Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer / Diferencias en la valoración económica y factores determinantes del cuidado informal a lo largo del tiempo: el caso de las neoplasias hematológicas

Objective: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. Methods: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. Results: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 Euros/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. Conclusions: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients

Objetivo: Estimar los factores sociodemográficos y clínicos asociados al cuidado informal a lo largo de las diferentes etapas del tratamiento y su valoración económica en pacientes con neoplasia hematológica. Métodos: 139 pacientes oncohematológicos que recibieron un trasplante de células madre respondieron un cuestionario longitudinal basado en tres fases del tratamiento: corto, medio y largo plazo. Los cuidados informales recibidos se valoraron económicamente mediante los métodos del bien más próximo y coste de oportunidad. Se estimaron modelos de regresión logística ordenada y binaria para identificar factores asociados al cuidado informal. Resultados: 123 pacientes recibieron cuidado informal, con una reducción progresiva del número de horas a lo largo del tiempo. El valor monetario del cuidado informal recibido por paciente fue de 1288-3409 Euros, 1045-2786 Euros y 336-854 Euros/mes en el corto, medio y largo plazo, respectivamente. Los/las pacientes con leucemia aguda y los/las que recibieron un trasplante alogénico no emparentado tuvieron un 22% (corto plazo) y un 33,5% (medio plazo) más probabilidad de recibir >8 horas al día de cuidado respecto a los/las pacientes diagnosticados/as de linfoma y trasplante autólogo. A largo plazo, los/las pacientes con mieloma múltiple fueron más proclives a recibir más atención. Un mejor estado de salud y un mayor nivel de estudios se asociaron a menos horas diarias de cuidado. Conclusiones: Existe gran variación en el tiempo, el valor monetario y los factores asociados al cuidado informal en pacientes con neoplasia hematológica a lo largo de las distintas etapas del tratamiento

Gasto público y salud en el mundo, 1990-2012 / A Public expenditure and world's health, 1990-2012

Introducción: La evidencia empírica dispar relacionada con el efecto del gasto público en materia sanitaria puede deberse a las importantes variaciones metodológicas de los estudios y a las diferencias significativas en la forma en que el gasto público influye dependiendo del nivel de desarrollo de los países. Objetivo: Determinar la relación entre el gasto público total del Gobierno general y la mortalidad infantil y la esperanza de vida. Métodos: Investigación realizada en una muestra de 78 países segmentada por niveles de renta, desde 1990 hasta 2012. Se constituyeron cinco submuestras de países divididos por su nivel de renta mediante un procedimiento de agrupación no jerárquico de k-medias. Se verificó la procedencia de la segmentación mediante el test de Chow. Para cada una de las submuestras construidas, se estimó el modelo correspondiente por mínimos cuadrados generales lineales y un test de cointegración. Resultados: En las submuestras superiores en nivel de renta, la salud se relacionó significativa y consistentemente con el gasto público. Sin embargo, en los países de renta inferior-baja, el coeficiente del gasto presentó un signo contrario al esperado. Conclusiones: Se demuestra un impacto positivo y de largo plazo entre el gasto público y la situación sanitaria. Sin embargo, para los países de menor renta, este parece haber superado su punto óptimo, lo que indicaría su ineficiencia en términos sanitarios. Se conjetura que lo anterior se debe a la baja capacidad institucional de estos países, lo que impide que un mayor gasto obtenga mejores resultados sanitarios(AU)

Introduction: The disparate empirical evidence related with the effect of public expenditure on health may be due to the significant methodological variations of the studies, as well as the significant differences in the way in which public expenditure influences depending on the level of development of the countries. Objective: To determine the relation among the total public expenditure of the General Government, and infant mortality and life expectancy. Methods: Research project carried out with a sample of 78 countries segmented by income levels from 1990 to 2012. By means of a non - hierarchical grouping of k - media, five sub-samples of countries were formed and divided by their income level. The origin of the segmentation was verified by means of the Chow test. Linear GLS and a cointegration test were applied on each subsample. Results: In the upper subsamples at the income level, health was significantly and consistently related to public expenditure. However, in the lower-low income countries, the expenditure coefficient showed a sign opposite to that expected. Conclusions: There is evidence of a positive and long-term impact among public expenditure and the health situation. However, for lower income countries, this seems to have surpassed its optimum point, which would indicate its inefficiency in sanitary terms. It is conjectured that this is due to the low institutional capacity of these countries, which hampers that greater expenditure obtains better sanitary results(AU)

Gasto público y salud en el mundo, 1990-2012 / A Public expenditure and world's health, 1990-2012

