An overview of health workforce mobility in the European Union under the current supply challenges. SESPAS Report 2024.

OBJECTIVE: Providing a general overview of the European Union's health workforce mobility under the challenges facing health systems regarding the supply of health workers. METHOD: We use a descriptive method, based on the analysis of secondary data, qualitative and quantitative, concerning the European Semester from the European Union, complemented with statistical data from both the Union and some international organisations. RESULTS: The mobility of health professionals in the Union, associated to strong reliance on recruiting abroad and shortages due to emigration, was identified as a challenge in the European Semester process in a significant number of times during 2017-2023. The pandemic aggravated pre-existing shortages and the need to strike a balance between maintaining the resolution capacity of health systems while abiding by the free movement of health professionals. The information shows that Romania, Slovakia, Spain, Lithuania, Latvia, Portugal, Bulgaria, Greece, Croatia, Hungary, Italy, and Slovenia could be flagged with an "issuer profile". Luxembourg, Ireland, Malta, and Sweden could be flagged with a "recipient profile". We benefited from improvements in the information system concerning the Union's health workforce. Further advances regarding the harmonisation of health professions' definition are needed, especially for nurses. CONCLUSIONS: The European Union faces internal migrations of health professionals. Mobility is used as a solution to shortages. The pandemic aggravated pre-existing shortages bringing to the forefront the need to strike a balance between health objectives and internal market objectives. Member States are immersed in health reforms, some financed with European Funds. Promoting health workforce planning and forecasting would emerge as a necessary action, including improving harmonised information. Drawing in a systematic way on the available information from the European Semester reports may provide some clues to give answers to policymaking concerning health professionals' mobility.

Evolución de la prestación real media en España por edad y sexo (1998-2008) y su repercusión en las proyecciones de gasto sanitario público / Real per capita health spending by age and sex in Spain (1998-2008): changes and effects on public healthcare expenditure projections

Objetivos: Analizar los cambios producidos en la prestación real sanitaria media por edad y sexo durante la década 1998-2008 en España, así como evaluar sus implicaciones en las proyecciones de gasto sanitario público. Métodos: Se estiman perfiles de gasto por persona en términos constantes para la población española, desagregada por sexo y grupos de edad quinquenales para los años 1998, 2003 y 2008, a partir de los datos del Conjunto Mínimo Básico de Datos al alta hospitalaria y de las Encuestas Nacionales de Salud. Una vez elaborados los perfiles y tomando como año base 1998, se comparan las cifras de gasto efectivamente observadas en 2003 y 2008 con las previsiones derivadas de aplicar la metodología de proyección utilizada por el Grupo de Trabajo sobre Envejecimiento de la Unión Europea. Resultados: El crecimiento anual medio de la prestación real por persona en 1998-2008 fue del 2,79%, superior al crecimiento del producto interior bruto per cápita (1,90%), como consecuencia de su elevado ritmo de aumento en la segunda mitad de la década. En 1998-2008, el gasto por persona aumenta en la mayor parte de los grupos de edad, y en particular en los tramos de 45-49, 60-64 y 75 años y más. Las proyecciones de gasto por persona en términos constantes para el año 2003 cubren el valor realmente observado, mientras que para 2008 son inferiores al valor real. Conclusiones: La evolución de la cantidad y de la calidad de los servicios sanitarios que consume cada persona es un factor importante en la evolución del gasto sanitario, que es necesario introducir en el cálculo de proyecciones (AU)

Objectives: To analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections. Methods: Age- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union. Results: The average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008. Conclusions: Changes in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections (AU)

Public healthcare expenditure in Spain: measuring the impact of driving factors.

OBJECTIVES: To assess the impact of demography, health status, death related costs and some macroeconomic variables on the evolution of health expenditure. METHODS: We follow the methodology used by the Ageing Working Group (AWG) of the European Union to simulate expenditure projections on the basis of healthcare expenditure profiles for age-sex population groups. We estimate the profiles using data from Hospital Discharges Statistics and the Spanish National Health Survey. RESULTS: The differences between the compression of morbidity scenario and the expansion of morbidity scenario range from 1.35 to 1.57 points of GDP in 2060. The overestimation of healthcare expenditure when death related costs are ignored ranges from 0.04 to 0.11 percentage points, depending on the health status hypothesis. Moreover, the effect of death related cost diminishes as health status improves. CONCLUSIONS: Our results support the fact that intensity of healthcare use, instead of ageing, is the main driver of health expenditure. Thus, the concern of keeping expenditure under control should be focused on factors such as the population's health status, economic growth and development, new technologies and medical progress, and the organization and management of the healthcare system.

Evaluating the redistributive impact of public health expenditure using an insurance value approach.

This article analyses the redistributive impact of public health expenditure in Spain using an insurance value approach to compute individual and household's value of health services non-cash benefit. We model the intensity of use of different health care services using a count data framework on a nationally representative health care survey and then predict probabilities on the 2006 Spanish EU-SILC sample. This allows us to extend disposable income with the expected monetary value of public health services and to compare it with strictly cash income. Since non-cash income due to public health services is associated with health needs, we use needs-adjusted equivalence scales to perform distributional analysis and poverty/inequality comparisons. The results show that public health expenditure in Spain acts progressively on income distribution, and that health in-kind benefits, once considered as part of disposable income, can be extremely effective in reducing poverty and inequality.

