[The challenges of human resources governance in public healthcare. SESPAS Report 2024]. / Los retos de la gobernanza de los recursos humanos de la sanidad pública. Informe SESPAS 2024.

Recurrent imbalances between supply, demand and personnel needs are one of the main challenges facing the National Health System (NHS). This situation has its origin both in supply factors and in the conditioning factors of the demand for human resources in the public health sector. The demographic structure of the NHS health professionals is generating an increasing number of outflows of doctors and nurses. On the other hand, the complex institutional architecture of the public health system produces dysfunctions in the structure of demand and in the form of recruitment. This paper argues for the need to articulate a strategic response that addresses the improvement of the governance of the human resources of the NHS and the reform of the instruments of coordination and harmonization of actions at the three levels of government of public healthcare.

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.