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 Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants.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
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
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
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
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
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
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
Incidencia, riesgo y evolución de las fracturas osteoporóticas de cuello de fémur en las mujeres en España, a partir de un modelo de Markov
(1998) Cabasés Hita, Juan Manuel; Carmona López, Guadalupe; Hernández Vecino, Ramón; Economía; Ekonomia
El objetivo de este estudio es estimar la incidencia, por edad y género, de fracturas osteoporóticas de cuello de fémur, así’ como el riesgo de dichas fracturas a lo largo de la vida, en mujeres de diferentes grupos de edad mayores de 45 a–os, y determinar el número de fracturas que pueden esperarse y los años de dependencia funcional atribuibles a las mismas que se generar’an en dicho horizonte temporal, en España. Estas estimaciones posibilitan el cálculo posterior de los costes sociales de la osteoporosis en España y la evaluación económica de alternativas preventivas de fracturas osteoporóticas de cadera. La historia natural de la enfermedad a partir de la fractura, se describe utilizando un modelo de Markov, y simulaciones de Monte Carlo. El modelo permite, para cada caso de incidencia de fractura, analizar su evolución posterior a lo largo de toda su esperanza de vida. Se estima el riesgo de fractura a lo largo de la vida y el estado de dependencia funcional debida a las fracturas, de cuatro cohortes de 10.000 mujeres de diferentes grupos de edad. Los resultados se extrapolan a la población española, según el censo de1.991. Los datos se obtuvieron de seis hospitales de diferente tamaño y localización geográfica en España, para captar las diferencias en la estructura de servicios hospitalarios. Los pacientes incorporados en el estudio fueron todos los casos nuevos de 1995 de fractura osteoporótica atendidos en los centros mencionados. Los resultados del modelo permiten predecir que en el grupo de mujeres de 50 o más años hoy en España, 968.036 sufrirán una fractura de cadera en el tiempo que les resta de vida, producindose 1.013.820 fracturas, y 135.004 mujeres pasarán a ser funcionalmente dependientes debido a las fracturas, lo que supondrá 1.177.204 años-persona de dependencia. La estimación de la incidencia de fractura osteoporótica en España nos permite realizar una primera aproximación al coste hospitalario en la fase aguda de dichas fracturas. Las 23.631 fracturas osteopor—ticas de cadera ocurridas en España en 1995 tuvieron, en su fase aguda, una estancia media hospitalaria de 18 dí’as, con un coste por caso de 850.000 pts, dando un coste directo hospitalario de la atención a esa primera fase de algo más de 20.000 millones de pts. El trabajo provee un prototipo para la estimación de los costes evitados de fracturas en futuros análisis coste-efectividad de medidas preventivas.
Open Access
Using bayesian techniques to build up an inconsistency free health status index
(2004) Cabasés Hita, Juan Manuel; Sánchez Iriso, Eduardo; Economía; Ekonomia
Objectives: 1-To obtain a set of values of health states of the EQ-5D based on self-related health VAS using linear and non- linear models Bayesian techniques. 2 - To analyse “logical consistency” in different models and to derive a model free from logical inconsistencies. 3 - To analyse and compare results of several models when using a priori sources of information. Methods: We apply the usual models and transformations of these, in order to attain logical consistency of the value set. Models proposed are: linear model (1); linear with dummy variables (2) and two models with a logistic structure with different distributions of the coefficients to be estimated (3 and 4). For two of these models new dummies are added in order to obtain logical consistency (2B and 4B). Results: We propose a modelling to guarantee consistency of values of the EQ-5D health states that may be applied to suitable samples at apparently low cost of fit. This model is nonlinear, has distribution Gamma in the coefficients and specific dummy variables. The introduction of priors may reduce the cost of forcing logical consistency.