No abstract

A19 (F= 3.16 and F= 3.15). The results from the regression model showed that as age increases, the expenditure rises especially at old ages. Patients from lower income groups spent more on ambulatory services than those in higher income groups, as well as individuals living in regions with very high level of social exclusion. Among other main determinants, individuals that looked for private health care attention along with those that perceived their health problems as severe increased their health expenditure. ConClusions: Out of pocket expenditure has been regressive among health care users at IMSS. Therefore especial attention to lower income patients should be paid.

A267 that a positive correlation exists in hospitals between service specialization and the level of clinical quality; furthermore, one also exists between clinical quality and financial performance. Finally, service specialization has a positive effect on financial performance, which is fully mediated by clinical quality. CONCLUSIONS: Based on a complete set of national data, this study demonstrates that hospital specialization has positive effects. Specialist hospital organizations provide superior quality of care and enhanced financial performance. Consequently, more specialization may prove to be a beneficial policy for the NHS.