Apoyo a las guías de publicación para estudios de evaluación económica por parte de las revistas biomédicas españolas / Endorsement of guidelines for reporting economic evaluation studies by Spanish biomedical journals

Objetivo: Examinar el apoyo a las guías de publicación para estudios de evaluación económica, como la declaración CHEERS (Consolidated Health Economic Evaluation Reporting Standards), por parte de las revistas biomédicas españolas. Método: Análisis transversal de las normas de autoría de las revistas biomédicas españolas incluidas en Journal Citation Reports 2017. Dos autores examinaron y extrajeron la siguiente información: mención de alguna guía de publicación, declaración CHEERS, recomendaciones del International Committee of Medical Journal Editors (ICMJE) e iniciativa Enhancing the QUAlity and Transparency Of health Research (EQUATOR). Resultados: De las 28 revistas incluidas, 23 (82,1%; intervalo de confianza del 95% [IC95%]: 63,1-93,9%) mencionaron alguna guía. Una única revista mencionó la declaración CHEERS para estudios de evaluación económica. Veinticuatro revistas (85,7%; IC95%: 67,3-96,0%) mencionaron las recomendaciones del ICMJE y 8 (28,6%; IC95%: 13,2-48,7%) la red EQUATOR. La declaración CONSORT (Consolidated Standards of Reporting Trials) para ensayos clínicos fue la guía más mencionada (n=21; 75,0%; IC95%: 55,1-89,3%). Discusión: La mayoría de las normas de autoría no incorporan información sobre cómo presentar evaluaciones económicas. Las revistas deberían apoyar el cumplimiento de las guías de publicación por parte de las personas autoras y revisoras

Objective: To examine the endorsement of reporting guidelines for economic evaluation studies, such as the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) statement, by Spanish biomedical journals. Method: Cross-sectional analysis of the instructions to authors of Spanish biomedical journals included in the Journal Citation Reports 2017. Two authors examined and extracted the following information: mention of any reporting guideline, the CHEERS statement, the recommendations of the International Committee of Medical Journal Directors (ICMJE) and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. Results: Of the 28 journals included, 23 (82.1%; 95% confidence interval [95%CI]: 63.1-93.9%) mentioned at least one reporting guideline in the instructions to authors. Only one journal mentioned the CHEERS statement for health economic evaluations. Twenty-four journals (85.7%; 95%CI: 67.3-96.0%) mentioned the ICMJE recommendations and 8 (28.6%; 95%CI: 13.2-48.7%) mentioned the EQUATOR network. The CONSORT (Consolidated Standards of Reporting Trials) statement for clinical trials was the most- mentioned reporting guideline (n=21; 75.0%; 95%CI: 55.1-89.3%). Discussion: Most of the instructions to authors do not provide guidance on how to report economic evaluations. Journals should support compliance with reporting guidelines by authors and peer-reviewers

[Endorsement of guidelines for reporting economic evaluation studies by Spanish biomedical journals]. / Apoyo a las guías de publicación para estudios de evaluación económica por parte de las revistas biomédicas españolas.

OBJECTIVE: To examine the endorsement of reporting guidelines for economic evaluation studies, such as the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) statement, by Spanish biomedical journals. METHOD: Cross-sectional analysis of the instructions to authors of Spanish biomedical journals included in the Journal Citation Reports 2017. Two authors examined and extracted the following information: mention of any reporting guideline, the CHEERS statement, the recommendations of the International Committee of Medical Journal Directors (ICMJE) and the Enhancing the QUAlity and Transparency Of health Research (EQUATOR) network. RESULTS: Of the 28 journals included, 23 (82.1%; 95% confidence interval [95%CI]: 63.1-93.9%) mentioned at least one reporting guideline in the instructions to authors. Only one journal mentioned the CHEERS statement for health economic evaluations. Twenty-four journals (85.7%; 95%CI: 67.3-96.0%) mentioned the ICMJE recommendations and 8 (28.6%; 95%CI: 13.2-48.7%) mentioned the EQUATOR network. The CONSORT (Consolidated Standards of Reporting Trials) statement for clinical trials was the most- mentioned reporting guideline (n=21; 75.0%; 95%CI: 55.1-89.3%). DISCUSSION: Most of the instructions to authors do not provide guidance on how to report economic evaluations. Journals should support compliance with reporting guidelines by authors and peer-reviewers.