Introducción: La evidencia empírica dispar relacionada con el efecto del gasto público en materia sanitaria puede deberse a las importantes variaciones metodológicas de los estudios y a las diferencias significativas en la forma en que el gasto público influye dependiendo del nivel de desarrollo de los países. Objetivo: Determinar la relación entre el gasto público total del Gobierno general y la mortalidad infantil y la esperanza de vida. Métodos: Investigación realizada en una muestra de 78 países segmentada por niveles de renta, desde 1990 hasta 2012. Se constituyeron cinco submuestras de países divididos por su nivel de renta mediante un procedimiento de agrupación no jerárquico de k-medias. Se verificó la procedencia de la segmentación mediante el test de Chow. Para cada una de las submuestras construidas, se estimó el modelo correspondiente por mínimos cuadrados generales lineales y un test de cointegración. Resultados: En las submuestras superiores en nivel de renta, la salud se relacionó significativa y consistentemente con el gasto público. Sin embargo, en los países de renta inferior-baja, el coeficiente del gasto presentó un signo contrario al esperado. Conclusiones: Se demuestra un impacto positivo y de largo plazo entre el gasto público y la situación sanitaria. Sin embargo, para los países de menor renta, este parece haber superado su punto óptimo, lo que indicaría su ineficiencia en términos sanitarios. Se conjetura que lo anterior se debe a la baja capacidad institucional de estos países, lo que impide que un mayor gasto obtenga mejores resultados sanitarios(AU)

Introduction: The disparate empirical evidence related with the effect of public expenditure on health may be due to the significant methodological variations of the studies, as well as the significant differences in the way in which public expenditure influences depending on the level of development of the countries. Objective: To determine the relation among the total public expenditure of the General Government, and infant mortality and life expectancy. Methods: Research project carried out with a sample of 78 countries segmented by income levels from 1990 to 2012. By means of a non - hierarchical grouping of k - media, five sub-samples of countries were formed and divided by their income level. The origin of the segmentation was verified by means of the Chow test. Linear GLS and a cointegration test were applied on each subsample. Results: In the upper subsamples at the income level, health was significantly and consistently related to public expenditure. However, in the lower-low income countries, the expenditure coefficient showed a sign opposite to that expected. Conclusions: There is evidence of a positive and long-term impact among public expenditure and the health situation. However, for lower income countries, this seems to have surpassed its optimum point, which would indicate its inefficiency in sanitary terms. It is conjectured that this is due to the low institutional capacity of these countries, which hampers that greater expenditure obtains better sanitary results(AU)

Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer.

OBJECTIVE: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. METHODS: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. RESULTS: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 €/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. CONCLUSIONS: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients.

Sombras y sombras en la aplicación de la ley de dependencia / Shades and shadows in the application of the long-term care law

El objetivo del presente trabajo es realizar un breve repaso a los aspectos más controvertidos de la Ley 39/2006, de Promoción de la Autonomía y Atención a las Personas en Situación de Dependencia, que han protagonizado en los últimos años fuertes debates entre el Estado y las comunidades autónomas. Los problemas de financiación surgidos tras una mala planificación inicial, el declive en las aportaciones de la Administración General del Estado en los últimos años, incluyendo la supresión del nivel acordado, y una baja recaudación del usuario mediante copago, han colmado de esfuerzo económico a las comunidades autónomas por mantener dicha política social, en un ambiente gobernado por la falta de transparencia del sistema. Por otro lado, las reformas normativas de mediados de 2012, con la finalidad de aliviar los presupuestos estatales y autonómicos, han supuesto un claro retroceso en el espíritu de la ley y una pérdida de bienestar de los dependientes y sus familias. Todas estas premisas han contribuido a un panorama muy heterogéneo de aplicación territorial de la norma, en el que se observan claras diferencias en las listas de espera, abuso de concesión de prestaciones económicas por parte de algunas regiones y disparidades en el número de solicitudes de acceso a las prestaciones y los servicios (AU)

The aim of this study was to provide a brief overview of the most controversial aspects of the Spanish Act of Promotion of Personal Autonomy and Long-Term Care 39/2006, which, in the last few years, has led to heated debates between the state and the autonomous regions. Because of the funding problems due to initial poor planning, the decline of contributions from the Spanish Government in the last few years, including the suppression of the agreed level, and low cash collection from the user through copayment, the autonomous regions have had to provide significant economic resources to maintain this social policy in an environment characterised by a lack of transparency of the system. In addition, the regulatory reforms of mid-2012 to ease the burden on state and autonomous budgets have represented a clear setback to the spirit of the act and a loss of welfare to dependent individuals and their families. All these circumstances have contributed to a widely heterogeneous picture in the territorial implementation of the act, with clear differences in waiting lists, abuse in the granting of cash benefits in some regions, and differences in the number of applications for benefits and services (AU)

[Shades and shadows in the application of the long-term care law]. / Sombras y sombras en la aplicación de la ley de dependencia.

