Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals.

BACKGROUND: As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. METHODS: This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37-42 weeks) singleton births. RESULTS: Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. CONCLUSIONS: Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.

[Financial incentives in improving healthcare quality. SESPAS Report 2012]. / Incentivos financieros en la mejora de la calidad asistencial. Informe SESPAS 2012.

We address the contribution of financial incentives linked to pay for performance (P4P) to improving the quality of care. The situation of P4P is analyzed internationally and in the distinct health services in Spain. The participation of P4P in wage compensation and the effects of the current economic crisis on these incentives is discussed. We review the results of recent studies to clarify the role of these incentive models and assess possible orientations and new proposals.

Mortalidad innecesariamente prematura y sanitariamente evitable en Costa Rica / Unnecessary premature and avoidable mortality in Costa Rica

Fundamentos: Para desarrollar políticas y estrategias orientadas a mitigarlas es fundamental identificar las desigualdades. El objetivo del trabajo es analizar las variaciones de la Mortalidad Innecesariamente Prematura y Sanitariamente Evitable (MIPSE) para cada uno de los 81 cantones de Costa Rica durante el período 2000-2005. Métodos: Se aplicó la clasificación MIPSE propuesta por miembros del Servicio de Información y Estudios de la Dirección General de Recursos Sanitarios de Catalunya. Mediante el empleo de el Indicador de Desarrollo Socioeconómico (IDSE) establecido por economistas de la Universidad de Costa Rica, previa estandarización de la población, se ordenaron los cantones en grupos por quintiles (I el más rico, V el más pobre). Resultados: Se encontraron como causas principales de mortalidad MIPSE la enfermedad isquémica del corazón (19,55% causas MIPSE), accidentes de tránsito con vehículos a motor (11,60%), enfermedades cerebrovasculares (6,95%), perinatal (6,92%) y suicidios (5,14%). Conclusión: La mortalidad por HIV y el Sida, el cáncer de mamá en mujeres, cáncer de cuerpo de útero, cáncer de piel y por hepatitis secundaria al consumo de alcohol, afectan más a los cantones con mayores ingresos. La mortalidad por hiperplasia benigna de próstata, la materna asociada al embarazo, parto o puerperio y la hernia abdominal afectan más a los de menor nivel económico. Se identificaron dos grupos de MIPSE con desigualdad equidistribuida: leucemia y enfermedades cardiovasculares congénitas(AU)

Backgrounds: With the intention of establishing economic inequities, the article analyzes the variations of the Unnecessarily Premature and Sanitarily Avoidable Mortality (MIPSE) of each of the 81 cantons of Costa Rica during 2000-2005. It is important to identify those inequities, to establish policies and strategies trying to mitigate them. Method: It applies the MIPSE classification proposed by members of the Information and Studies Service, of the Catalunya’s Sanitary Resources Headquarter, Spain. By an Indicator of Socioeconomic Development (IDSE) of a University of Costa Rica economist’s team, it organised each canton in groups of quintiles (I for the richest, V for the poorest), previous people standardization. Results: We found as a major causes of mortality MIPSE in the country: Heart Isquemic Disease (19,55% MIPSE causes), Traffic Accidents with Motor Vehicles (11,60%), Brain Vascular Disease (6,95%), Perinatal (6,92%) and Suicide (5,14%). Conclusion: The VIH infection - AIDS mortality, the Best Cancer in Women, Uterus Cancer, Skin Cancer and Hepatic Disease Secondary to Alcohol Consumption, affects more the cantons with better financial conditions and the Prostate Benign Hyperplasia mortality, Mothers mortality related with Pregnancy, Childbirth or Puerperal Stage and the Abdominal Hernia mortality, affects more to those with worst economic level. Two MIPSE groups were identified with similar inequality: Leukaemia and Congenital Cardiovascular Disease(AU)

[Unnecessary premature and avoidable mortality in Costa Rica]. / Mortalidad innecesariamente prematura y sanitariamente evitable en Costa Rica.