Cambios de regulación y de gobierno de la sanidad. Informe SESPAS 2014 / Changes in the regulation and government of the health system. SESPAS report 2014

La crisis económica y fiscal del año 2008ha irrumpido en el debate de la sostenibilidad sanitaria; en algunos países, como España, se han impuesto duras políticas de consolidación fiscal y austeridad en los servicios públicos. El marco institucional y de gobierno del Sistema Nacional de Salud (SNS) tras las transferencias de 2002 tenía importantes debilidades, no evidentes en la etapa de crecimiento rápido, pero que eclosionan a partir de 2010. En este trabajo se exponen los cambios en regulación y gobierno desde la perspectiva estatal y del SNS, tanto los de carácter general (con clara iniciativa de las autoridades económicas) como los más específicos de la sanidad. El Real Decreto Ley 16/2012 supone la pieza central de la austeridad sanitaria, pero también implica una ruptura con consensos políticos existentes y un retorno a modelos de seguridad social. La caracterización de la austeridad sanitaria explora los impactos en el ahorro, en los servicios y en el modelo sanitario, aunque la información disponible sólo permite algunas consideraciones indicativas. Las conclusiones inciden en la necesidad de cambiar la senda de recortes lineales, acelerados y radicales, aportando un marco temporal para aplicar reformas en clave de sostenibilidad interna; a tal efecto se plantea la conveniencia de restaurar consensos políticos e institucionales, de enfatizar el trabajo en gestión clínica y la desinversión de servicios inapropiados (aproximación a la profesión médica y activación de su papel microgestor), y de crear los marcos de buen gobierno e innovación organizativa que den soporte a estas reformas estructurales (AU)

The economic and fiscal crisis of 2008 has erupted into the debate on the sustainability of health systems; some countries, such as Spain, have implemented strong policies of fiscal consolidation and austerity. The institutional framework and governance model of the national health system (NHS) after its devolution to regions in 2002 had significant weaknesses, which were not apparent in the rapid growth stage but which have been clearly visible since 2010. In this article, we describe the changes in government regulation from the national and NHS perspective: both general changes (clearly prompted by the economic authorities), and those more specifically addressed to healthcare. The Royal Decree-Law 16/2012 represents the centerpiece of austerity policies in healthcare but also implies a rupture with existing political consensus and a return to social security models. Our characterization of austerity in healthcare explores impacts on savings, services, and on the healthcare model itself, although the available information only allows some indications. The conclusions highlight the need to change the path of linear, rapid and radical budget cuts, providing a time-frame for implementing key reforms in terms of internal sustainability; to do so, it is appropriate to restore political and institutional consensus, to emphasize «clinical management» and divestment of inappropriate services (approach to the medical profession and its role as micro-manager), and to create frameworks of good governance and organizational innovations that support these structural reforms (AU)

[Changes in the regulation and government of the health system. SESPAS report 2014]. / Cambios de regulación y de gobierno de la sanidad. Informe SESPAS 2014.

The economic and fiscal crisis of 2008 has erupted into the debate on the sustainability of health systems; some countries, such as Spain, have implemented strong policies of fiscal consolidation and austerity. The institutional framework and governance model of the national health system (NHS) after its devolution to regions in 2002 had significant weaknesses, which were not apparent in the rapid growth stage but which have been clearly visible since 2010. In this article, we describe the changes in government regulation from the national and NHS perspective: both general changes (clearly prompted by the economic authorities), and those more specifically addressed to healthcare. The Royal Decree-Law 16/2012 represents the centerpiece of austerity policies in healthcare but also implies a rupture with existing political consensus and a return to social security models. Our characterization of austerity in healthcare explores impacts on savings, services, and on the healthcare model itself, although the available information only allows some indications. The conclusions highlight the need to change the path of linear, rapid and radical budget cuts, providing a time-frame for implementing key reforms in terms of internal sustainability; to do so, it is appropriate to restore political and institutional consensus, to emphasize "clinical management" and divestment of inappropriate services (approach to the medical profession and its role as micro-manager), and to create frameworks of good governance and organizational innovations that support these structural reforms.

