Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer / Diferencias en la valoración económica y factores determinantes del cuidado informal a lo largo del tiempo: el caso de las neoplasias hematológicas

Objective: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. Methods: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. Results: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 Euros/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. Conclusions: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients

Objetivo: Estimar los factores sociodemográficos y clínicos asociados al cuidado informal a lo largo de las diferentes etapas del tratamiento y su valoración económica en pacientes con neoplasia hematológica. Métodos: 139 pacientes oncohematológicos que recibieron un trasplante de células madre respondieron un cuestionario longitudinal basado en tres fases del tratamiento: corto, medio y largo plazo. Los cuidados informales recibidos se valoraron económicamente mediante los métodos del bien más próximo y coste de oportunidad. Se estimaron modelos de regresión logística ordenada y binaria para identificar factores asociados al cuidado informal. Resultados: 123 pacientes recibieron cuidado informal, con una reducción progresiva del número de horas a lo largo del tiempo. El valor monetario del cuidado informal recibido por paciente fue de 1288-3409 Euros, 1045-2786 Euros y 336-854 Euros/mes en el corto, medio y largo plazo, respectivamente. Los/las pacientes con leucemia aguda y los/las que recibieron un trasplante alogénico no emparentado tuvieron un 22% (corto plazo) y un 33,5% (medio plazo) más probabilidad de recibir >8 horas al día de cuidado respecto a los/las pacientes diagnosticados/as de linfoma y trasplante autólogo. A largo plazo, los/las pacientes con mieloma múltiple fueron más proclives a recibir más atención. Un mejor estado de salud y un mayor nivel de estudios se asociaron a menos horas diarias de cuidado. Conclusiones: Existe gran variación en el tiempo, el valor monetario y los factores asociados al cuidado informal en pacientes con neoplasia hematológica a lo largo de las distintas etapas del tratamiento

Gasto público y salud en el mundo, 1990-2012 / A Public expenditure and world's health, 1990-2012

Introducción: La evidencia empírica dispar relacionada con el efecto del gasto público en materia sanitaria puede deberse a las importantes variaciones metodológicas de los estudios y a las diferencias significativas en la forma en que el gasto público influye dependiendo del nivel de desarrollo de los países. Objetivo: Determinar la relación entre el gasto público total del Gobierno general y la mortalidad infantil y la esperanza de vida. Métodos: Investigación realizada en una muestra de 78 países segmentada por niveles de renta, desde 1990 hasta 2012. Se constituyeron cinco submuestras de países divididos por su nivel de renta mediante un procedimiento de agrupación no jerárquico de k-medias. Se verificó la procedencia de la segmentación mediante el test de Chow. Para cada una de las submuestras construidas, se estimó el modelo correspondiente por mínimos cuadrados generales lineales y un test de cointegración. Resultados: En las submuestras superiores en nivel de renta, la salud se relacionó significativa y consistentemente con el gasto público. Sin embargo, en los países de renta inferior-baja, el coeficiente del gasto presentó un signo contrario al esperado. Conclusiones: Se demuestra un impacto positivo y de largo plazo entre el gasto público y la situación sanitaria. Sin embargo, para los países de menor renta, este parece haber superado su punto óptimo, lo que indicaría su ineficiencia en términos sanitarios. Se conjetura que lo anterior se debe a la baja capacidad institucional de estos países, lo que impide que un mayor gasto obtenga mejores resultados sanitarios(AU)

Introduction: The disparate empirical evidence related with the effect of public expenditure on health may be due to the significant methodological variations of the studies, as well as the significant differences in the way in which public expenditure influences depending on the level of development of the countries. Objective: To determine the relation among the total public expenditure of the General Government, and infant mortality and life expectancy. Methods: Research project carried out with a sample of 78 countries segmented by income levels from 1990 to 2012. By means of a non - hierarchical grouping of k - media, five sub-samples of countries were formed and divided by their income level. The origin of the segmentation was verified by means of the Chow test. Linear GLS and a cointegration test were applied on each subsample. Results: In the upper subsamples at the income level, health was significantly and consistently related to public expenditure. However, in the lower-low income countries, the expenditure coefficient showed a sign opposite to that expected. Conclusions: There is evidence of a positive and long-term impact among public expenditure and the health situation. However, for lower income countries, this seems to have surpassed its optimum point, which would indicate its inefficiency in sanitary terms. It is conjectured that this is due to the low institutional capacity of these countries, which hampers that greater expenditure obtains better sanitary results(AU)

Gasto público y salud en el mundo, 1990-2012 / A Public expenditure and world's health, 1990-2012

