Open Access
Osasunaren ekonomia: balioa neurtzeko modua osasungintzan
(2020) Cabasés Hita, Juan Manuel; Economía; Ekonomia
Osasunari eta ekonomiari buruz hitz egin behar dut gaur. Edo bestela, hobeki esateko, osasunaren ekonomiari buruz, herritarren osasuna eta ongizatea hobetzeko eskasak diren baliabideak esleitzea helburutzat duen diziplinari buruz. Hausnarketa batzuk eginen ditut, zehazki osasun teknologien ebaluazio ekonomikoari buruz, eta ebaluazio horren alderdi espezifikoenean eta konplexuenean jarriko dut arreta: osasuna neurtzeko moduan, osasungintzako esku-hartzeen eraginkortasunaren aldagaia den aldetik. Eta espero dut erakutsiko dizuedala nolako garrantzia duen neurtzeko modu horretan pazienteak esaten duenak, guk gerok esaten dugunak, galdera erabakigarri honi erantzuteko: Zenbat geundeke prest ordaintzeko osasun beteko urte bat izateagatik?
Open Access
La financiación sanitaria autonómica. Bases para una propuesta
(1998) Cabasés Hita, Juan Manuel; Economía; Ekonomia
Se analizan las novedades recientes en el debate sobre financiación territorial sanitaria: el nuevo modelo de financiación autonómica para el quinquenio 1997-2001, y la nueva RAWP, fórmula inglesa de reparto financiero sanitario y el acuerdo del Consejo de Polí’tica Fiscal y Financiera de 27 de Noviembre de 1997 estableciendo un mecanismo de financiación de la sanidad de la Seguridad Social para el cuatrienio 1998-2001. La discusión sobre financiación auton—çomica de la sanidad es un asunto donde el consenso deviene crucial, y éste ha de empezar por un acuerdo de principio ético. Consideramos que el principio es la igualdad de oportunidades. Nuestra propuesta consiste en profundizar en la corresponsabilidad fiscal incorporando la sanidad a la financiación autonómica general. En este nuevo marco, habrá que diseñar los mecanismos de garantí’a que permitan el logro de los objetivos de la Ley General de Sanidad. Quedan, así’, establecidas, las bases para una agenda de trabajo para elaborar el acuerdo del año 2001.
Open Access
Impact of successful treatment with directacting antiviral agents on health-related quality of life in chronic hepatitis C patients
(Public Library of Science, 2018) Juanbeltz Zurbano, Regina; Martínez Baz, Iván; San Miguel Elcano, Ramón; Goñi Esarte, Silvia; Cabasés Hita, Juan Manuel; Castilla Catalán, Jesús; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Economía; Ekonomia
Background. Direct-acting antivirals (DAA) have demonstrated high efficacy to achieve sustained virological response (SVR) in chronic hepatitis C patients. We aim to assess the change in healthrelated quality of life (HRQoL) among patients successfully treated, and to identify predictors of this variation. Methods. In a prospective observational study, patients with chronic hepatitis C who started DAA therapy between May 2016 and April 2017 completed the EQ-5D-5L questionnaire at baseline and 12 weeks after the end of therapy before knowing the virological result. Analysis included all patients with SVR. Results. Median baseline EQ-5D-5L scores of the 206 enrolled patients were 0.857 utility and 70.0 visual analogue scale (VAS). Following SVR, a reduction occurred in the proportion of patients with mobility problems (35% vs 24%, p = 0.012), pain/discomfort (60% vs 42%, p<0.001) and anxiety/depression (57% vs 44%, p = 0.012), with an increase in utility (+0.053, p<0.001) and VAS (+10, p<0.001). Score improvements were also observed in cirrhotic (+0.048 utility, p = 0.027; +15 VAS, p<0.001) and HIV co-infected patients (+0.039 utility, p = 0.036; +5 VAS, p = 0.002). In multivariate analyses, middle age (45±64 years) and baseline anxiety/depression were associated to greater improvement in utility after SVR, and moderate-advanced liver fibrosis and cirrhosis to greater increase in VAS score. Low baseline values were associated to greater improvements in utility value and VAS score. Conclusions The cure of chronic hepatitis C infection with DAA has a short term positive impact on HRQoL with improvement in mobility, pain/discomfort, anxiety/depression, utility value and VAS score. Patients with poor baseline HRQoL were the most beneficed.