Primaria y estrategias de crónicos: venciendo reticencias propias e ignorando despropósitos ajenos / Primary prevention and chronic disease strategies: overcoming our own reluctance and ignoring what others say

No disponible

[Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report]. / Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008.

The Spanish National Health System (SNHS) is currently in a complex equilibrium which, even if acceptable in the short term, faces major sustainability and governance challenges; the so far inconclusive outcome of the SNHS decentralization process clearly underlines the importance of seeking new alternatives to effectively bring about the real benefits of decentralization, while taking advantage of the system's economies of scale and achieving its equity objectives. To this end, four lines of action are proposed in this paper: first, redefine the SNHS based on universal public coverage, as a civic right and equal for all; second, reframe the financing system and the role of the Cohesion Fund; third, review the role of central government and its Ministry of Health, and fourth, create of a SNHS Agency headed by a Commissioner, for providing an organizational framework and identity for the SNHS, and serving as the cooperative body of the seventeen Autonomous Communities' Health Services.

Externalización, eficiencia y calidad (segunda parte). Análisis de costes y efectos potenciales de las políticas de externalización / Adherence to the clinic practical guideline in the functional surgery of nasal septum

La privatización, externalización de servicios sanitarios se analiza desde la perspectiva de la economía y la gestión, explorando desdela teoría de los costes de transacción cuatro modalidades de externalización: centros, servicios asistenciales, servicios centrales y servicios generales. Se analizan los efectos potenciales de las externalizaciones y sobre esta base se indican ventajas y riesgos, situando el debate en el contexto del Sistema Nacional de Salud español, y se concluye con algunas consideraciones finales que afectan a la agenda política y de investigación (AU)

Outsourcing and privatization of healthcare services are analyzed from Management and Economics perspectives, exploring form the Transaction Costs theory four types of outsourcing: centres, clinical services, diagnostic-therapeutic support services, and ancillary services.Potential effects of externalization are analysed, addressing the advantages and risks, and putting it into the context of the Spanish NHS. Some final remarks are made regarding policy and research agenda (AU)

Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008 / Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report

El Sistema Nacional de Salud (SNS) presenta una complejasituación de equilibrio, que aunque puede ser satisfactorioa corto plazo, plantea grandes problemas de sostenibilidady gobernabilidad; el incierto balance del procesode descentralización sanitaria en España señala claramentela senda de buscar nuevas alternativas organizativas parahacer efectivas las ventajas de la descentralización, a la vezque ser capaces de aprovechar las economías del sistemay conseguir la equidad pretendida. Se proponen cuatro líneasde actuación: redefinición del SNS en torno al aseguramientopúblico y derecho cívico igual para todos; replanteamientodel sistema de financiación y del papel delfondo de cohesión; redefinir el papel del gobierno central yel Ministerio de Sanidad, y crear un nuevo organismo, laAgencia del SNS con un Comisionado que de soporte organizativoe identidad al SNS como ámbito de acción cooperativa(AU)

The Spanish National Health System (SNHS) is currently ina complex equilibrium which, even if acceptable in the shortterm, faces major sustainability and governance challenges;the so far inconclusive outcome of the SNHS decentralizationprocess clearly underlines the importance of seeking new alternativesto effectively bring about the real benefits of decentralization,while taking advantage of the system’s economiesof scale and achieving its equity objectives.To this end, four lines of action are proposed in this paper:first, redefine the SNHS based on universal public coverage,as a civic right and equal for all; second, reframe the financingsystem and the role of the Cohesion Fund; third, reviewthe role of central government and its Ministry of Health, andfourth, create of a SNHS Agency headed by a Commissioner,for providing an organizational framework and identity forthe SNHS, and serving as the cooperative body of the seventeenAutonomous Communities’ Health Services(AU)

