Reflexiones sobre la justicia y equidad de los copagos / Reflections on justice and equity of copayments

No disponible

Copago en farmacia de receta en la sanidad pública española: certezas, riesgos y selección de riesgos / Co-payment on prescription drugs in the Spanish public health system: Certainty, risk and selection of risks

El modelo de copago en farmacia de receta del SNS cambió el 1 de julio de 2012. Hacía más de 3 décadas que no se modificaba. En este artículo se hace un pequeño recuerdo histórico de la evolución del modelo de copago en farmacia de receta del SNS introducido por primera vez en 1967. Se comparan las características básicas del mismo con el copago en farmacia de receta del Mutualismo Administrativo. Se proporciona información detallada referida al porcentaje de copago efectivo, los efectos recaudatorios, la participación del paciente, entre otros, en ambos modelos. Por último, se señalan las mejoras pendientes no abordadas por la modificación de 2012, como son la concentración del copago en la población de pacientes activos y la selección de riesgos promovida por las diferencias en la aportación de ambos modelos de copago (SNS y Mutualista)

The model of co-payment on prescription drugs in the Spanish National Health System (NHS) changed on 1 July 2012. For more than three decades that it was not modified. This article provides a brief historical reminder of the evolution of this model of co-payment. The basic characteristics of this model are compared with the model of copayment on prescription drugs of the Administrative Mutualism (Civil Servants). The document provides detailed information on the percentage of effective copayment, fundraising effects, the economic participation of the patient, among others, in both models. Finally, listed pending improvements not addressed by 2012 changes such as the concentration of the co-payment in the active patient population and risk selection promoted by the differences in the financial contribution between the two models of co-payment (NHS and Mutualist)

[Co-payment on prescription drugs in the Spanish public health system: Certainty, risk and selection of risks]. / Copago en farmacia de receta en la sanidad pública española: certezas, riesgos y selección de riesgos.

The model of co-payment on prescription drugs in the Spanish National Health System (NHS) changed on 1 July 2012. For more than three decades that it was not modified. This article provides a brief historical reminder of the evolution of this model of co-payment. The basic characteristics of this model are compared with the model of copayment on prescription drugs of the Administrative Mutualism (Civil Servants). The document provides detailed information on the percentage of effective copayment, fundraising effects, the economic participation of the patient, among others, in both models. Finally, listed pending improvements not addressed by 2012 changes such as the concentration of the co-payment in the active patient population and risk selection promoted by the differences in the financial contribution between the two models of co-payment (NHS and Mutualist).

Utilización de medicamentos en España y en Europa / Use of prescription drugs in Spain and Europe

Objetivo: Comparar el consumo español de medicamentos con el de los países europeos. Diseño: Revisión bibliográfica y de fuentes de datos de consumo de medicamentos. Emplazamiento: Países europeos; últimas 3 décadas. Participantes: Se incluyen aquellos grupos terapéuticos cuya información detectada permite comparar su consumo en España con el de otros países europeos. Mediciones: Se incluyen aquellos estudios, informes y fuentes de datos cuyos resultados de consumo se expresen en DHD (dosis diarias definidas/1.000 habitantes/día). Resultados: La información detectada permitió comparar 18 grupos terapéuticos: antiulcerosos (A02B), antidiabéticos (A10), antitrombóticos antivitamina K (B01AA), antihipertensivos (C02), diuréticos (C03), vasodilatadores periféricos (C04), betabloqueantes (C07), bloqueantes de los canales del calcio (C08), agentes activos sobre el sistema renina-angiotensina (C09), hipolipidemiantes (C10), antibióticos (J01), antiinflamatorios y antirreumáticos no esteroideos (M01A), analgésicos opioides (N02A), antipsicóticos (N05A), ansiolíticos (N05B), hipnóticos y sedantes (N05C), antidepresivos (N06A) y agentes contra enfermedades obstructivas de las vías respiratorias (R03). Respecto al promedio europeo (100), el consumo español de estos grupos terapéuticos es: N02A, 37; C07, 40; B01AA, 41; C03, 70; N05C, 72; C10, 75; C08, 76; N05A, 77; J01, 97; N06A, 98; C09, 104; M01A, 101; R03, 101; C02, 107; A10, 114; N05B, 137; A02B, 150, y C04, 234. Conclusiones: El consumo español de la mayor parte de los grupos terapéuticos se encuentra muy cerca del promedio del grupo de países con el que ha sido posible compararlo o claramente por debajo del mismo, exceptuando el consumo de antiulcerosos, ansiolíticos y vasodilatadores periféricos que superan notablemente el promedio del grupo(AU)