Introducción: La evidencia empírica dispar relacionada con el efecto del gasto público en materia sanitaria puede deberse a las importantes variaciones metodológicas de los estudios y a las diferencias significativas en la forma en que el gasto público influye dependiendo del nivel de desarrollo de los países. Objetivo: Determinar la relación entre el gasto público total del Gobierno general y la mortalidad infantil y la esperanza de vida. Métodos: Investigación realizada en una muestra de 78 países segmentada por niveles de renta, desde 1990 hasta 2012. Se constituyeron cinco submuestras de países divididos por su nivel de renta mediante un procedimiento de agrupación no jerárquico de k-medias. Se verificó la procedencia de la segmentación mediante el test de Chow. Para cada una de las submuestras construidas, se estimó el modelo correspondiente por mínimos cuadrados generales lineales y un test de cointegración. Resultados: En las submuestras superiores en nivel de renta, la salud se relacionó significativa y consistentemente con el gasto público. Sin embargo, en los países de renta inferior-baja, el coeficiente del gasto presentó un signo contrario al esperado. Conclusiones: Se demuestra un impacto positivo y de largo plazo entre el gasto público y la situación sanitaria. Sin embargo, para los países de menor renta, este parece haber superado su punto óptimo, lo que indicaría su ineficiencia en términos sanitarios. Se conjetura que lo anterior se debe a la baja capacidad institucional de estos países, lo que impide que un mayor gasto obtenga mejores resultados sanitarios(AU)

Introduction: The disparate empirical evidence related with the effect of public expenditure on health may be due to the significant methodological variations of the studies, as well as the significant differences in the way in which public expenditure influences depending on the level of development of the countries. Objective: To determine the relation among the total public expenditure of the General Government, and infant mortality and life expectancy. Methods: Research project carried out with a sample of 78 countries segmented by income levels from 1990 to 2012. By means of a non - hierarchical grouping of k - media, five sub-samples of countries were formed and divided by their income level. The origin of the segmentation was verified by means of the Chow test. Linear GLS and a cointegration test were applied on each subsample. Results: In the upper subsamples at the income level, health was significantly and consistently related to public expenditure. However, in the lower-low income countries, the expenditure coefficient showed a sign opposite to that expected. Conclusions: There is evidence of a positive and long-term impact among public expenditure and the health situation. However, for lower income countries, this seems to have surpassed its optimum point, which would indicate its inefficiency in sanitary terms. It is conjectured that this is due to the low institutional capacity of these countries, which hampers that greater expenditure obtains better sanitary results(AU)

Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer.

OBJECTIVE: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. METHODS: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. RESULTS: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 €/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. CONCLUSIONS: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients.

[Sociodemographic and Clinical Factors Associated with Informal Care in Hematologic Malignancy Patients: a Study Based on Different Phases of the Treatment, Spain]. / Factores sociodemográficos y clínicos asociados a la recepción de cuidado informal en pacientes con neoplasia hematológica: estudio basado en las diferentes etapas del tratamiento.

BACKGROUND: There is little information on factors related to use of to informal care in cancer patients. Our objective is to study sociodemographic and clinical factors associated with use of informal care in patients with hematologic malignancy and analyze how these changes throughout different phases of the treatment. METHODS: 139 patients diagnosed with hematologic malignancy who received an haematopoietic stem cell transplantation between 2006-2011 in two Spanish hospitals completed the developed postal questionnaire. A binary logistic regression model was used to analyse the factors associated with use of informal care each of four phases of the treatment (pretransplant, first year, second and third year, and from the fouth to sixth year postransplant). Dependent variable was receive vs. not receive informal care. RESULTS: Patients diagnosed with acute leukemia had higher probability of receiving informal care during pretransplant period (OR = 6.394) and during the second and third year postransplantation (OR = 42.212). In the long-term (4-6 years), multiple myeloma patients were the ones who required more informal care (OR = 15.977). Health status was statistically significant during all phases. Being male (OR = 0.263), having partner (OR = 0.137) and being employed (OR = 0.110) were associated with lower likelihood of receiving informal care in the long-term. CONCLUSIONS: Over 75% of patients diagnosed with hematologic malignancy received informal care during pretrasplant and first year postransplant. Type of diagnosis and health status are decisive factors in the probability of receiving informal care at all phases, while the type of transplantation is not. Sociodemografic factors are relevant in the long-term.

