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
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
Changes in inequality in use of maternal health care services: evidence from skilled birth attendance in mauritania for the period 2007-2015
(MDPI, 2022) Taleb Hassen, Mohamed Vadel; Cabasés Hita, Juan Manuel; Zine-Eddine El Idrissi, Moulay Driss; Mills, Samuel; Economía; Ekonomia
Skilled birth attendance is critical to reduce infant and maternal mortality. Health development plans and strategies, especially in developing countries, consider equity in access to maternal health care services as a priority. This study aimed to measure and analyze the inequality in the use of skilled birth attendance services in Mauritania. The study identifies the inequality determinants and explores its changes over the period 2007-2015. The concentration curve, concentration index, decomposition of the concentration index, and Oaxaca-type decomposition technique were performed to measure socioeconomically-based inequalities in skilled birth attendance services utilization, and to identify the contribution of different determinants to such inequality as well as the changes in inequality overtime using data from Mauritania Multiple Indicator Cluster Surveys (MICS) 2007 and 2015. The concentration index for skilled birth attendance services use dropped from 0.6324 (p < 0.001) in 2007 to 0.5852 (p < 0.001) in 2015. Prenatal care, household wealth level, and rural-urban residence contributed most to socioeconomic inequality. The concentration index decomposition and the Oaxaca-type decomposition revealed that changes in prenatal care and rural-urban residence contributed positively to lower inequality, but household economic status had an opposite contribution. Clearly, the pro-rich inequality in skilled birth attendance is high in Mauritania, despite a slight decrease during the study period. Policy actions on eliminating geographical and socioeconomic inequalities should target increased access to skilled birth attendance. Multisectoral policy action is needed to improve social determinants of health and to remove health system bottlenecks. This will include the socioeconomic empowerment of women and girls, while enhancing the availability and affordability of reproductive and maternal health commodities. This policy action can be achieved through improving the availability of obstetric service providers in rural areas; ensuring better distribution and quality of health infrastructure, particularly health posts and health centers; and, ensuring user fees removal for equitable, efficient, and sustainable financial protection in line with the universal health coverage objectives.
Open Access
Economía de la salud: la medida del valor en la sanidad
(2020) Cabasés Hita, Juan Manuel; Economía; Ekonomia
La lección trata de economía de la salud, una disciplina cuyo objeto es la asignación de recursos escasos para mejorar la salud y el bienestar de los ciudadanos. Concretamente, se realizarán algunas reflexiones sobre la evaluación económica de tecnologías sanitarias centrándose en su aspecto más específico y complejo, la medida de la salud como variable de efectividad de las intervenciones sanitarias. El autor espera mostrar la relevancia que en esa medida ha de tener la voz del paciente, nuestra propia voz, que responde a esta pregunta crucial: ¿Cuánto estaríamos dispuestos a pagar por ganar un año en salud plena?
Open Access
Perceived health and earnings: evidence from the European working conditions survey 2015
(MDPI, 2022) Erro Garcés, Amaya; Aramendia Muneta, María Elena; Errea Rodríguez, María; Cabasés Hita, Juan Manuel; Institute for Advanced Research in Business and Economics - INARBE
This paper aims to analyse the relationship between perceived health and earnings across Europe. Empirical analysis is based on the last published round from the European Working Conditions Survey (N = 43,850) and offers updated evidence on the effect of earnings on perceived health in 35 countries. The main findings show a positive and significant relationship between earnings and health, which is consistent with the existing literature. Moreover, health seems to be U-shaped relative to earnings. On the other hand, age is negatively related to health, which is consistent with previous research. This paper shows the health differences between countries, where cultural, geographic, and economic differences imply health inequalities across countries. From a practical perspective, understanding the dynamics of perceived health and earnings’ processes can contribute to health policy.