RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008-2021).

AIMS: This work aims to analyze the structure, activity, and outcomes of internal medicine units and departments (IMU) of the Spanish National Health System (SNHS) and to analyze the challenges for the specialty and propose policies for improvement. It also aims to compare the results from the 2021 RECALMIN survey with IMU surveys from previous years (2008, 2015, 2017, 2019). METHODS: This work is a cross-sectional, descriptive study of IMUs in acute care general hospitals of the SNHS that compares data from 2020 with previous studies. The study variables were collected through an ad hoc questionnaire. RESULTS: Between 2014 and 2020, hospital occupancy and discharges by IMU increased (annual mean of 4% and 3.8%, respectively), as did hospital cross-consultation and initial consultation rates (2.1% in both cases). E-consultations increased notably in 2020. Risk-adjusted mortality and length of hospital stay did not show significant changes from 2013-2020. Progress in the implementation of good practices and systematic care for complex chronic patients was limited. A consistent finding in RECALMIN surveys was the variability among IMUs in terms of resources and activity, though no statistically significant differences were found in regard to outcomes. CONCLUSIONS: There is considerable room for improvement in the operation of IMUs. The reduction in unjustified variability in clinical practice and inequities in health outcomes are a challenge for IMU managers and the Spanish Society of Internal Medicine.

Health care system reforms in western European countries: the relevance of health care organization.

The problems within the health care systems of western European countries, and their current attempts at reform, can be analyzed by comparing those countries having national health care service (NHS) systems with those having social security systems. There are important differences in the structures, processes, and outcomes of these two types of health care systems, and thus in the problems they face. Greater cost control, equity, and, possibly, efficiency in improving the population's health are the advantages of NHS systems; however, public satisfaction is lower than in social security systems. Attempts to overcome this trade-off between the outcomes of the two types of health care systems are the main goal of the reforms. To achieve this goal, there has been a trend toward convergence of NHS and social security systems. For the NHS systems of Latin-rim countries, however, which have received less political commitment and public support than those elsewhere, this means a return to the former social security systems--a trend that may reintroduce the problems associated with these types of systems but without any evidence that public satisfaction will increase.

[Relationship between ideology and efficiency of health care systems. Notes on the reform of the Spanish health care system]. / La relación entre ideología y eficiencia de los sistemas sanitarios. Unas notas de cara a la reforma del sistema sanitario español.

This paper explores the relation between ideology and efficiency of the health care systems. In order to achieve this goal, this study: analyzes the relation between ideology and health care system organization, defines the concept of health care system efficiency, and reviews the relation between health care organization and efficiency. The last part of the paper is devoted to discuss the relevance of the conclusions of the above mentioned analyses to the debate on the reform of the Spanish National Health Care System.

Health indicators and the organization of health care systems in western Europe.

OBJECTIVES: This study investigated the association between health care systems and health indicators in developed countries. METHODS: Cross-national comparisons were conducted with regression analysis between 17 Western European countries with two types of health care systems: national health services and social security systems. RESULTS: Health care expenditures were inversely correlated to potential years of life lost to females and to infant mortality rates; they were positively correlated to life expectancy for females. Regression models predicted that countries with national health services systems would have lower infant mortality rates at similar levels of gross domestic product (GDP) and health care expenditures. Finally, increases in health care expenditures would decrease the ratio of observed to predicted infant mortality rates according to GDP; this decrease would be greater in countries with national health services than in those with social security systems. The model predicted this difference to be about 13% at average levels of health expenditures. CONCLUSIONS: National health services seem to be more efficient at producing lower infant mortality rates than social security systems in Western European countries.