BACKGROUNDS: With the intention of establishing economic inequities, the article analyzes the variations of the Unnecessarily Premature and Sanitarily Avoidable Mortality (MIPSE) of each of the 81 cantons of Costa Rica during 2000-2005. It is important to identify those inequities, to establish policies and strategies trying to mitigate them. METHOD: It applies the MIPSE classification proposed by members of the Information and Studies Service, of the Catalunya's Sanitary Resources Headquarter, Spain. By an Indicator of Socioeconomic Development (IDSE) of a University of Costa Rica economist's team, it organised each canton in groups of quintiles (I for the richest, V for the poorest), previous people standardization. RESULTS: We found as a major causes of mortality MIPSE in the country: Heart Isquemic Disease (19,55% MIPSE causes), Traffic Accidents with Motor Vehicles (11,60%), Brain Vascular Disease (6,95%), Perinatal (6,92%) and Suicide (5,14%). CONCLUSION: The VIH infection - AIDS mortality, the Best Cancer in Women, Uterus Cancer, Skin Cancer and Hepatic Disease Secondary to Alcohol Consumption, affects more the cantons with better financial conditions and the Prostate Benign Hyperplasia mortality, Mothers mortality related with Pregnancy, Childbirth or Puerperal Stage and the Abdominal Hernia mortality, affects more to those with worst economic level. Two MIPSE groups were identified with similar inequality: Leukaemia and Congenital Cardiovascular Disease.

Los incentivos para la mejora de la calidad en los servicios de salud / Incentives for quality improvement in health services

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[The impact of economics on health policy and management in Spain]. / Impacto de la economía en la politica y gestión sanitaria.

BACKGROUND: Despite the intrinsic value of scientific disciplines, such as Economics, it is appropriate to gauge the impact of its applications on social welfare, or at least--Health Economics' (HE) case--its influence on health policy and management. METHODS: The three relevant features of knowledge (production, diffusion and application) are analyzed, more from an 'emic' perspective--the one used in Anthropology relying on the experience of the members of a culture--than from an 'etic' approach seated on material descriptions and dubious statistics. RESULTS: The soundness of the principles and results of HE depends on its disciplinary foundations, whereas its relevance--than does not imply translation into practice--is more linked with the problems studied. Important contributions from Economics to the health sphere are recorded. HE in Spain ranks seventh in the world despite the relatively minor HE contents of its clinical and health services research journals. HE has in Spain more presence than influence, having failed to impregnate sufficiently the daily events. CONCLUSIONS: HE knowledge required by a politician, a health manager or a clinician is rather limited; the main impact of HE could be to develop their intuition and awareness.

Impacto de la economía en la política y gestión sanitaria / The impact of economics on health policy and management in Spain

Fundamento: Las disciplinas científicas, como la Economía,tienen valor per se, conviene, sin embargo, aproximar el impacto desus aplicaciones en el bienestar social, o como mínimo –caso de laEconomía de la Salud (ES)– en la política y gestión sanitarias.Métodos: Se atiende a las tres vertientes relevantes del conocimiento(producción de nuevo conocimiento, difusión y aplicación)utilizando más la perspectiva 'emic' –la empleada en antropologíabasándose en la experiencia de los integrantes de una cultura–, que laperspectiva 'etic' asentada en descripciones materiales y dudosasestadísticas.Resultados: La solidez de los principios y resultados de la ESdepende de la base disciplinaria en la que se apoya, mientras que surelevancia –que no su traslación a la práctica– está vinculada a la delas cuestiones a las que atiende. Se registran las aportaciones relevantesde la Economía al ámbito sanitario. El grado de desarrollo dela ES en España resulta notable: séptima posición mundial pese a losrelativamente menores contenidos de ES en las revistas clínicas y deinvestigación sobre servicios sanitarios de España. La ES tiene enEspaña más presencia que influencia, no habiendo logrado impregnarsuficientemente la práctica diaria.Conclusiones: Los conocimientos de Economía que necesita unpolítico o un gestor sanitario o un clínico son limitados; el impactode la ES pasará, sobre todo, por educarles el olfato

Background: Despite the intrinsic value of scientific disciplines,such as Economics, it is appropriate to gauge the impact of itsapplications on social welfare, or at least –Health Economics' (HE)case– its influence on health policy and management.Methods: The three relevant features of knowledge (production,diffusion and application) are analyzed, more from an 'emic' perspective–the one used in Anthropology relying on the experience ofthe members of a culture– than from an 'etic' approach seated onmaterial descriptions and dubious statistics.Results: The soundness of the principles and results of HEdepends on its disciplinary foundations, whereas its relevance –thandoes not imply translation into practice– is more linked with the problemsstudied. Important contributions from Economics to the healthsphere are recorded. HE in Spain ranks seventh in the world despitethe relatively minor HE contents of its clinical and health servicesresearch journals. HE has in Spain more presence than influence,having failed to impregnate sufficiently the daily events.Conclusions: HE knowledge required by a politician, a healthmanager or a clinician is rather limited; the main impact of HE couldbe to develop their intuition and awareness

Comercio y salud / Trade and health

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Urgencias hospitalarias o colapso crónico: los pacientes crónicos no deberían colapsar urgencias / Chronic saturation of emergency departments: they should not be flooded by patients with chronic diseases

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Mejor (servicio) siempre es más (salud) / Better (Care) is always more (Health)

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