El copago farmacéutico en España tras la reforma del año 2012 desde la perspectiva del usuario. ¿Evidencias de inequidad? / Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?

Objetivo: Identificar cuáles son las características que se asocian con aquella parte de la población que manifiesta no poder comprar todos los medicamentos recetados por un médico de la sanidad pública, relacionándolas con los criterios que definen el sistema de copago farmacéutico fijado por el Real Decreto 16/2012, con la finalidad de orientar cambios que eliminen posibles inequidades. Método: Estudio de asociación y relación causal entre la dificultad para comprar medicamentos recetados por la sanidad publica que manifiestan los usuarios a través de la encuesta Barómetro Sanitario y un conjunto de variables que reflejan la capacidad económica, el nivel de necesidad de servicios de salud y que, a su vez, forman parte de los criterios de copago, mediante técnicas de análisis de correspondencias múltiples y de regresión. Resultados: Tras el análisis de las oleadas correspondientes a los años 2013-2017 se ha encontrado evidencia a favor de la hipótesis de que los usuarios más pobres, los activos y los de peor salud manifiestan mayores dificultades para acceder a los medicamentos que les han sido recetados por un médico de la sanidad pública. Conclusiones: Los resultados son compatibles con la hipótesis de que el copago actual es percibido como una barrera de acceso a medicamentos necesarios por parte de algunos sectores de la población. Aunque del trabajo pueden derivarse ciertas acciones dirigidas a reducir dicha barrera, es necesario realizar más investigación que tenga en cuenta la opinión de los usuarios. (AU)

Objective: Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. Method: Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. Results: After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. Conclusions: The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed. (AU)

[Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?] / El copago farmacéutico en España tras la reforma del año 2012 desde la perspectiva del usuario. ¿Evidencias de inequidad?

OBJECTIVE: Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. METHOD: Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. RESULTS: After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. CONCLUSIONS: The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed.

Differences in healthcare utilisation between users and non-users of homeopathic products in Spain: Results from three waves of the National Health Survey (2011-2017).

OBJECTIVE: To compare the differences in the use of healthcare services: visits to the doctor and hospitalisation, performance of routine tests, and preventive influenza vaccination, between users and non-users of homeopathic products. METHODS: We used the microdata for adults over 15 years old from three waves of the Spanish National Health Survey, corresponding to the years 2011, 2014 and 2017. We proposed a comparative design of a quasi-experimental type, considering as the treatment group the respondents who said that they had used homeopathic products in the past two weeks; and another group, for control, comprising respondents who said that they had not used this type of products, but only conventional medicines, with observable characteristics similar to those of the treatment group. We used a model for rare events logistics regression (relogit) to estimate the probability of using homeopathy. From the propensity score and a vector of control variables, we used techniques of genetic matching to match individuals from the treatment group with similar individuals belonging to the control group. RESULTS: There are no statistically significant differences between users and non-users of homeopathy in visits to the general practitioner (P>|z| 0.387), to the specialist (P>|z| 0.52), in hospitalisations (P>|z| 0.592) or in the use of emergency services (P>|z| 0.109). Nor were there any statistically significant differences in the performance of routine tests, except for the faecal occult blood test, which is more prevalent in users of homeopathic products. 20.9% of users of homeopathy had done this test compared with 15.3% of non-users (P>|z| 0.022). There are also significant differences in vaccination against influenza with 12.6% of homeopathy users stating that they had been vaccinated in the last influenza campaign, against 21.0% of non-users (P>|z| <0.001). The health conditions which homeopathy users reported were constipation (OR: 1.65 CI: 1.16-2.36), malignant tumour (OR: 1.60 CI: 1.09-2.36) osteoporosis (OR: 1.49 CI: 1.05-2.10), varicose veins (OR: 1.35 CI: 1.05-1.74) and allergy (OR: 1.35 CI: 1.06-1.72). CONCLUSIONS: Differences in the use of healthcare resources between users and non-users of homeopathic products have not been found to be statistically significant in Spain. It has been shown that most homeopathic products are used as a complement to treatment with conventional medicine. Nevertheless, our results highlight some warning signs which should raise the attention of healthcare authorities. The use of these therapies in patients with malignant tumours and the rejection of vaccines are warning signs of a possible health hazard in the long term.

