Abstract
Introduction
The sustainability of public hospital financing in Spain is a recurring issue, given its representativeness in annual public healthcare budgets which must adapt to the macroeconomic challenges that influence the evolution of spending. Knowing whether the responsiveness of hospital expenditure to its determinants (need, utilisation, and quasi-prices) varies according to the type of hospital could help better design strategies aimed at optimising performance.
Methods
Using SARIMAX models, we dynamically assess unique nationwide monthly activity data over a 14-year period from 274 acute-care hospitals in the Spanish National Health Service network, clustering these providers according to the average severity of the episodes treated.
Results
All groups showed seasonal patterns and increasing trends in the evolution of expenditure. The fourth quartile of hospitals, treating the most severe episodes and accounting for more than 50% of expenditure, is the most sensitive to quasi-price factors, particularly the number of beds per hospital. Meanwhile, the first quartile of hospitals, which treat the least severe episodes and account for 10% of expenditure, is most sensitive to quantity factors, for which expenditure showed an elasticity above one, while factors of production were not affected.
Conclusions
Belonging to one or another cluster of hospitals means that the determinants of expenditure have a different impact and intensity. The system should focus on these differences in order to optimally modulate expenditure not only according to the needs of the population, but also according to the macroeconomic situation, while leaving hospitals room for manoeuvre in case of unforeseen events. The findings suggest strengthening a network of smaller hospitals (Group 1)–closer to their reference population, focused on managing and responding to chronicity and stabilising acute events–prior to transfer to tertiary hospitals (Group 4)–larger but appropriately sized, specialising in solving acute and complex health problems–when needed.
Funder
Instituto de Salud Carlos III
Agencia Estatal de Investigación
Publisher
Public Library of Science (PLoS)
Reference46 articles.
1. Gasto Sanitario. Informe Anual del Sistema Nacional de Salud 2017. Madrid. Ministry of Health, Consumption and Social Welfare. 2019. https://www.sanidad.gob.es/estadEstudios/estadisticas/sisInfSanSNS/tablasEstadisticas/InfAnualSNS2017/8_CAP_17.pdf [accessed 22nd May 2023].
2. Factors Underlying the Growth of Hospital Expenditure in Spain in a Period of Unexpected Economic Shocks: A Dynamic Analysis on Administrative Data;E Bernal-Delgado;Health Policy,2020
3. General Health Act 14/1986 of 25 April (in Spanish: Ley 14/1986, de 25 de abril, General de Sanidad). https://www.boe.es/eli/es/l/1986/04/25/14/con (accessed 18 September 2019).
4. Spain: Health system review;S García-Armesto;Health Syst Transit,2010