Open Access
Head-to-head comparison between the EQ-5D-5L and the EQ-5D-3L in general population health surveys
(BioMed Central, 2018) Martí Pastor, Marc; Pont, Angels; Ávila, Mónica; Garin, Olatz; Cabasés Hita, Juan Manuel; Economía; Ekonomia
Background: The EQ-5D has been frequently used in national health surveys. This study is a head-to-head comparison to assess how expanding the number of levels from three (EQ-5D-3L) to five in the new EQ-5D-5L version has improved its distribution, discriminatory power, and validity in the general population. Methods: A representative sample (N = 7554) from the Catalan Health Interview Survey 2011–2012, aged ≥18, answered both EQ-5D versions, and we evaluated the response redistribution and inconsistencies between them. To assess validity of this redistribution, we calculated the mean of the Visual Analogue Scale (VAS), which measures perceived health. The discriminatory power was examined with Shannon Indices, calculated for each dimension separately. Spanish preference value sets were applied to obtain utility indices, examining their distribution with statistics of central tendency and dispersion. We estimated the proportion of individuals reporting the best health state in EQ-5D-5L and EQ-5D-3L within groups of specific chronic conditions and their VAS mean. Results: A very small reduction in the percentage of individuals with the best health state was observed, from 61.8% in EQ-5D-3L to 60.8% in EQ-5D-5L. In contrast, a large proportion of individuals reporting extreme problems in the 3 L version moved to severe problems (level 4) in the 5 L version, particularly for pain/discomfort (75.5%) and anxiety/depression (66.4%). The average proportion of inconsistencies was 0.9%. The pattern of the perceived health VAS mean confirmed the hypothesis established a priori, supporting the validity of the observed redistribution. Shannon index showed that absolute informativity was higher in the 5 L version for all dimensions. The means (SD) of the Spanish EQ-5D-3L and EQ-5D-5L indices were 0.87 (0.25) and 0.89 (0.22). The proportion of individuals with the best health state within each specific chronic condition was very similar, regardless of the EQ-5D version (≤ 30% in half of the 28 chronic conditions). Conclusion: Although the proportion of individuals with the best possible health state is still very high, our findings support that the increase of levels provided by the EQ-5D-5L contributed to the validity and discriminatory power of this new version to measure health in general population, as in the national health surveys.
Open Access
An economic model of behaviour: attitudes towards altruistic blood and organ donations
(2009) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
The aim of this research is to model altruistic blood and organ donors behaviour. First, we make an analysis of the decision of to be or not to be a donor for any individual. We propose a model where individuals compare the expected utility of deciding to become a donor, with the utility of the alternative decision (not to become a donor). Second, we continue with the identification of the variables having influence over this decision, the expected effects of such a donation (positive and negative) and the importance of the expectations over individuals well-being and the subsequent decision. We work with rational individuals that behave altruistically when making a decision. The model is specific because the goods we consider can only cover vital needs. We posed hypothesis about some variables for each kind of the donations considered (blood and organ donations). This hypothesis can be useful to identify which are the variables having influence actually over this decision. We propose a pilot survey to test our model. First results from a university students survey show the relevant variables influencing blood an organ donations, and seem to confirm the model.
Open Access
Attitudes towards blood and living organ donations
(2010) Cabasés Hita, Juan Manuel; Errea Rodríguez, María; Economía; Ekonomia
We model the decision of whether or not to become a blood/living organ donor. The expected utility for becoming a donor is a function of the degree of altruism, the consumption of goods, the costs of donation, the very pleasure of giving, and the recipient’s utility associated to donation. Empirically, we observe differences in the expected costs and benefits from donation between blood and non-blood donors, and between individuals with different willingness to donate living organs. Looking at benefits/costs of donation through reasons for donating/not donating, we conclude policies to encourage donation should focus on raising awareness and provide information.
Open Access
Tailoring integrated care services for high-risk patients with multiple chronic conditions: a risk stratification approach using cluster analysis
(BioMed Central, 2020) Bretos Azcona, Pablo Evaristo; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Economía; Ekonomia; Gobierno de Navarra / Nafarroako Gobernua
Background: The purpose of this study was to produce a risk stratification within a population of high-risk patients with multiple chronic conditions who are currently treated under a case management program and to explore the existence of different risk subgroups. Different care strategies were then suggested for healthcare reform according to the characteristics of each subgroup. Methods: All high-risk multimorbid patients from a case management program in the Navarra region of Spain were included in the study (n = 885). A 1-year mortality risk score was estimated for each patient by logistic regression. The population was then divided into subgroups according to the patients' estimated risk scores. We used cluster analysis to produce the stratification with Ward's linkage hierarchical algorithm. The characteristics of the resulting subgroups were analyzed, and post hoc pairwise tests were performed. Results: Three distinct risk strata were found, containing 45, 38 and 17% of patients. Age increased from cluster to cluster, and functional status, clinical severity, nursing needs and nutritional values deteriorated. Patients in cluster 1 had lower renal deterioration values, and patients in cluster 3 had higher rates of pressure skin ulcers, higher rates of cerebrovascular disease and dementia, and lower prevalence rates of chronic obstructive pulmonary disease. Conclusions: This study demonstrates the existence of distinct subgroups within a population of high-risk patients with multiple chronic conditions. Current case management integrated care programs use a uniform treatment strategy for patients who have diverse needs. Alternative treatment strategies should be considered to fit the needs of each patient subgroup.