Factores sociodemográficos y clínicos asociados a la recepción de cuidado informal en pacientes con neoplasia hematológica: Estudio basado en las diferentes etapas del tratamiento / Sociodemographic and clinical factors associated with informal care in hematologic malignancy patients: a study based on different phases of the treatment, Spain

Fundamentos: Los factores relacionados con la recepción de cuidado informal (CI) en pacientes oncológicos es una cuestión poco estudiada. El objetivo fue analizar los factores sociodemográficos y clínicos asociados a la recepción de cuidado informal en pacientes con neoplasia hematológica a lo largo de las diferentes etapas del tratamiento. Métodos: 139 pacientes diagnosticados de neoplasia hematológica que recibieron un trasplante de células madre durante el período 2006-2011 en dos centros sanitarios españoles completaron la encuesta elaborada para el estudio. Se estimó un modelo de regresión logística binaria para cada una de las cuatro etapas de tratamiento: pretrasplante, primer año, segundo y tercer año, cuarto al sexto año postrasplante. La variable dependiente fue recibir o no cuidado informal. Resultados: Pacientes diagnosticados de leucemia aguda presentaron mayor probabilidad de recibir CI durante la etapa pretrasplante (OR=6,394) y durante el segundo y tercer año postrasplante (OR=42,212). A largo plazo (4º-6º año) los pacientes con mieloma múltiple fueron los que requirieron mayor cuidado (OR=15,977). El estado de salud fue estadísticamente significativo en la mayoría de las etapas. Ser hombre (OR=0,263), tener pareja (OR=0,137) y estar empleado (OR=0,110) se asociaron a una menor probabilidad de recibir CI a largo plazo. Conclusiones: El CI está presente en más del 75% de los pacientes con neoplasia hematológica durante la etapa pretrasplante y primer año postrasplante. El diagnóstico y estado de salud son decisivos en la probabilidad de recibirlo, pero no el tipo de trasplante. Los factores sociodemográficos cobran protagonismo a largo plazo (AU)

Background: There is little information on factors related to use of to informal care in cancer patients. Our objective is to study sociodemographic and clinical factors associated with use of informal care in patients with hematologic malignancy and analyze how these changes throughout different phases of the treatment. Methods: 139 patients diagnosed with hematologic malignancy who received an haematopoietic stem cell transplantation between 2006-2011 in two Spanish hospitals completed the developed postal questionnaire. A binary logistic regression model was used to analyse the factors associated with use of informal care each of four phases of the treatment (pretransplant, first year, second and third year, and from the fouth to sixth year postransplant). Dependent variable was receive vs. not receive informal care. Results: Patients diagnosed with acute leukemia had higher probability of receiving informal care during pretransplant period (OR=6.394) and during the second and third year postransplantation (OR=42.212). In the long-term (4-6 years), multiple myeloma patients were the ones who required more informal care (OR=15.977). Health status was statistically significant during all phases. Being male (OR=0.263), having partner (OR=0.137) and being employed (OR=0.110) were associated with lower likelihood of receiving informal care in the long-term. Conclusions: Over 75% of patients diagnosed with hematologic malignancy received informal care during pretrasplant and first year postransplant. Type of diagnosis and health status are decisive factors in the probability of receiving informal care at all phases, while the type of transplantation is not. Sociodemografic factors are relevant in the long-term (AU)

La financiación del nivel acordado de la Ley de Dependencia: el coste de una evolución hacia variables reales de dependencia / Level of funding in the Long-Term Care Law: the cost of moving toward real dependency variables

Introducción: El Sistema para la Autonomía y Atención a la Dependencia que establece la Ley 39/2006 se financia, además de con las aportaciones particulares de los dependientes, mediante transferencias finalistas en tres fondos principales: un nivel mínimo, un nivel acordado y otras aportaciones adicionales voluntarias por parte de las propias comunidades autónomas. Los recursos que aporta el estado al nivel acordado se están distribuyendo, entre otras variables de menor relevancia, en función de la población potencialmente dependiente, y en menor medida en función de la población dependiente ya evaluada. Objetivo: Puesto que el concepto de lo que se considera población dependiente ha ido modificándose, pasando de ser la población potencialmente dependiente según una estimación (dependientes estimados) a ser el número real de dependientes reconocidos (dependientes declarados), algunas comunidades autónomas han podido tener déficit o superávit de financiación. Métodos. Se ha comparado la distribución realizada para el periodo 2007-2011 más otra estimada para 2012, en la cual computan los dependientes estimados, con una alternativa donde dependientes declarados ponderen una medida similar a la que entrará en vigor en 2013. Resultados: Durante el periodo de 2007 a 2011, aquellas comunidades autónomas en que la cifra de dependientes declarados ha sido superior a la de dependientes estimados han sufrido un déficit de financiación (en el caso de Andalucía se superan los 100 millones de euros). Por el contrario, aquellas otras en que los dependientes estimados han sido más que los evaluados han resultado beneficiadas por el actual sistema de distribución (es el caso de Madrid y la Comunidad Valenciana, con un superávit de 49 y 37 millones de euros, respectivamente). Conclusiones: Se aprecia una amplia heterogeneidad en la financiación pública del nivel acordado en términos de población dependiente declarada que, entre otras consecuencias no menos graves, puede lastrar la implantación de la Ley de Dependencia en las comunidades autónomas deficitarias (AU)