Objective: To compare the Spanish prescription drug consumption with that of European countries. Design: A review of the literature and data sources for prescription drug consumption. Setting: European countries; last three decades. Participants: Included therapeutic groups where the available information allowed a comparison of the consumption in Spain with that of other European countries. Measurements: Studies, reports, or data sources were included in which the consumption was expressed in DHD (DDD/1000 inhabitants per day). Results: It was possible to compare 18 therapeutic groups: drugs for peptic ulcer (A02B), glucose lowering drugs (A10), antithrombotic agents vitamin K antagonists (B01AA), antihypertensives (C02), diuretics (C03), peripheral vasodilators (C04), beta-blocking agents (C07), calcium channel blockers (C08), agents acting on the renin-angiotensin system (C09), lipid-lowering drugs (C10), antibacterials for systemic use (J01), antiinflammatory & antirheumatic products non-steroids (M01A), opioid analgesics (N02A), antipsychotics (N05A); anxiolytics (N05B), hypnotics & sedatives (N05C), antidepressants (N06A) and drugs for obstructive airway diseases (R03). With regard to the European average (100), the Spanish consumption of these therapeutic groups was: N02A, 37; C07, 40; B01AA, 41; C03, 70; N05C, 72; C10, 75; C08, 76; N05A, 77; TH01, 97; N06A, 98; C09, 104; M01A, 101; R03, 101; C02, 107; A10, 114; N05B, 137; A02B, 150 and C04, 234. Conclusions: The Spanish consumption of most of the therapeutic groups was very close to the average of the group of the countries where it was possible to compare it, or clearly below average, with the exception of the consumption of drugs for peptic ulcer, anxiolytics and peripheral vasodilators, which considerably exceeded the average of the group(AU)

Doctor, con su conocimiento médico, de la sanidad y de mí, explíqueme, ¿qué haría en mi lugar? / Doctor, with your knowledge of medicine and health care and me, tell me, what would you do in my place?

No disponible

El gasto sanitario en España, 2002-2008: ¿empieza el rescate presupuestario de la atención primaria? / Health spending in Spain, 2002-2008. Does the Primary Care budget rescue begin?

Objetivo: Conocer el reparto del gasto sanitario público (GSP) entre 2002 y 2008 según sectores y las eventuales diferencias relacionadas con la riqueza y el envejecimiento poblacional de las comunidades autónomas. Diseño: Estudio longitudinal retrospectivo. Emplazamiento: España. Participantes: Las 17 comunidades autónomas. Mediciones: Se analiza la relación de los gastos con la renta y el envejecimiento, su crecimiento y participación en el GSP. Resultados: El gasto en atención primaria de salud (APS) crece un 25% más que el GSP, el hospitalario crece un 18% más que el de APS y el gasto de personal hospitalario crece un 5% más que el de personal de APS. La participación hospitalaria en el GSP aumenta el doble (10%) que la de APS (5%). Las variables de gasto hospitalario se relacionan positivamente con la renta pero apenas, o negativamente, con el envejecimiento. Las variables de gasto en APS se relacionan de forma positiva con el envejecimiento pero negativamente con la renta. Las regiones más ricas gastan menos en fármacos (r=0,56, p=0,02), más en hospital (r=0,52, p=0,03) pero no más en APS (r=0,07). Las más envejecidas gastan más en APS (r=0,39, p=0,12) y en fármacos (r=0,63, p<0,01) pero apenas más en hospital (r=0,15). La renta y el envejecimiento apenas se correlacionan (r=0,15). Conclusiones: Entre 2002 y 2008 se reducen las diferencias en el crecimiento presupuestario detectadas los años previos entre hospital y APS. El crecimiento del gasto hospitalario supera al de APS pero éste supera al del GSP. Se acentúa el hospitalocentrismo presupuestario en las regiones más ricas(AU)

Objective: To determine the distribution of the public health spending (PHS) among health sectors from 2002 to 2008, and the eventual regional inequalities related to the regional income level and the ageing population. Design: A longitudinal and retrospective study. Setting: Spain. Participants: The 17 Autonomous Communities. Methods: The relationship between health expenditure and income and ageing population in the regions, their growth and participation in PHS was analysed. Results: Primary Care (PC) expenditure has increased 25% more than the PHS; hospital spending has grown 18% more than the PC and hospital staff spending has grown 5% more than the PC staff. Hospital participation in PHS is twice (10%) that of PC participation (5%). Hospital expenditure variables were positively correlated with income but barely, or negatively, with ageing population. PC expenditure variables were positively correlated with ageing but negative with income. The richest regions spend less on drugs (r=0.56, p=0.02), more on hospitals (r=0.52, p=0.03) but not more on PC (r=0.07). Regions with more ageing populations spend more on PC (r=0.39, P=.12) and drugs (r=0.63, P<.01) but just more on hospitals (r=0.15). The income level barely correlates with ageing population (r=0.15). Conclusions: Between 2002 and 2008 the differences detected during the previous years in the budget growth between hospitals and PC were reduced. The growth of spending on hospitals is higher than on PC, but this is higher than PHS. The centralising of care in hospitals is notable in the richest regions(AU)

