Austerity, healthcare provision, and health outcomes in Spain

Abstract

The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1997 to 2014 to provide novel causal evidence on the short-term impact of health care provision on health outcomes. The fact that regional governments have discretionary powers in deciding health care budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (2000) fixed effects model, we find that staff or hospital bed reductions account for a significant increase in mortality rates from cardiovascular disease and external causes, for 25-34 and 65-74 year-old groups, and in the late foetal mortality rate. Mortality rates, however, do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments. Contrary to expectations, we find some evidence of reduced mortality rates for cancer and female cancer as a result of the 2012 changes in migrants' access restrictions to the Spanish NHS. Overall, our analyses suggest that short-term impacts of decreases in health care provision on mortality are significant but small. However, impacts prove to be economically and quantitatively significant in the case of fatalities due to external causes, especially accidental deaths.

Death by austerity? The impact of cost containment on avoidable mortality in Italy

“…As they do not attempt to use the Piano di Rientro (PdR) reform as an instrumental variable (IV), they simply conclude that higher regional health spending was associated with lower mortality. Borra, Pons‐Pons, and Vilar‐Rodriguez (2020) is another example of an approach that is similar to ours as it employs regional Spanish data and two‐way fixed effects models to estimate the effects, not of health expenditure but of healthcare inputs like the number of hospital workers and beds, and so forth, on disease‐specific mortality rates. But while their period of analysis (1996–2015) includes periods of austerity, they do not explicitly employ health‐specific austerity measures as instruments to estimate causal effects.…”

The Effect of Health System Responsiveness on Health Outcome: Evidence from Spain

“…For instance, average waiting times for cataract surgery increased -from 89 days in 2010 to 105.1 days in 2015 and for hip replacement increased from 136 to 150.1 days in the same period [4,7]. The increase in waiting lists observed in Spanish NHS is likely to be due to the austerity measures adopted by the Spanish government such as budgetary and supply cutbacks [7,8]. The Spanish economic recession began in 2008 due to falls in gross domestic products for two consecutive quarters and an increase in the unemployment rate [8].…”

“…The increase in waiting lists observed in Spanish NHS is likely to be due to the austerity measures adopted by the Spanish government such as budgetary and supply cutbacks [7,8]. The Spanish economic recession began in 2008 due to falls in gross domestic products for two consecutive quarters and an increase in the unemployment rate [8]. The austerity measures in Spain were implemented in 2010 and this aggravated the situation of the Spanish public healthcare system [8].…”

“…The Spanish economic recession began in 2008 due to falls in gross domestic products for two consecutive quarters and an increase in the unemployment rate [8]. The austerity measures in Spain were implemented in 2010 and this aggravated the situation of the Spanish public healthcare system [8]. Cutbacks in healthcare provision which induce an increase in waiting times might have a potential impact on health outcomes.…”

Death by Austerity? The Impact of Cost Containment on Avoidable Mortality in Italy

“…As they do not attempt to use the Piano di Rientro (PdR) reform as an instrumental variable (IV), they simply conclude that higher regional health spending was associated with lower mortality. Borra, Pons-Pons, and Vilar-Rodriguez (2020) is another example of an approach that is similar to ours as it employs regional Spanish data and two-way fixed effects models to estimate the effects, not of health expenditure but of healthcare inputs like the number of hospital workers and beds, and so forth, on disease-specific mortality rates. But while their period of analysis (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) includes periods of austerity, they do not explicitly employ health-specific austerity measures as instruments to estimate causal effects.…”