Gobernabilidad del Sistema Nacional de Salud: mejorando el balance entre los beneficios y los costes de la descentralización. Informe SESPAS 2008 / Governability of the Spanish national health system: improving the balance between the benefits and costs of decentralization. 2008 SESPAS Report

El Sistema Nacional de Salud (SNS) presenta una compleja situación de equilibrio, que aunque puede ser satisfactorio a corto plazo, plantea grandes problemas de sostenibilidad y gobernabilidad; el incierto balance del proceso de descentralización sanitaria en España señala claramente la senda de buscar nuevas alternativas organizativas para hacer efectivas las ventajas de la descentralización, a la vez que ser capaces de aprovechar las economías del sistema y conseguir la equidad pretendida. Se proponen cuatro líneas de actuación: redefinición del SNS en torno al aseguramiento público y derecho cívico igual para todos; replanteamiento del sistema de financiación y del papel del fondo de cohesión; redefinir el papel del gobierno central y el Ministerio de Sanidad, y crear un nuevo organismo, la Agencia del SNS con un Comisionado que de soporte organizativo e identidad al SNS como ámbito de acción cooperativa

The Spanish National Health System (SNHS) is currently in a complex equilibrium which, even if acceptable in the short term, faces major sustainability and governance challenges; the so far inconclusive outcome of the SNHS decentralization process clearly underlines the importance of seeking new alternatives to effectively bring about the real benefits of decentralization, while taking advantage of the system¿s economies of scale and achieving its equity objectives. To this end, four lines of action are proposed in this paper: first, redefine the SNHS based on universal public coverage, as a civic right and equal for all; second, reframe the financing system and the role of the Cohesion Fund; third, review the role of central government and its Ministry of Health, and fourth, create of a SNHS Agency headed by a Commissioner, for providing an organizational framework and identity for the SNHS, and serving as the cooperative body of the seventeen Autonomous Communities Health Services (AU)

Externalización, eficiencia y calidad (primera parte) / Outsourcing, efficiency and quality (part one). Public and private health care

La privatización y la externalización de servicios sanitarios se analizan desde la perspectiva de la economía y la gestión, explorando desde la teoría de los costes de transacción cuatro modalidades de externalización: centros, servicios asistenciales, servicios centrales y servicios generales. Se analizan los efectos potenciales de las externalizaciones y sobre esta base se indican ventajas y riesgos, situando el debate en el contexto del Sistema Nacional de Salud español, y se concluye con algunas consideraciones finales que afectan a la agenda política y de investigación (AU)

Outsourcing and privatization of healthcare services are analyzed from management and economics perspectives, examining four types of outsourcing from the transaction costs theory: centres, clinical services, diagnostic-therapeutic support services, and ancillary services. Potential effects of outsourcing are analysed, addressing the advantages and risks, and putting it into the context of the Spanish NHS. Some final remarks are made regarding policy and research agenda (AU)

[Not Available]. / Externalización, eficiencia y calidad (primera parte). Público y privado en la sanidad.

Outsourcing and privatization of healthcare services are analyzed from management and economics perspectives, examining four types of outsourcing from the transaction costs theory: centres, clinical services, diagnostic-therapeutic support services, and ancillary services. Potential effects of outsourcing are analysed, addressing the advantages and risks, and putting it into the context of the Spanish NHS. Some final remarks are made regarding policy and research agenda.

[Not Available]. / Externalización, eficiencia y calidad (segunda parte): Análisis de costes y efectos potenciales de las políticas de externalización.

Outsourcing and privatization of healthcare services are analyzed from Management and Economics perspectives, exploring form the Transaction Costs theory four types of outsourcing: centres, clinical services, diagnostic-therapeutic support services, and ancillary services. Potential effects of externalization are analysed, addressing the advantages and risks, and putting it into the context of the Spanish NHS. Some final remarks are made regarding policy and research agenda.

El camino del caos para llegar a la excelencia / Achieving excellence through chaos

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¿Es de buena calidad nuestro sistema de financiación? / Is our financing system high quality?

No disponible