[Health spending in Spain, 2002-2008. Does the Primary Care budget rescue begin?]. / El gasto sanitario en España, 2002-2008. Empieza el rescate presupuestario de la atención primaria?

OBJECTIVE: To determine the distribution of the public health spending (PHS) among health sectors from 2002 to 2008, and the eventual regional inequalities related to the regional income level and the ageing population. DESIGN: A longitudinal and retrospective study. SETTING: Spain. PARTICIPANTS: The 17 Autonomous Communities. METHODS: The relationship between health expenditure and income and ageing population in the regions, their growth and participation in PHS was analysed. RESULTS: Primary Care (PC) expenditure has increased 25% more than the PHS; hospital spending has grown 18% more than the PC and hospital staff spending has grown 5% more than the PC staff. Hospital participation in PHS is twice (10%) that of PC participation (5%). Hospital expenditure variables were positively correlated with income but barely, or negatively, with ageing population. PC expenditure variables were positively correlated with ageing but negative with income. The richest regions spend less on drugs (r=0.56, p=0.02), more on hospitals (r=0.52, p=0.03) but not more on PC (r=0.07). Regions with more ageing populations spend more on PC (r=0.39, P=.12) and drugs (r=0.63, P<.01) but just more on hospitals (r=0.15). The income level barely correlates with ageing population (r=0.15). CONCLUSIONS: Between 2002 and 2008 the differences detected during the previous years in the budget growth between hospitals and PC were reduced. The growth of spending on hospitals is higher than on PC, but this is higher than PHS. The centralising of care in hospitals is notable in the richest regions.

[Use of prescription drugs in Spain and Europe]. / Utilización de medicamentos en España y en Europa.

OBJECTIVE: To compare the Spanish prescription drug consumption with that of European countries. DESIGN: A review of the literature and data sources for prescription drug consumption. SETTING: European countries; last three decades. PARTICIPANTS: Included therapeutic groups where the available information allowed a comparison of the consumption in Spain with that of other European countries. MEASUREMENTS: Studies, reports, or data sources were included in which the consumption was expressed in DHD (DDD/1000 inhabitants per day). RESULTS: It was possible to compare 18 therapeutic groups: drugs for peptic ulcer (A02B), glucose lowering drugs (A10), antithrombotic agents vitamin K antagonists (B01AA), antihypertensives (C02), diuretics (C03), peripheral vasodilators (C04), beta-blocking agents (C07), calcium channel blockers (C08), agents acting on the renin-angiotensin system (C09), lipid-lowering drugs (C10), antibacterials for systemic use (J01), antiinflammatory & antirheumatic products non-steroids (M01A), opioid analgesics (N02A), antipsychotics (N05A); anxiolytics (N05B), hypnotics & sedatives (N05C), antidepressants (N06A) and drugs for obstructive airway diseases (R03). With regard to the European average (100), the Spanish consumption of these therapeutic groups was: N02A, 37; C07, 40; B01AA, 41; C03, 70; N05C, 72; C10, 75; C08, 76; N05A, 77; TH01, 97; N06A, 98; C09, 104; M01A, 101; R03, 101; C02, 107; A10, 114; N05B, 137; A02B, 150 and C04, 234. CONCLUSIONS: The Spanish consumption of most of the therapeutic groups was very close to the average of the group of the countries where it was possible to compare it, or clearly below average, with the exception of the consumption of drugs for peptic ulcer, anxiolytics and peripheral vasodilators, which considerably exceeded the average of the group.

