursing home; and living in a place with more population density. Intraregional differences related to health areas also exists in both pandemic and non-pandemic periods. These findings are critical with a view to enhancing protocols for the care of the most vulnerable population groups.

Impact of implementation of the Dependency Act on the Spanish economy: an analysis after the 2008 financial crisis.

The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries' copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input-output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input-Output Table at current prices was extracted from the WIOD Database's 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services.

Socioeconomic and Lifestyle Factors Related to Cost and Frequency of Hospitalization in European Older Adults.

Individuals' lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the Survey of Health, Aging, and Retirement in Europe. Generalized regression models for panel data were developed and adjusted hospitalization costs derived from the length of hospital stay were also estimated. The average adjusted cost of hospitalization was I$ 9901.50 and the analyses showed that performing weekly physical activity significantly reduces the probability of hospitalization (OR: 0.624) and its costs (I$ 2594.5 less per person per year than subjects who never performed physical activity). Muscle strength plays an important role in this relationship and eating habits are not of great significance. Furthermore, we found interesting differences in the frequency and costs of hospitalization between subjects by country.

Shadow and extended shadow cost sharing associated to informal long-term care: the case of Spain.

BACKGROUND: A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. METHODS: The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. RESULTS: 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. CONCLUSIONS: This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State.

[Costs of health services associated with fruit and vegetable consumption habits]. / Costes de los servicios sanitarios asociados a los hábitos de consumo de frutas y verduras.

INTRODUCTION: healthy eating habits, such as the consumption of fruits and vegetables, allow better health and, consequently, reduce the consumption of health resources. It is important to establish a relationship between fruit and vegetable consumption and the use of health services in the Spanish population to consider the need to intervene. METHODS: the European Health Survey in Spain for 2014 was used, and the possible existence of differences in access and visit frequency to the family physician, specialist physician and emergency services depending on fruits and vegetables consumption habits was assessed through Hurdle models. Subsequently, two groups were generated through the propensity score matching technique in order to compare the differences in the frequenting of services depending on the consumption of fruits and/or vegetables and other adjustment covariates. Finally, the cost generated by such differences was estimated according to consumption groups. RESULTS: there are differences in access to the emergency services, both in subjects who never consume fruit and in subjects who never consume vegetables. In the first case, there is an increase of 420 visits per year for every 1,000 persons with attributable costs of €75,000, whereas in the second case, an increase of 780 visits per year for every 1,000 persons, with a cost of €139,000, is observed. CONCLUSIONS: certain eating habits of the Spanish population, such as never consuming fruits or vegetables, produce important avoidable expenses in the health system. It would be of interest to implement prevention policies to reduce such costs and use resources appropriately.

Introducción: los buenos hábitos de alimentación, como el consumo de frutas y verduras, permiten tener una mejor salud y, consecuentemente, minorar el consumo de recursos sanitarios. Es importante establecer una asociación entre consumo de frutas y verduras y el uso de los servicios sanitarios en la población española para considerar la necesidad de intervenir.Métodos: se empleó la Encuesta Europea de Salud en España del año 2014 y, mediante la utilización de modelos Hurdle, se valoró si existían diferencias en el acceso y la frecuentación al médico de familia, especialista y urgencias, dependiendo de los hábitos de consumo de frutas y verduras. Posteriormente, mediante la técnica propensity score matching se generaron dos grupos con los que poder comparar las diferencias en la frecuentación de los servicios sanitarios dependiendo del consumo de frutas y/o verduras y otras covariables de ajuste. Finalmente, se estima el coste de dichas diferencias por grupos de consumo.Resultados: se revela la existencia de diferencias en el acceso al servicio de urgencias, tanto por los sujetos que no consumen nunca fruta como por parte de los sujetos que no consumen nunca verdura. En el primer caso hay un incremento de 420 visitas al año por cada 1.000 personas con un coste atribuible de 75.000 €, mientras que en el segundo caso se observa un incremento de 780 visitas al año por cada 1.000 personas, con un coste equivalente de 139.000 €.Conclusiones: determinados hábitos de alimentación de la población española como no consumir nunca fruta o verdura producen importantes gastos evitables en el sistema sanitario. Es de gran interés implementar políticas de prevención para minorar dichos gastos y emplear los recursos de forma adecuada.

[The role of informal care in individualized care plan delivery: a conditional choice for dependent people]. / El papel del apoyo informal en las prestaciones del Plan Individualizado de Atención: una elección condicionada para las personas dependientes.

OBJECTIVES: To analyze the relationship between sociodemographic and health variables (including informal care) and the healthcare service delivery assigned in the individualized care plan. METHODS: An observational cross-sectional study was conducted in a representative sample of the dependent population in Cuenca (Spain) in February, 2009. Information was obtained on people with level II and III dependency. Four different logistic regression models were used to identify the factors associated with the care service delivery assigned in the individualized care plan. Independent variables consisted of age, gender, marital status, annual income, place of residence, health conditions, medical treatment, and perception of informal care. RESULTS: A total of 83.7% of the sample was assigned economic benefits and 15.3% were assigned services. Eighty percent of the sample received informal care in addition to dependency benefits. People who received informal care were 3239 times more likely to be assigned economic benefits than persons not receiving informal care. CONCLUSION: For the period analyzed (the first phase of the implementation of the Dependency Act), the variables associated with receiving economic benefits (versus services) were being married, having a high annual income, the place of residence (rural areas versus urban area), and receiving hygiene-dietary treatment and informal care.