The aim of this study was to provide a brief overview of the most controversial aspects of the Spanish Act of Promotion of Personal Autonomy and Long-Term Care 39/2006, which, in the last few years, has led to heated debates between the state and the autonomous regions. Because of the funding problems due to initial poor planning, the decline of contributions from the Spanish Government in the last few years, including the suppression of the agreed level, and low cash collection from the user through copayment, the autonomous regions have had to provide significant economic resources to maintain this social policy in an environment characterised by a lack of transparency of the system. In addition, the regulatory reforms of mid-2012 to ease the burden on state and autonomous budgets have represented a clear setback to the spirit of the act and a loss of welfare to dependent individuals and their families. All these circumstances have contributed to a widely heterogeneous picture in the territorial implementation of the act, with clear differences in waiting lists, abuse in the granting of cash benefits in some regions, and differences in the number of applications for benefits and services.

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation / Pérdidas de productividad por mortalidad prematura debido a una neoplasia hematológica: estudio basado en pacientes sometidos a un trasplante de células madre

Introduction: Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. Methods: We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. Results: Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. Conclusions: Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses (AU)

Introducción: Durante muchos años el trasplante de células madre se ha usado para tratar neoplasias hematológicas que no podrían haber sido curadas mediante otras terapias. A pesar de este avance médico, la ratio de mortalidad es aún elevada. Nuestro objetivo es evaluar las pérdidas de productividad laboral por mortalidad prematura debido a una neoplasia hematológica en receptores de trasplante de células madre. Métodos: Se recogieron datos primarios de las historias clínicas de pacientes con neoplasia hematológica, trasplantados durante los años 2006 y 2011 en dos hospitales españoles. Se realizó un análisis descriptivo y se calcularon los años potenciales de vida y los años potenciales de vida laboral perdidos. Las pérdidas de productividad laboral se estimaron usando el método del Capital Humano. El método de los Costes de Fricción se empleó como parte del análisis de sensibilidad. Resultados: En una población de 179 pacientes trasplantados y fallecidos, se dan mayores pérdidas de productividad laboral en varones y en personas de edades comprendidas entre los 30 y 49 años. La pérdida estimada está por encima de €31.4 millones usando el método del Capital Humano (€480,152 usando el método Costes Fricción), lo que significa una pérdida media de €185,855 por persona fallecida. Las mayores pérdidas globales son generadas por la leucemia. Sin embargo, el linfoma genera las mayores pérdidas por fallecimiento. Conclusiones: Mayores esfuerzos son necesarios para reducir la mortalidad prematura de pacientes trasplantados por neoplasia hematológica y reducir el impacto económico y social asociado a la misma (AU)

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation.

INTRODUCTION: Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. METHODS: We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. RESULTS: Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. CONCLUSIONS: Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses.

La financiación del nivel acordado de la Ley de Dependencia: el coste de una evolución hacia variables reales de dependencia / Level of funding in the Long-Term Care Law: the cost of moving toward real dependency variables

Introducción: El Sistema para la Autonomía y Atención a la Dependencia que establece la Ley 39/2006 se financia, además de con las aportaciones particulares de los dependientes, mediante transferencias finalistas en tres fondos principales: un nivel mínimo, un nivel acordado y otras aportaciones adicionales voluntarias por parte de las propias comunidades autónomas. Los recursos que aporta el estado al nivel acordado se están distribuyendo, entre otras variables de menor relevancia, en función de la población potencialmente dependiente, y en menor medida en función de la población dependiente ya evaluada. Objetivo: Puesto que el concepto de lo que se considera población dependiente ha ido modificándose, pasando de ser la población potencialmente dependiente según una estimación (dependientes estimados) a ser el número real de dependientes reconocidos (dependientes declarados), algunas comunidades autónomas han podido tener déficit o superávit de financiación. Métodos. Se ha comparado la distribución realizada para el periodo 2007-2011 más otra estimada para 2012, en la cual computan los dependientes estimados, con una alternativa donde dependientes declarados ponderen una medida similar a la que entrará en vigor en 2013. Resultados: Durante el periodo de 2007 a 2011, aquellas comunidades autónomas en que la cifra de dependientes declarados ha sido superior a la de dependientes estimados han sufrido un déficit de financiación (en el caso de Andalucía se superan los 100 millones de euros). Por el contrario, aquellas otras en que los dependientes estimados han sido más que los evaluados han resultado beneficiadas por el actual sistema de distribución (es el caso de Madrid y la Comunidad Valenciana, con un superávit de 49 y 37 millones de euros, respectivamente). Conclusiones: Se aprecia una amplia heterogeneidad en la financiación pública del nivel acordado en términos de población dependiente declarada que, entre otras consecuencias no menos graves, puede lastrar la implantación de la Ley de Dependencia en las comunidades autónomas deficitarias (AU)

