Utilización y tiempos de espera: dos vertientes inseparables del análisis de la equidad en el acceso al sistema sanitario público

  1. Ignacio Abásolo Alessón
  2. Miguel Angel Negrín Hernández
  3. Jaime Pinilla Domínguez
Hacienda Pública Española / Review of Public Economics

ISSN: 0210-1173

Year of publication: 2014

Issue: 208

Pages: 11-38

Type: Article

DOI: 10.7866/hpe-rpe.14.1.1 DIALNET GOOGLE SCHOLAR


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.

Bibliographic References

  • Abásolo, I. (1998), "Equidad horizontal en la distribución del gasto público en sanidad por grupos so-cioeconómicos en Canarias: un estudio comparado con el conjunto español", Hacienda Pública Es-pañola,147: 3-28.
  • Abásolo, I.; Manning, R. Jones A. (2001), "Equity in the utilisation of and access to public-sectorgPs in spain", Applied Economics,33: 349-364.
  • Abásolo, I.; Pinilla, J. Negrín, M. (2008) "Equidad en la utilización de servicios sanitarios públicospor 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 socioeconomicgroups: 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 ofwaiting 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 exten-sions 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 theinfluence of supplemental private health insurance?", International Journal for Quality in HealthCare, 13: 117-125.
  • Collins, E. and Klein, K. (1980), "Equity and the nHs: self reported morbidity, access and primarycare", British Medical Journal,281: 1111-1115.
  • Cooper, Z.; Mcguire, A.; Jones, s.; Legrand, J. and Titmuss, R. (2009), "Equity, waiting times andthe 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 NewEngland Journal of Medicine,331 (16): 1068-1071.
  • Crespo-Cebada, E. and Urbanos-Garrido, R.M. (2012), "Equity and equality in the use of gP servicesfor 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 Mem-ber 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 endoge-neity: application to health care expenditure", Journal of Applied Econometrics,21: 1081-1099.
  • Ding, P. (2014), "bayesian robust inference of sample selection using selection-t models", Journal ofMultivariate 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 Practi-ce,10 (1): 3-9.
  • Gelman, A. (2006), "Prior distributions for variance parameters in hierarchical models", BayesianAnalysis, 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 swe-dish micro data", Health Economics,6: 303-319.
  • Geweke, J. (1992), "Evaluating the Accuracy of sampling-based Approaches to Calculating PosteriorMoments", en JM bernardo, JO berger, AP Dawid, AFM smith (ed.), bayesian statistics 4. Cla-rendon Press, Oxford, uK.
  • Gilks, W. R.; Richardson, S. and Spiegelhalter, D. J. (1996), "strategies for improving MCMC", enMarkov 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 andEquity in Primary Care and specialist Office Visits: A Population-based study", Annals of FamilyMedicine,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 Econo-mía Pública,186 (3): 9-42.
  • González, B.; Urbanos, R. M. Ortega, P. (2004), "Oferta pública y privada de servicios sanitarios porcomunidades autónomas", Gaceta Sanitaria,18: 82-89.
  • Grossman, M. (1972), "A stock approach to the demand for health" en grossman M. (ed.), The demand forhealth: a theoretical and empirical investigation, nbER, Columbia university Press, capítulo I: 1-10.
  • Hacker, J. and Stanistreet, D. (2004), "Equity in waiting times for two surgical specialties: a case studyat a hospital in the north West of England", Journal of Public Health, 26 (1): 56-60.
  • Heckman, J. (1976), "The common structure of statistical models of truncation, sample selection andlimited dependent variables and a simple estimator for such models", Annals of Economic SocialMeasurement,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 In-itial 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 ste-vens, 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 de-mand 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 formajor 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 mo-dels: a comparison of statistical packages for binary and ordinal outcomes", BMC Medical ResearchMethodology,11: 77.
  • Li, P. and Rahman, M. (2011), "bayesian Analysis of Multivariate sample selection Models usinggaussian Copulas", en David M. Drukker (ed.) Missing Data Methods:Cross-sectional Methodsand 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 thespanish '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), "Wai-ting for orthopaedic surgery: factors associated with waiting times and patients' opinion", Interna-tional 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 serviciossanitarios entre las CC.AA. españolas (1987-2003) y su relación con la evolución del gasto sanita-rio 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 En-gland: 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 estimatorand 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 wai-ting 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 Po-licy,15: 293-313.
  • Puhani, P. (2000), "The Heckman correction for sample selection and its critique", Journal of Econo-mic 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 universityPress, 763-773.
  • Regidor, E.; De Mateo, S.; Gutiérrez-Fisac, J. L.; Fernández de la Hoz, K. Rodríguez, C. (1996), "Di-ferencias 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 delos ingresos económicos con la utilización y la accesibilidad de los servicios sanitarios en España alinicio del siglo XXI", Gaceta Sanitaria;20 (5): 352-59.
  • Regidor E.; Martínez D.; Calle M.; Astasio P.; Ortega P. and Domínguez V. (2008), "socioeconomicpatterns in the use of public and private health services and equity in health care", BMC Health Ser-vices Research,8 (183): 1-9.
  • Rendon, S. (2013), "Fixed and Random Effects in Classical and bayesian Regression", Oxford Bulle-tin 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 inspain", en Van Doorslaer E. (eds.) Equity in the finance and delivery of health care: an internatio-nal perspective, Oxford university Press. Oxford.
  • Shortt, S. and Shaw, R. (2003), "Equity in Canadian health care: does socioeconomic status affect wai-ting 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 Europe-ans: evidence from sHARE", Health Economics,18: 1295-1306.
  • Spiegelhalter, D. A., Best, N. and Lunn, D. (2003), WinBUGS User Manual. Version 1.4. Technicalreport, 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 des-igualdad 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 in-dividuals with cardiovascular disease in England - accounting for vertical inequity", Health Econo-mics, 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 randomeffects 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 HumanResources,33 (1): 127-169.
  • Vikum, E.; Krokstad, S. and Westin, S. (2012), "socioeconomic inequalities in health care utilisationin norway: the population based HunT3 survey", International Journal for Equity in Health Care,11 (48): 1-9.