Utilización y tiempos de espera: dos vertientes inseparables del análisis de la equidad en el acceso al sistema sanitario público
- Abásolo Alessón, Ignacio
- Negrín Hernández, Miguel Angel
- Pinilla Domínguez, Jaime
ISSN: 0210-1173
Año de publicación: 2014
Número: 208
Páginas: 11-38
Tipo: Artículo
Otras publicaciones en: Hacienda Pública Española / Review of Public Economics
Resumen
El objetivo de esta investigación consiste en analizar si existe equidad en el acceso a los servicios sanita-rios públicos por niveles socioeconómicos. se analiza conjuntamente la probabilidad de utilizar los servi-cios sanitarios y los tiempos de espera hasta ser atendidos, corrigiéndose así el sesgo de selección que sederivaría de su estudio separado, tal y como se evidencia en esta investigación. se propone una aproxima-ción bayesiana y se hace uso de la información a nivel individual sobre la utilización sanitaria, tiempos deespera, nivel socioeconómico, necesidad sanitaria y otras variables sociodemográficas contenidas en la En-cuesta nacional de salud (2006). Los resultados muestran que hay inequidad en el acceso a los serviciosespecializados y hospitalarios (tanto en utilización como en tiempos de espera) que perjudica a los nivelessocioeconómicos inferiores. En los servicios de medicina general, si bien la utilización beneficia relativa-mente más a los grupos de menor nivel socioeconómico, los tiempos de espera perjudican a los de menornivel educativo.
Referencias bibliográficas
- Abásolo, I. (1998), "Equidad horizontal en la distribución del gasto público en sanidad por grupos socioeconómicos en Canarias: un estudio comparado con el conjunto español", Hacienda Pública Española,147: 3-28.
- Abásolo, I.; Manning, R. Jones A. (2001), "Equity in the utilisation of and access to public-sector GPs in Spain", Applied Economics, 33: 349-364.
- Abásolo, I.; Pinilla, J. Negrín, M. (2008) "Equidad en la utilización de servicios sanitarios públicos por Comunidades Autónomas en España: un análisis multinivel", Hacienda Pública Española, 187(4): 87-106.
- Abásolo, I.; Negrín, M. Pinilla, J. (2014), "Equity in specialist waiting times by socioeconomic groups: evidence from Spain", European Journal of Health Economics,15 (3): 323-334.
- Allison, P. (2002), Missing Data, SAGE Publications.
- Arnesen, K.; Eriksen, J. and Stavem, K. (2002), "Gender and socioeconomic status as determinants of waiting time for inpatient surgery in a system with implicit queue management", Health Policy, 62(3): 329-341.
- Birch, s.; Eyles, J. and Newbold, K. B. (1993), "Equitable access to health care: methodological extensions to the analysis of physician utilisation in Canada", Health Economics, 2: 87-101.
- Borrell, C.; Fernandez, E.; Schiaffino, A.; Benach, J.; Rajmil, L.; Villalbi, J. R. and Segura, A. (2001), "Social class inequalities in the use of and access to health services in Catalonia. Spain: What is the influence of supplemental private health insurance?", International Journal for Quality in Health Care, 13: 117-125.
- Collins, E. and Klein, K. (1980), "Equity and the NHS: self reported morbidity, access and primary care", British Medical Journal,281: 1111-1115.
- Cooper, Z.; Mcguire, A.; Jones, s.; Legrand, J. and Titmuss, R. (2009), "Equity, waiting times and the NHs reforms: retrospective study", British Medical Journal,339: 1-7.
- Coyte, P.; Wright, J.; Hawker, G. A.; Bombardier, C.; Dittus, R. s.; Paul, J. E.; Freund, D. A. and Ho, E. (1994), "Waiting times for knee-replacement surgery in the United States and Ontario", The New England Journal of Medicine, 331 (16): 1068-1071.
- Crespo-Cebada, E. and Urbanos-Garrido, R.M. (2012), "Equity and equality in the use of GP services for elderly people: the Spanish case", Health Policy,104 (2): 193-199.
- De Vos, K. and Zaidi, M. A. (1997), "Equivalence scale sensitivity of Poverty statistics for the Member states of the European Community?", Review of Income and Wealth, 43 (3): 319-334.
- Deb, P.; Munkin, M. and Trivedi, P. (2006), "Bayesian Analysis of the two-part model with endogeneity: application to health care expenditure", Journal of Applied Econometrics, 21: 1081-1099.
- Ding, P. (2014), "Bayesian robust inference of sample selection using selectiont models", Journal of Multivariate Analysis,124: 451-464.
- Dudik, M.; Schapire, R. and Phillips, s. (2005), "Correcting sample selection bias in maximum entropydensity estimation", Advances in neural information processing systems, 17: 323-330.
- Fitzpatrick, R.; Norquist, J.; Reeves, b.; Morris, R. W.; Murray, D. W. and Gregg, P. J. (2004), "Equityand need when waiting for total hip replacement surgery", Journal of Evaluation in Clinical Practice,10 (1): 3-9.