Introduction: The system for the Promotion of Personal Autonomy and Care of Dependent Persons established by Act 39/2006 is funded through private contributions of dependent individuals and earmarked transfers in three main funds: a minimum level, an agreed level distributed among the various autonomous regions according to their relative needs, and a further voluntary additional contribution by Spain's autonomous regions. The resources distributed by the state to the regions are assigned, among other less important variables, according to the potentially dependent population and, to a lesser extent, according to the population already evaluated as dependent. Objective: Because the concept of what constitutes disability has changed over the years from the population potentially dependent according to an estimate (estimated dependent individuals) to the actual number of dependent individuals recognized as such (declared dependent), some autonomous regions may have been overfunded or underfunded. Methods: The funding obtained by the autonomous regions each year from 2007 to 2011 was compared with the funding that would have been assigned to each region if, since 2007, the variables and weighting that will be representative of the funding needs for 2013 (distribution mainly according to declared dependent individuals) had been taken into account. Results: From 2007-2011, regions where declared dependent persons outnumbered estimated disabled persons were underfunded (in Andalusia by more than 100 million euros). In contrast, regions where the situation was reversed were overfunded (by 49 million euros in Madrid and 37 million euros in the region of Valencia). Conclusions: There is wide variation in public funding to the autonomous regions, depending on the number of individuals declared as dependent. Among other no less serious consequences, this situation could hamper the implantation of the Promotion of Personal Autonomy and Care of Dependent Persons Act in underfunded regions (AU)

[Level of funding in the Long-Term Care Law: the cost of moving toward real dependency variables]. / La financiación del nivel acordado de la Ley de Dependencia: el coste de una evolución hacia variables reales de dependencia.

INTRODUCTION: The system for the Promotion of Personal Autonomy and Care of Dependent Persons established by Act 39/2006 is funded through private contributions of dependent individuals and earmarked transfers in three main funds: a minimum level, an agreed level distributed among the various autonomous regions according to their relative needs, and a further voluntary additional contribution by Spain's autonomous regions. The resources distributed by the state to the regions are assigned, among other less important variables, according to the potentially dependent population and, to a lesser extent, according to the population already evaluated as dependent. OBJECTIVE: Because the concept of what constitutes disability has changed over the years from the population potentially dependent according to an estimate (estimated dependent individuals) to the actual number of dependent individuals recognized as such (declared dependent), some autonomous regions may have been overfunded or underfunded. METHODS: The funding obtained by the autonomous regions each year from 2007 to 2011 was compared with the funding that would have been assigned to each region if, since 2007, the variables and weighting that will be representative of the funding needs for 2013 (distribution mainly according to declared dependent individuals) had been taken into account. RESULTS: From 2007-2011, regions where declared dependent persons outnumbered estimated disabled persons were underfunded (in Andalusia by more than 100 million euros). In contrast, regions where the situation was reversed were overfunded (by 49 million euros in Madrid and 37 million euros in the region of Valencia). CONCLUSIONS: There is wide variation in public funding to the autonomous regions, depending on the number of individuals declared as dependent. Among other no less serious consequences, this situation could hamper the implantation of the Promotion of Personal Autonomy and Care of Dependent Persons Act in underfunded regions.

Estimation of an index of regional health needs in Spain using count regression models with filter.

The aim of this study is to obtain a measure of health needs at regional level, on the basis of information provided by the health module of the Survey of Disabilities, Deficiencies and State of Health, 1999 (SDDSH99). The methodology includes a careful selection of the independent variables and both estimations as tests of alternative regression models. The results show that, in the five analysed use dimensions, important differences exist in the clinical practice for a same health necessity (horizontal inequity) in function of the residence area. Nevertheless, the main results and conclusions indicate that, as the framework of analysis is broadened, adding different healthcare services, and as the population size of the region is increased, the relative healthcare needs converge to the percentage of population of each region.