[Real per capita health spending by age and sex in Spain (1998-2008): changes and effects on public healthcare expenditure projections]. / Evolución de la prestación real media en España por edad y sexo (1998-2008) y su repercusión en las proyecciones de gasto sanitario público.

OBJECTIVES: To analyze changes in real per capita spending by age and sex from 1998 to 2008 in Spain, and to assess their effects on public healthcare expenditure projections. METHODS: Age- and sex-related expenditure profiles in constant terms were estimated for the Spanish population for 3 distinct years (1998, 2003 and 2008) by using data from hospital records and several National Health Surveys. These profiles were used to compare actual healthcare expenditure for 2003 and 2008 with the projections obtained by considering 1998 as the base year and by applying the methodology used by the Working Group on Aging of the European Union. RESULTS: The average annual growth rate of real per capita spending per person from 1998 to 2008 was 2.79%, which was higher than the GDP per capita growth rate (1.90%), basically due to its high rate of increase in the second half of the decade. From 1998 to 2008, per capita healthcare expenditure increased in most age groups, particularly in the groups aged 45-49 years, 60-64 years and 75 years and older. Projections of per capita expenditure in constant terms covered the real value observed for 2003, but were below the real value for 2008. CONCLUSIONS: Changes in the quantity and quality of healthcare services consumed by each person are an important factor in changes in healthcare expenditure and must be included in spending projections.

El sistema sanitario y la inmigración en España desde la perspectiva de la política fiscal / Immigration in Spain and the health system: A fiscal policy perspective

La población española ha crecido en los últimos 10 años en más de 6 millones de personas, de las cuales más de las tres cuartas partes son inmigrantes. Aunque en buena medida se trata de un fenómeno de inmigración económica ligado al intenso ritmo de crecimiento de la economía española, los determinantes sociológicos del proceso confieren al colectivo inmigrante un perfil cuya consideración es relevante para la valoración del impacto de la inmigración en el gasto público y en el sistema de protección social. El crecimiento de la población inmigrante, con menor edad media y tasas de natalidad más altas, permite compensar transitoriamente los desequilibrios demográficos del sistema de pensiones. Por otra parte, las características sociológicas y económicas del colectivo determinan demandas específicas al sistema de protección social. La integración de los inmigrantes se ve facilitada por el acceso a los servicios básicos, educación y salud, lo que, por otra parte, pudiera influir positivamente en el flujo migratorio. El rápido crecimiento de la población ha supuesto en el corto plazo una congestión de los servicios sanitarios, especialmente de la atención primaria, como consecuencia de la desigual distribución de los inmigrantes en el territorio. El gasto imputable a los inmigrantes es menos que proporcional a su peso en la población y se concentra en cuatro comunidades autónomas (AU)

The Spanish population has grown by over 6 million people in the last 10 years and immigrants account for 4.5 million of this increase. Although this influx has largely been motivated by economic reasons, stimulated by the sharp growth of the Spanish economy, sociological factors must also be considered to assess the impact of immigration shock on public expenditure and the social welfare system. On the one hand, the demographic growth caused by immigration temporarily balances the pension system, as immigrants have a lower average age and a higher fertility rate. On the other hand, the demographic and economic features of the immigrant community make additional demands on the social welfare system. Universal access to basic public services such as the education and health systems is a crucial asset in the integration policy aimed at the immigrant collective, and compensates for its possible effect as an incentive to immigrate. In the short term, the huge population growth has led to health services’ congestion, especially in primary health care, because of the unequal geographic distribution of immigrants. The health expenditure imputable to immigrants is lower than their share in the total population and is highly concentrated in four autonomous regions (AU)

[Immigration in Spain and the health system: a fiscal policy perspective]. / El sistema sanitario y la inmigración en España desde la perspectiva de la política fiscal.

The Spanish population has grown by over 6 million people in the last 10 years and immigrants account for 4.5 million of this increase. Although this influx has largely been motivated by economic reasons, stimulated by the sharp growth of the Spanish economy, sociological factors must also be considered to assess the impact of immigration shock on public expenditure and the social welfare system. On the one hand, the demographic growth caused by immigration temporarily balances the pension system, as immigrants have a lower average age and a higher fertility rate. On the other hand, the demographic and economic features of the immigrant community make additional demands on the social welfare system. Universal access to basic public services such as the education and health systems is a crucial asset in the integration policy aimed at the immigrant collective, and compensates for its possible effect as an incentive to immigrate. In the short term, the huge population growth has led to health services' congestion, especially in primary health care, because of the unequal geographic distribution of immigrants. The health expenditure imputable to immigrants is lower than their share in the total population and is highly concentrated in four autonomous regions.

El análisis del gasto sanitario en el ámbito de la Conferencia de Presidentes: el Grupo de Trabajo de Análisis del Gasto Sanitario / The analysis of health care cost in the scope of the Presidents' Conference: the Health Care Cost Work Group

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