- Gelman, A. (2006), "Prior distributions for variance parameters in hierarchical models", Bayesian Analysis, 3: 515-533.
- Gelman, A. and Rubin, D. B. (1992), "Inference from Iterative simulation using Multiple sequences (with discussion)", Statistical Science, 7, 457-511.
- Gerdtham, U. (1997), "Equity in health care utilization: further tests based on hurdle models and swedish micro data", Health Economics, 6: 303-319.
- Geweke, J. (1992), "Evaluating the Accuracy of sampling-based Approaches to Calculating Posterior Moments", en JM Bernardo, JO Berger, AP Dawid, AFM Smith (ed.), Bayesian Statistics 4. Clarendon Press, Oxford, UK.
- Gilks, W. R.; Richardson, S. and Spiegelhalter, D. J. (1996), "Strategies for improving MCMC", en Markov Chain Monte Carlo in Practice, Chapman & Hall/CRC, London, 89-114.
- Glazier R. H.; Agha M. M.; Moinneddin R. and Sibley L.M. (2009), "Universal Health Insurance and Equity in Primary Care and Specialist Office Visits: A Population-based study", Annals of Family Medicine, 7 (5): 396-405.
- González M. L. Clavero A. (2008) Análisis de las desigualdades socioeconómicas en la utilizaciónde asistencia sanitaria mediante modelos dinámicos. Hacienda Pública Española/Revista de Economía Pública,186 (3): 9-42.
- González, B.; Urbanos, R. M. Ortega, P. (2004), "Oferta pública y privada de servicios sanitarios por comunidades autónomas", Gaceta Sanitaria,18: 82-89.
- Grossman, M. (1972), "A stock approach to the demand for health" en Grossman M. (ed.), The demand for health: a theoretical and empirical investigation, NBER, Columbia University Press, capítulo I: 1-10. UI-BUTTON
- Hacker, J. and Stanistreet, D. (2004), "Equity in waiting times for two surgical specialties: a case study at a hospital in the north West of England", Journal ofhe demand for health: a theoretical and empirical investigation, Public Health, 26 (1): 56-60.
- Heckman, J. (1976), "The common structure of statistical models of truncation, sample selection and limited dependent variables and a simple estimator for such models", Annals of Economic Social Measurement, 5 (4): 475-492.
- Heckman, J. (1979), "Sample selection bias as a specification error", Econometrica, 47 (1): 153-161.
- Heidelberger, P. and Welch, P. D. (1983), "Simulation Run Length Control in the Presence of an Initial Transient", Operations Research,31: 1109-1144.
- Hirschman, A. O. (1970), Exit, voice, and loyalty. Cambridge, Harvard University Press.
- Hsiao, C. and Pesaran, M. (2006), "Random Coefficient Panel Data Models", en Matyas, L. and Stevens, P. (eds.), The Econometrics of Panel Data (3rd edn),. Kluwer Academic Publishers: Dordrecht.
- Kee, F. and Gaffney, B. (1995), "Priority for coronary artery surgery: who gets by-passed when demand outstrips capacity?", Quarterly Journal of Medicine, 88 (1): 15-22.
- Kelly, K.; Voaklander, D.; Johnston, W. and Suarez-Amador, M. (2002), "Equity in waiting times for major arthroplasty", Canadian Journal of Surgery, 45 (4): 269-276.
- Lee, P. (1997) Bayesian Statistics: An introduction, 2nd Ed. John Wiley, New York.
- Legrand, J. (1982), The Strategy of Equality: Redistribution and the Social Services. Allen & Unwin, London, Boston.
- Li, B.; Lingsma, H.; Steyerberg, E. and Lesaffre, E. (2011), "Logistic random effects regression models: a comparison of statistical packages for binary and ordinal outcomes", BMC Medical Research Methodology, 11: 77.
- Li, P. and Rahman, M. (2011), "Bayesian Analysis of Multivariate sample selection Models using Gaussian Copulas", en David M. Drukker (ed.) Missing Data Methods: Cross-sectional Methods and Applications (Advances in Econometrics, Volume 27), Emerald Group Publishing Limited, 269-288.
- López-Casasnovas, G.; Costa-Font, J. and Planas, I. (2005), "Diversity and regional inequalities in the Spanish 'system of health care services'", Health Economics,14, supl 1: 221-235.
- Löfvendahl, S.; Eckerlund, I.; Hansagi, H.; Malmqvist, B.; Resch, S. and Hanning, M. (2005), "Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion", International Journal for Quality in Health Care,17 (2): 133-140.
- Mokatrin, L. Bayesian Approach for selection bias correction in regression. American University. Washington, D.C. 2011
- Montero, R. Jiménez, J. (2008), "Evolución de la equidad interterritorial en el acceso a los servicios sanitarios entre las CC.AA. españolas (1987-2003) y su relación con la evolución del gasto sanitario público", Cuadernos Económicos del ICE: 167-190.
