Austerity, healthcare provision, and health outcomes in Spain.

The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (Q J Econ 115(2):617-650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.

El sistema hospitalario catalán entre 1889 y 1986: el predominio de lo privado sobre lo público / The Catalonian hospital system between 1889 and 1986: the predominance of the private over the public

Este trabajo se centra en el estudio del sistema hospitalario catalán desde la década de 1880 hasta la aprobación de la primera Ley General de Sanidad (1986), ya en el marco democrático. Dentro de este contexto, el estudio trata de analizar las diferencias del modelo hospitalario catalán respecto a otros territorios, sigularidades basadas sobre todo en la importancia de su red hospitalaria privada, que presenta un mayor peso desde el punto de vista histórico que la oferta pública. El estudio determinará los principales factores que han configurado esta diferencia histórica y sus consecuencias sobre la construcción y funcionamiento del sistema hospitalario catalán en el largo plazo

This work focussess on the study of the Catalonian hospital system from the decade of the 1889s to the approval of the first General Law of Halthcare (1986), already within the democratic framework. Within this context, the study tries to analyse the Catalonian hospital system with respect to other territories, peculiarities based above all on the importance of its network of private hospitals, which has more weight historically than the public offer. This study Will determine the primary factors that have mad up this historical difference and their long term consequences on the construction and functioning of the Catloniana hospital system

La extension del seguro de salud en Iberoamérica: una estrategia de política exterior del franquismo en la inmediata posguerra (1942-1959) / The expansión of health insurance in Latin America: a foreign policy strategy of the franco regime in the post-civil war perior (1942-1959)

La dictadura franquista por motivos de estrategia política intentó influir en materia de seguros sociales, en especial en la cobertura de la enfermedad, en los países iberoamericanos durante las décadas de 1940 y 1950. Los resultados de esta colaboración resultaron mediocres en la práctica y produjeron pocos avances reales, al margen de la imitación de las instituciones de gestión y algunos cursos de formación actuarial y estadística. Este fracaso se debió en gran medida al propio atraso y debilidad del modelo de cobertura sanitaria de la dictadura franquista ahogado por un déficit financiero crónico y con graves limitaciones tanto en la cobertura de la población como en las prestaciones ofrecidas. A partir de la década de 1960, una vez superada la etapa de aislamiento y autarquía, las autoridades franquistas redujeron su interés en la estrategia iberoamericana y comenzaron a mirar a Europa (AU)

For reasons of political strategy, the Franco dictatorship sought to have an influence in matters of social insurance, especially sickness coverage, in Latin American countries during the 1940s and 1950s. The results of this collaboration were mediocre in practice and led to little real progress, apart from imitating management institutions and some actuarial and statistical training courses. This failure was due to a large extent to the backwardness and weakness of the Franco dictatorship’s own model of health care provision, stifled by a chronic financial deficit and with serious shortcomings in both coverage of the population and provisions offered. Beginning in the 1960s, once the stage of isolation and autarky was overcome, the Francoist authorities reduced their interest in the Latin American strategy and started to look towards Europe (AU)