Tamaño del cupo e importe, intensidad y calidad de la prescripción de los médicos de familia / Patient workload and costs, intensity and quality of family doctor prescriptions

ObjetivosConocer la relación entre algunas características de la prescripción (importe, intensidad y calidad) de los médicos de familia de un departamento de salud y el tamaño de sus cupos, y se controla por eventuales confusores. Analizar la intensidad prescriptora de determinados grupos terapéuticos según el tamaño del cupo.DiseñoEstudio cuantitativo de consumo de medicamentos.EmplazamientoDepartamento de Salud N.o 20 de la Agencia Valenciana de Salud.ParticipantesTodos cupos de médicos de familia (n=122) del modelo reformado de atención primaria del departamento en 2007.Mediciones y resultadosSe analiza toda la prescripción en receta oficial del SNS en los 122 cupos en 2007. Se definen variables referidas al cupo y al importe, a la intensidad y a la calidad de la prescripción. Se analiza la relación entre el tamaño del cupo y las características de la prescripción y se ajusta por posibles confusores. Se analiza la intensidad de la prescripción de los 35 grupos terapéuticos más representativos (el 81% de la prescripción) según el tamaño del cupo. De forma estadísticamente significativa, en los pacientes activos de los cupos más numerosos se detecta un menor importe de la prescripción por persona (β=–0,22) y por receta (β=–0,26), y una menor intensidad prescriptora de algunos grupos terapéuticos, como antihipertensivos (r=–0,23), antidiabéticos (r=–0,29) y antiagregantes plaquetarios (r=–0,19).ConclusionesSe plantea la hipótesis de que los pacientes activos de los cupos más numerosos estarían infradiagnosticados o infratratados de determinados procesos como la hipertensión, la diabetes o la prevención del riesgo cardiovascular, lo que contribuye a un menor importe de la prescripción en estos cupos(AU)

ObjectivesTo determine the relationship between some characteristics (cost, intensity, quality) of prescriptions issued by general practitioners in a health district and their patient loads, controlling for possible confounders. To analyze the intensity of prescription of certain groups of therapeutic drugs according to the patient load.DesignQuantitative study of consumption of medicines.SettingHealth District n° 20 of the Valencian Health Agency.ParticipantsAll patients on the lists of general practitioners (n=122) in the reformed model of primary healthcare in the Health District in 2007.Measurements and resultsAll official prescriptions issued in 2007 to patients on the 122 lists were analysed. We defined variables relating to the patient load and the cost, intensity and quality of the prescription. The relationship between patient load and prescription characteristics was analysed, adjusting for possible confounders. The intensity of prescription of the 35 most representative groups of therapeutic drugs (81% of prescriptions) was analysed according to patient load. With statistical significance, a lower prescription cost by person (beta=−0,22) and by prescription (beta=−0,26),was found in active patients of the largest patient loads and a lower intensity of prescription of some drugs groups such as antihypertensives (r=−0.23), antidiabetics (r=−0.29) and antiaggregates (r=−0.19).ConclusionsWe put forward the hypothesis that the active patients in the largest patient loads may be under-diagnosed or undertreated for certain disorders, such as hypertension, diabetes mellitus, or the prevention of cardiovascular risk, thereby contributing to the lower prescription cost in such patient loads(AU)

[Patient workload and costs, intensity and quality of family doctor prescriptions]. / Tamaño del cupo e importe, intensidad y calidad de la prescripción de los médicos de familia.

OBJECTIVES: To determine the relationship between some characteristics (cost, intensity, quality) of prescriptions issued by general practitioners in a health district and their patient loads, controlling for possible confounders. To analyze the intensity of prescription of certain groups of therapeutic drugs according to the patient load. DESIGN: Quantitative study of consumption of medicines. SETTING: Health District n° 20 of the Valencian Health Agency. PARTICIPANTS: All patients on the lists of general practitioners (n=122) in the reformed model of primary healthcare in the Health District in 2007. MEASUREMENTS AND RESULTS: All official prescriptions issued in 2007 to patients on the 122 lists were analysed. We defined variables relating to the patient load and the cost, intensity and quality of the prescription. The relationship between patient load and prescription characteristics was analysed, adjusting for possible confounders. The intensity of prescription of the 35 most representative groups of therapeutic drugs (81% of prescriptions) was analysed according to patient load. With statistical significance, a lower prescription cost by person (beta=-0,22) and by prescription (beta=-0,26),was found in active patients of the largest patient loads and a lower intensity of prescription of some drugs groups such as antihypertensives (r=-0.23), antidiabetics (r=-0.29) and antiaggregates (r=-0.19). CONCLUSIONS: We put forward the hypothesis that the active patients in the largest patient loads may be under-diagnosed or undertreated for certain disorders, such as hypertension, diabetes mellitus, or the prevention of cardiovascular risk, thereby contributing to the lower prescription cost in such patient loads.