- Mooney, G. (1983), "Equity in health care: confronting the confusion", Effective Health Care,1: 179-185.
- Morris, S.; Sutton, M. and Gravelle, H. (2005), "Inequity and inequality in the use of health care in England: an empirical investigation", Social Science and Medicine, 60 (6): 1251-66.
- MSPSI (2006), Ministerio de Sanidad, Política Social e Igualdad. Encuesta Nacional de Salud. Madrid.
- Nawata, K. (1994), "Estimation of sample selection bias models by the maximum likelihood estimator and Heckman's two-step estimator", Economic Letters,45, 1, 33-40.
- Pell, J.; Pell, A.; Norrie, J.; Ford, I. Cobbe, S. (2000), "Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study", British Medical Journal, 320: 15-19.
- Puffer, F. (1986), "Access to primary care: a comparison of the US and the UK", Journal of Social Policy,15: 293-313.
- Puhani, P. (2000), "The Heckman correction for sample selection and its critique", Journal of Economic Surveys, 14, 1: 53-68.
- Raftery, A. E. and Lewis, S. (1992), "How Many Iterations in the gibbs sampler?", en J.M. Bernardo, J. Berger, A.P. Dawid and A.F.M. Smith (eds.), Bayesian Statistics 4, Oxford: Oxford University Press, 763-773.
- Regidor, E.; De Mateo, S.; Gutiérrez-Fisac, J. L.; Fernández de la Hoz, K. Rodríguez, C. (1996), "Diferencias socioeconómicas en la utilización y accesibilidad de los servicios sanitarios en España", Medicina Clínica (Barcelona), 107: 285-288.
- Regidor, E.; Martínez, D.; Astasio, P.; Ortega, P.; Calle, M. Domínguez, V. (2006), "Asociación de los ingresos económicos con la utilización y la accesibilidad de los servicios sanitarios en España al inicio del siglo XXI", Gaceta Sanitaria; 20 (5): 352-59.
- Regidor E.; Martínez D.; Calle M.; Astasio P.; Ortega P. and Domínguez V. (2008), "Socioeconomic patterns in the use of public and private health services and equity in health care", BMC Health Services Research, 8 (183): 1-9.
- Rendon, S. (2013), "Fixed and Random Effects in Classical and bayesian Regression", Oxford Bulletin of Economics and Statistics, 75 (3): 460-476.
- Robert, C. P. and Casella, G. (1999), Monte Carlo Statistical Methods. Springer-Verlag, New York.
- Rodríguez, M.; Calonge, S. and Reñé, J. (1993), "Equity in the finance and delivery of health care in Spain", en Van Doorslaer E. (eds.) Equity in the finance and delivery of health care: an international perspective, Oxford university Press. Oxford.
- Shortt, S. and Shaw, R. (2003), "Equity in Canadian health care: does socioeconomic status affect waiting times for elective surgery?", Canadian Medical Association Journal,168(4): 413-416.
- Siciliani, L. and Verzulli. R. (2009), "Waiting times and socioeconomic status among elderly Europeans: evidence from SHARE", Health Economics,18: 1295-1306.
- Spiegelhalter, D. A., Best, N. and Lunn, D. (2003), WinBUGS User Manual. Version 1.4. Technical report, Medical Research Council Biostatistcs Unit, Cambridge.
- Urbanos, R. (2000), "La prestación de los servicios sanitarios públicos en España: cálculo análisis dela equidad horizontal interpersonal para el período 1987-1995", Hacienda Pública Española,153:139-160.
- Urbanos R. (2011), "Determinantes de salud utilización de servicios sanitarios: un análisis de desigualdad desde la perspectiva de género", Presupuesto Gasto Público,64: 117-130.
- Vallejo-Torres, L. and Morris, S. (2013), "Income-related inequity in health care utilisation among individuals with cardiovascular disease in England - accounting for vertical inequity", Health Economics, 22 (5): 533-553.
- Van Doorslaer, E.; Koolman, X. and Jones, A. M. (2004), "Explaining income-related inequalities indoctor utilisation in Europe", Health Economics,13: 629-647.
- Van Doorslaer E.; Masseria C. and Koolman X. (2006), "Inequalities in access to medical care by in-come in developed countries", Canadian Medical Association Journal, 174 (2): 177-83.
- Van Hasselt, M. (2011), "Bayesian inference in a sample selection model", Journal of Econometrics,165: 221-232.
- Van Ourti, T. (2004), "Measuring horizontal inequity in belgian health care using a gaussian random effects two part count data model", Health Economics,13 (7): 705-24.
- Vella, F. (1998), "Estimating models with sample selection bias: a survey", The Journal of Human Resources,33 (1): 127-169.
- Vikum, E.; Krokstad, S. and Westin, S. (2012), "Socioeconomic inequalities in health care utilisation in Norway: the population based HunT3 survey", International Journal for Equity in Health Care,11 (48): 1-9.