Open Access
Contracting arrangements in the health strategy contex. A regional approach for Spain
(2000) Cabasés Hita, Juan Manuel; Gaminde, Idoia; Gabilondo, Luis; Economía; Ekonomia
Background. Several different proposals have been made recently to reform the organisation, financing and management of the health care system in Spain. The aim is to obtain improved efficiency, without prejudicing the equity level already achieved, by creating a more competitive framework. However, current health strategies seem not to be in accord with these proposals. This paper approaches the issue of matching these two main components of the health systems, health strategy and contracts, and emphasises the need to develop contracting arrangements within the general health policy framework. Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants. Results and discussion. A review of regional health strategies and regional contracts developed in the 1990s is presented, followed by an analysis of the degree of incoherence between them. Then we discuss whether the programme contract can be an instrument guided by the health plan, commenting on its potential and limitations. Conclusion. The relationship between health strategy and health care management is practically non-existent in Spain. The need to insert the contract cycle within the broader framework of the planning cycle has led to proposals to adapt contracts and health plans to guarantee their coherence. This will require changes in the structure of both of these instruments and, probably, deeper structural modifications of the context within which both have been developed. To this aim, we make some recommendations for policy making.
Open Access
Actividad física y salud autopercibida en personas mayores de 50 años
(Universidad Autonoma de Madrid, 2017) Lera López, Fernando; Garrués Irisarri, Mirian; Ollo López, Andrea; Sánchez Iriso, Eduardo; Cabasés Hita, Juan Manuel; Sánchez-Santos, José Manuel; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
El propósito del estudio es analizar los posibles efectos de la actividad física sobre la salud autopercibida. Para ello, se encuestó a 765 personas entre 50-70 años durante 2012 en España. Se utilizó el cuestionario internacional de actividad física (IPAQ) para estimar el equivalente metabólico de la tarea (MET) total y en cuatro ámbitos: trabajo, ocio, hogar y desplazamientos. La salud auto-percibida se obtuvo de la escala visual analógica del EQ-5D-5L. Los resultados muestran que únicamente el gasto energético de actividad física en el tiempo de ocio incide positivamente en el nivel de salud percibido, el resto de ámbitos no tienen influencia significativa. Asimismo, la autopercepción de la salud es más negativa con mayor edad, menor nivel educativo y mayor frecuencia de uso de servicios sanitarios. En conclusión, la actividad física desarrollada en el tiempo libre podría plantearse como alternativa para mejorar la calidad de vida de los mayores.
Open Access
How the relationship between physical activity and health changes with age
(Springer, 2018-03-28) Lera López, Fernando; Ollo López, Andrea; Garrués Irisarri, Mirian; Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia; Gestión de Empresas; Enpresen Kudeaketa
In the context of age-related declines in physical activity (PA) and the dramatic increase in ageing populations in many countries, this paper sheds further light on the link between PA and self-perceived health (SPH) by examining whether the magnitude of this relationship is age specific. With a sample of 14,456 Spanish individuals aged 18–69, we estimated three levels of intensity in PA using the International Physical Activity Questionnaire. Individuals who did more PA per week showed higher levels of SPH (β = 0.28; 95% CI 0.24–0.32), and age moderated this relationship, with a positive effect over age 49. People aged 50–59 and 60–69 who practiced PA had higher probabilities of better SPH compared with those aged 40–49 (β = 0.14; 95% CI 0.04–0.24) and (β = 0.32; 95% CI 0.21–0.43), respectively. This association between PA and SPH also depended on the intensity of PA, especially for walking (β = 0.14; 95% CI 0.04–0.24). In particular, in comparison with people age 40–49, a statistically significant relationship with SPH was found among people age 50–59 who walked (β = 0.22; 95% CI 0.07–0.36) and people age 60–69 who did moderate PA (β = 0.38; 95% CI 0.23–0.54). This paper provides a major rationale for the design, organisation and implementation of public policies promoting PA and healthy ageing for different age groups.