[Cost-effectiveness of an intervention to reduce overweight and obesity in 9-10-year-olds. The Cuenca study]. / Coste-efectividad de un programa de actividad física de tiempo libre para prevenir el sobrepeso y la obesidad en niños de 9-10 años.

OBJECTIVE: To assess the cost-effectiveness a school-based intervention designed to reduce overweight/obesity and other cardiovascular risk factors in children. METHODS: Standard cost effectiveness analysis methods and two perspectives (societal and institutional) were used. A cluster-randomized controlled trial with 10 intervention schools (691 children) and 10 control schools (718 children) was performed. Net costs were calculated by subtracting the usual after-school care cost from intervention costs. The effectiveness of the intervention was measured as the reduction in health outcomes compared with the control group. RESULTS: The intervention costs totaled 125,469.75€, representing 269.83 €/year/child. The usual after-school care was estimated at 844,56 €/year/child. Intervention children showed a decrease in triceps skinfold thickness (-1.25mm, 95% CI: -1.82 to -0.67; P<.001). Intervention children with body mass index (BMI) between the percentiles 25 and 75 showed a decrease in the percentage of body fat (-0.59%; 95% CI: -1.03 to -0.67; P<.001), and those with a BMI>P75 showed a decrease in triceps skinfold thickness (-1.87mm; 95%CI: -3.43 to -0.32; P<.001), and percentage of body fat (-0.67%; 95%CI: -1.32 to -0.01; P<.05). CONCLUSIONS: This type of after-school program for recreational physical activity to prevent obesity are likely to be a cost-effective use of public funds and warrant careful consideration by policy makers and program planners.

[Pharmaceutical expenditure among primary care physicians in the province of Cuenca (Spain)]. / Gasto farmacéutico de médicos de atención primaria del área de salud de Cuenca.

OBJECTIVE: To determine the factors related to pharmaceutical expenditure per primary care physician in the province of Cuenca, which could allow public health authorities to take decisions to curb expenditure. Determining these factors could also be of interest to primary care physicians, specialists, health authorities, health economists, and health management researchers. METHODS: We performed a multiple linear regression analysis with three dependent variables to determine which factors explain variability in generic drug prescription, the referral rate, and pharmaceutical expenditure among primary care physicians. RESULTS: Not being a resident physician, practicing in a town with more than 10,000 people and having a large patient list had a negative impact on the percentage of generic drugs prescribed. Physicians using electronic medical records and with a high referral rate to specialized care prescribed fewer generic drugs. The two most important factors explaining pharmaceutical expenditure were having a large patient list and a high percentage of patients aged more than 65 years old. Expenditure was reduced by greater prescription of generic drugs and was increased by a larger proportion of elderly patients on the patient list. CONCLUSIONS: After controlling for the size of the patient list, the proportion of elderly patients and other factors, the percentage of generic drugs prescribed was one of the most important factors explaining pharmaceutical expenditure in primary care physicians.

[Costs associated to informal caregiving hours for older people living in rural communities [Spain]]. / Costes asociados a las horas de cuidado informal de los mayores dependientes en un ámbito rural.

OBJECTIVES: To determine the costs associated with the variables that best predict hours of informal care among people living at home with some level of dependency for activities of daily living (ADL). METHODS: We performed a crosssectional observational study of 241 men and women aged more than 64 years old living in rural communities (men 37.8%, women 62.2%). The mean (standard deviation) age was 81.07 (7.07) years. Through the Resident Assessment Instrument Home Care (RAI-HC) questionnaire, sociodemographic variables, ADL dependencies and caregiving hours were assessed. Multiple linear regression analysis was applied. RESULTS: The predictive variables in the multiple linear regression model were living alone and requiring assistance for eating, meal preparation, bed mobility, and outdoor mobility. These predictive variables explained 46.3% of the total variation in caregiving hours. Standardized b coefficients were obtained from needing help to eat (0.272) and prepare meals (0.205). Needing help to eat represented an increment of 275 annual caregiving hours and its associated cost was 2,406.15 euro/year. Becoming dependent for meal preparation represented an increment of 307.2 h and a cost of 2688.18 euro/year. Dependency had a cost of between 4,972.72 and 21,479.15 euro/year, depending on ADL limitations. CONCLUSIONS: Almost 50% of the costs related to the care giving hours that may be required by an elderly person with some degree of dependency can be attributed to the fact of living alone and to some ADL that can be easily evaluated, such as eating, cooking, bed mobility, and outdoor mobility.