El Gasto Sanitario Público en Castilla-La Mancha, 1995-2008: comparación con el conjunto de las Comunidades Autónomas / Public Health Expenditure in Castilla-La Mancha, 1995-2008: compared with that of all the Autonomous Communities

Objetivo. Conocer el crecimiento y reparto del gasto público (GSP) entre 1995 y 2008 según sectores en la sanidad pública de Castilla-La Mancha y su comparación con el conjunto de las 17 comunidades autónomas (CCAA). Diseño. Estudio longitudinal retrospectivo. Participantes. Las 17 CCAA. Mediciones. Se determina el reparto del GSP castellano-manchego entre sus principales sectores y su crecimiento anual, comparándolo con la media autonómica. Se consideran también variables sociodemográficas como la renta y el envejecimiento poblacional. Resultados. Entre 1995 y 2008, el GSP per cápita castellano-manchego es un 7% inferior a la media autonómica, pero crece un 8% más. El gasto farmacéutico per cápita castellanomanchego es un 7% mayor que la media y su peso en el GSP es un 15% mayor. En Castilla- La Mancha, el incremento anual del gasto en atención hospitalaria es un 38% mayor que el de atención primaria (4,292% vs. 3,109%) y el hospital aumenta su participación en el GSP castellano-manchego un 0,079% anual, pero la atención primaria la reduce un 0,695%, un comportamiento similar al del conjunto autonómico. En términos per cápita, y en el promedio del periodo, el gasto hospitalario castellano-manchego es un 17% inferior a la media y el gasto en atención primaria un 6% superior. Conclusiones. Entre 1995 y 2008, y a pesar de exhibir un GSP per cápita inferior al promedio autonómico, Castilla-La Mancha mantiene su atención primaria con ventaja presupuestaria respecto al promedio autonómico y respecto al propio sector hospitalario castellano-manchego(AU)

Objective. To determine the growth and the distribution of public health expenditure (PHE) among health sectors in Castilla-La Mancha (CLM) from 1995 to 2008 and to compare them with those of all the 17 Autonomous Communities (ACs). Design. A longitudinal and retrospective study. Participants. The 17 ACs. Measurements. The distribution of the PHE among CLM health sectors and its annual growth are determined and compared to the AC average.. Demographic variables were also considered such as income level and population ageing. Results. Between 2002 and 2008, the CLM PHE per capita was 7% lower than the AC average but increased by 8%. The CLM pharmaceutical expenditure per capita was 7% higher than the AC average and its share in the PHE was 15% higher. The annual growth of hospital care expenditure in CLM was 38% higher than that of primary care (4.292% versus 3.109%) and the share of hospital care in the CLM PHE grew by 0.079% annually but the primary care decreased by 0.695%, similar to that of the ACs. On average, over this period, the hospital care expenditure per capita in CLM was 17% lower than the AC average but the per capita expenditure in primary care was 6% higher. Conclusions. Between 1995 and 2008, in spite of having a PHE per capita lower than the AC average, CLM maintained its primary care with a budgetary advantage compared to the AC average and to the CLM the hospital care expenditure(AU)

[Health expenditure in Spain, 1995-2002. Primary care, the Cinderella of the National Health Service]. / El gasto sanitario en España, 1995-2002. La atención primaria, Cenicienta del Sistema Nacional de Salud.

OBJECTIVE: To find the share-out of the public health budget from 1995 to 2002 by health sector (primary care, hospital care, and drugs) in autonomous communities (AC) in Spain and the eventual inequalities related to regional level of income and population aging. DESIGN: A longitudinal, retrospective study. SETTING: Spain. PARTICIPANTS: The 17 AC in Spain. MEASUREMENTS: The socio-economic and health care public expenditure data came from official bodies (Spain's Ministry of Health, the National Statistics Institute). The growth in expenditure was described and the relationship of this with the income and aging levels of the regions was analysed. RESULTS: Hospital expenditure variables grew more (or decreased less) than those of primary care. The share of primary care in public health care expenditure fell twice as much as the hospital share. Per cápita and real expenditure in public hospitals grew 36% more than in primary care; and hospital staff expenditure grew 146% more than primary care staff expenditure. Hospital expenditure variables related positively to AC income, but did not relate to, or related negatively to, population aging. Primary care expenditure variables related to aging positively, but not, or negatively, to income. The richest regions spent less on drugs (r=-0.62, P< .01) and more on public hospitals (r=0.39, P=.12), but did not spend more on primary care (r=0.06). The regions with most aging spent more on primary care (r=0.37, P=.15) and on drugs (r=0.36, P=.16), but not on hospitals (r=0.06). Income level correlated very little with population aging (r=-0.17). CONCLUSIONS: A weighting towards hospitals in the public health care budget between 1995 and 2002 was confirmed, especially in the richest regions.

Carreras profesionales: ¿algo más que reconocimiento? / Professional courses: something more than recognition?

No disponible

No disponible