Effect of Tourism Pressure on the Mediterranean Diet Pattern.

Despite proposed conceptual frameworks of eating behaviors, little is known about environmental factors contributing to changes in food habits. Few studies have reported the external influence of tourism on the inhabitants' eating patterns. The present study aimed to investigate whether tourism pressure affects Canary Islands inhabitants' adherence to the Mediterranean diet pattern. Data were obtained from a health and lifestyle population-based survey conducted in 2009 and 2015. From the reported intake frequency, a Mediterranean diet score was defined (0 to 11 points). Tourist overnight stays, which were stratified by nationality and area of destination, were used as a proxy variable to measure tourism pressure. A multilevel linear regression analysis by restricted maximum likelihood estimation was performed to examine the relationship between tourism pressure and the Mediterranean diet score. A significant negative association between the Mediterranean diet score and British tourism pressure was observed (ß = -0.0064, p = 0.010), whereas German tourism pressure increased inhabitants' adherence (ß = 0.0092, p = 0.042). The socioeconomic level of tourists seems to play a role in differences in the tourism pressure effect by nationality. Further investigation of other highly touristic destinations is needed to confirm these findings that could contribute to a shift in tourism and public health nutrition policies.

Unconditional quantile regressions to determine the social gradient of obesity in Spain 1993-2014.

BACKGROUND: There is a well-documented social gradient in obesity in most developed countries. Many previous studies have conventionally categorised individuals according to their body mass index (BMI), focusing on those above a certain threshold and thus ignoring a large amount of the BMI distribution. Others have used linear BMI models, relying on mean effects that may mask substantial heterogeneity in the effects of socioeconomic variables across the population. METHOD: In this study, we measure the social gradient of the BMI distribution of the adult population in Spain over the past two decades (1993-2014), using unconditional quantile regressions. We use three socioeconomic variables (education, income and social class) and evaluate differences in the corresponding effects on different percentiles of the log-transformed BMI distribution. Quantile regression methods have the advantage of estimating the socioeconomic effect across the whole BMI distribution allowing for this potential heterogeneity. RESULTS: The results showed a large and increasing social gradient in obesity in Spain, especially among females. There is, however, a large degree of heterogeneity in the socioeconomic effect across the BMI distribution, with patterns that vary according to the socioeconomic indicator under study. While the income and educational gradient is greater at the end of the BMI distribution, the main impact of social class is around the median BMI values. A steeper social gradient is observed with respect to educational level rather than household income or social class. CONCLUSION: The findings of this study emphasise the heterogeneous nature of the relationship between social factors and obesity across the BMI distribution as a whole. Quantile regression methods might provide a more suitable framework for exploring the complex socioeconomic gradient of obesity.

[The economic implications of interventions to prevent obesity]. / El trasfondo económico de las intervenciones sanitarias en la prevención de la obesidad.

In spite of methodological, organizational and economical difficulties, it is necessary to evaluate the cost-effectiveness of obesity prevention policies and the resources that society allocates to fighting this epidemic. This paper reviews the economic reasoning behind these policies and presents a review of the scientific literature on the economic burden of disease and on the cost-effectiveness of individual and community interventions to prevent obesity.

El trasfondo económico de las intervenciones sanitarias en la prevención de la obesidad / The economic implications of interventions to prevent obesity

Aunque hay dificultades metodológicas, organizativas y económicas para evaluar el coste-efectividad de las políticas contra la obesidad, es necesario conocer la rentabilidad social de los recursos que la sociedad destina a afrontar la epidemia. Este artículo revisa de forma ordenada los argumentos económicos relacionados con dichas políticas, y presenta una revisión de la literatura sobre los costes macro de la enfermedad y sobre la efectividad y el coste-efectividad de las intervenciones individuales y comunitarias contra la obesidad (AU)

In spite of methodological, organizational and economical difficulties, it is necessary to evaluate the cost-effectiveness of obesity prevention policies and the resources that society allocates to fighting this epidemic. This paper reviews the economic reasoning behind these policies and presents a review of the scientific literature on the economic burden of disease and on the cost-effectiveness of individual and community interventions to prevent obesity (AU)