Introduction: The system for the Promotion of Personal Autonomy and Care of Dependent Persons established by Act 39/2006 is funded through private contributions of dependent individuals and earmarked transfers in three main funds: a minimum level, an agreed level distributed among the various autonomous regions according to their relative needs, and a further voluntary additional contribution by Spain's autonomous regions. The resources distributed by the state to the regions are assigned, among other less important variables, according to the potentially dependent population and, to a lesser extent, according to the population already evaluated as dependent. Objective: Because the concept of what constitutes disability has changed over the years from the population potentially dependent according to an estimate (estimated dependent individuals) to the actual number of dependent individuals recognized as such (declared dependent), some autonomous regions may have been overfunded or underfunded. Methods: The funding obtained by the autonomous regions each year from 2007 to 2011 was compared with the funding that would have been assigned to each region if, since 2007, the variables and weighting that will be representative of the funding needs for 2013 (distribution mainly according to declared dependent individuals) had been taken into account. Results: From 2007-2011, regions where declared dependent persons outnumbered estimated disabled persons were underfunded (in Andalusia by more than 100 million euros). In contrast, regions where the situation was reversed were overfunded (by 49 million euros in Madrid and 37 million euros in the region of Valencia). Conclusions: There is wide variation in public funding to the autonomous regions, depending on the number of individuals declared as dependent. Among other no less serious consequences, this situation could hamper the implantation of the Promotion of Personal Autonomy and Care of Dependent Persons Act in underfunded regions (AU)

[Level of funding in the Long-Term Care Law: the cost of moving toward real dependency variables]. / La financiación del nivel acordado de la Ley de Dependencia: el coste de una evolución hacia variables reales de dependencia.

INTRODUCTION: The system for the Promotion of Personal Autonomy and Care of Dependent Persons established by Act 39/2006 is funded through private contributions of dependent individuals and earmarked transfers in three main funds: a minimum level, an agreed level distributed among the various autonomous regions according to their relative needs, and a further voluntary additional contribution by Spain's autonomous regions. The resources distributed by the state to the regions are assigned, among other less important variables, according to the potentially dependent population and, to a lesser extent, according to the population already evaluated as dependent. OBJECTIVE: Because the concept of what constitutes disability has changed over the years from the population potentially dependent according to an estimate (estimated dependent individuals) to the actual number of dependent individuals recognized as such (declared dependent), some autonomous regions may have been overfunded or underfunded. METHODS: The funding obtained by the autonomous regions each year from 2007 to 2011 was compared with the funding that would have been assigned to each region if, since 2007, the variables and weighting that will be representative of the funding needs for 2013 (distribution mainly according to declared dependent individuals) had been taken into account. RESULTS: From 2007-2011, regions where declared dependent persons outnumbered estimated disabled persons were underfunded (in Andalusia by more than 100 million euros). In contrast, regions where the situation was reversed were overfunded (by 49 million euros in Madrid and 37 million euros in the region of Valencia). CONCLUSIONS: There is wide variation in public funding to the autonomous regions, depending on the number of individuals declared as dependent. Among other no less serious consequences, this situation could hamper the implantation of the Promotion of Personal Autonomy and Care of Dependent Persons Act in underfunded regions.

Estimation of an index of regional health needs in Spain using count regression models with filter.

The aim of this study is to obtain a measure of health needs at regional level, on the basis of information provided by the health module of the Survey of Disabilities, Deficiencies and State of Health, 1999 (SDDSH99). The methodology includes a careful selection of the independent variables and both estimations as tests of alternative regression models. The results show that, in the five analysed use dimensions, important differences exist in the clinical practice for a same health necessity (horizontal inequity) in function of the residence area. Nevertheless, the main results and conclusions indicate that, as the framework of analysis is broadened, adding different healthcare services, and as the population size of the region is increased, the relative healthcare needs converge to the percentage of population of each region.

Decentralisation and convergence in health among the provinces of Spain (1980-2001).

This study measures the process of convergence in the state of health among the provinces and regions of Spain during 1980-2001 in order to analyse the possible influence of the decentralisation of healthcare management to the regions in this period. Sigma and beta convergence models, traditionally employed in macroeconomics, have been used, taking Life Expectancy at Birth (LEB) and Infant Mortality (IM) as health indicators. The analysis was carried out at two territorial levels: provinces and regions. The results reveal that the process of decentralisation either does not affect convergence or leads to divergence in health. Indeed, in the case of IM the so-called change of role scenario seems to have occurred. Thus, certain provinces with initially poor indicators have improved, overtaking those that were originally in a better position. The final result, however, is of greater dispersion than initially.