The effects of the financial crisis and austerity measures on the Spanish health care system: A qualitative analysis of health professionals’ perceptions in the region of Valencia

The recent financial crisis has seen severe austerity measures imposed on the Spanish health care system. However, the impacts are not yet well documented. We describe the findings from a qualitative study that explored health care professionals’ perception of the effects of austerity measures in the Spanish Autonomous Community of Valencia. A total of 21 semi-structured interviews were conducted with health professionals, recorded and fully transcribed. We coded all interviews using an inductive approach, drawing on techniques used in the constant comparative method. Health professionals reported increases in mental health conditions and malnutrition linked to a loss of income from employment and cuts to social support services. Health care professionals perceived that the quality of health care had become worse and health outcomes had deteriorated as a result of austerity measures. Interviewees also suggested that increased copayments meant that a growing number of patients could not afford necessary medication. While a few supported reforms and policies, such as the increase in copayments for pharmaceuticals, most opposed the privatization of health care facilities, and the newly introduced Royal Decree-law 16/2012, particularly the exclusion of non-residents from the health care system. The prevailing perception is that austerity measures are having negative effects on the quality of the health care system and population health. In light of this evidence there is an urgent need to evaluate the austerity measures recently introduced and to consider alternatives such as the derogation of the Royal Decree-law 16/2012.     

Patient mobility in the context of austerity and an enlarged EU: The European Court of Justice's ruling in the Petru Case

Since 1998, the European Court of Justice (EUCJ) has established a set of principles concerning patient mobility across Member States. At present, these principles are challenged against a new background, i.e., an enlarged EU and austerity-driven measures in the field of healthcare. This is even more relevant in view of the significant differences between countries and between services on healthcare access. In the Petru case, a Romanian woman sought healthcare in Germany due to an alleged lack of basic infrastructure in her local Romanian hospital. A crucial question arises in this context of whether the patient′s interests (i.e., right to cross-border healthcare) or the Member State′s interests (i.e., financial stability of the healthcare system) prevail. We analyse this case and its implications for future patient mobility. From the point of view of patients, the EUCJ′s decision implies that also a lack of medication and basic medical supplies can be claimed as “undue delay”, however for Member States it is sufficient to provide quality treatments in at least one hospital. Although the Court has provided a solution for the Petru case, we argue that major challenges remain, such as the definition of the international state-of-the-art or other limitations to reductions of the health basket.     

The resistance of nurses to austerity measures in the health sector during the financial crisis in Spain

ObjectiveThis study explores nurses’ perspectives on how the financial crisis and austerity measures introduced in the Spanish Health System affected their ability to provide care in these new circumstancesMethodCross-sectional observational study. In 2013, during an international annual congress in Spain, 123 nurses out of a total of 350 attendees completed a 14-item open-ended response questionnaire to examine the perceived impact of the financial crisis and austerity measures on quality of services and their experiences at work.Results84% of the sample were women and the mean age of the respondents was 40 (standard deviation: 11.13). Seventy-seven percent of the nurses reported austerity measures introduced in their workplace. The nurses voiced strong disagreement with austerity measures (86%), due to the negative repercussions on nurses’ working conditions (47%), a decrease in human resources (37%), negative effects such as work overload (37%); a perceived deterioration in the quality of healthcare (77%) and pharmaceutical services (86%); and worsening conditions in access to health services by vulnerable populations (43%), leading to ethical dilemmas in clinical practice (26%).ConclusionThis study showed that nurses participating in this study overwhelmingly opposed austerity measures imposed on the National Health System as a response to the financial crisis, which had a negative effect both on nurses’ working conditions and on the quality of health services. Institutional measures to improve recruitment and retention of nurses including policies for preventing stress and burnout, a decrease of patient-nurse ratio, and greater work stability should be considered.     

Indicators of health system coverage and activity in Ireland during the economic crisis 2008–2014 – From ‘more with less’ to ‘less with less’

A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s.     

Deterioration,drift, distraction,and denial: How the politics of austerity challenges the resilience of prison health governance and delivery in England

Extant scholarship has demonstrated that macroeconomic austerity disproportionately harms marginalised end-users. Its impact on the governance and delivery of health provisions on such individuals, however, has received less attention. Drawing on interviews with 27 policy elites involved with England’s prison health policy, interviewees perceive that austerity policies have shaped and constrained the prison health system through the politics of deterioration, drift, distraction, and denial. The deterioration of the prison workforce size has been linked to diminished prisoner access to healthcare, attendant with an increased number of riots, assaults, acts of self-harm, and suicides. Concurrently, the microeconomic structure of organised crime is filling the void in prison governance, thus conducing to heightened abuse of psychoactive substances, as well as a surge in associated medical emergencies and violence. Successful prosecution of prior sexual offences, continued incarceration of those imprisoned for indeterminate sentences, and harsh sentencing practices have created policy drift, unremitting overcrowding, and reinforced excessive dependency on prison healthcare resources. The rapid turnover of justice ministers and intensified push for prison privatisation have enabled widespread distraction. Moreover, despite well-documented crises besetting English prisons, politicians seemingly remain in a state of denial. Preventive imprisonment, recurrent spending, and enhanced financial and political accountability measures are necessary to mitigate the effects of austerity and germane policies fomenting inimical impacts on England’s prison health system.     

政治经济紧缩与卫生服务——基于1995—2011年27个欧洲国家费用变化的跨国分析

在经济衰退期间卫生支出为何呈现出多样化？本文采用1995—2011年27个欧洲国家的数据,对可能引起卫生支出变化的政治、经济和卫生体系等关键因素进行评估。纠正之前存在的时间趋势,采用随机效应模型和固定效应模型对2013年欧盟统计局、国际货币基金组织和世界银行的数据进行了测量和评估。研究发现,政府卫生支出的削减与经济衰退的程度关系不大;执政党的意识形态也不会对政府卫生支出产生很大影响。相反,税收每减少100美元,卫生支出将减少2.72美元。在控制可能的混淆因素后,国际货币基金组织贷款国家比非贷款国家更有可能削减政府卫生支出。在欧盟成员国中,与经济条件和政党意识形态等因素相比,向国际金融机构贷款、税收减少以及实施削减政策等可能更会导致政府卫生支出的削减。     

Health policy making under information constraints: An evaluation of the policy responses to the economic crisis in Greece

Introduction

Cost consolidation in the highly fragmented and inefficient Greek health care system was necessary. However, policies introduced were partly formed in a context of insufficient information. Expenditure data from a consumption point of view were lacking and the depth of the political and structural problems was of unknown magnitude to the supervisory authorities.

Methods

Drawing upon relevant literature and evidence from the newly implemented OECD System of Health Accounts, the paper evaluates the health policy responses to the economic crisis in Greece. The discussion and recommendations are also of interest to other countries where data sources are not reliable or decisions are based on preliminary data and projections.

Results

Between 2009 and 2012, across-the-board cuts have resulted in a decline in public health expenditure for inpatient care by 8.6%, for pharmaceuticals by 42.3% and for outpatient care by 34.6%. Further cuts are expected from the ongoing reforms but more structural changes are needed.

Conclusion

Cost-containment was not well targeted and expenditure cuts were not always addressed to the real reasons of the pre-crisis cost explosion. Policy responses were restricted to quick and easy fiscal adjustment, ignoring the need for substantial structural reforms or individuals’ right to access health care irrespective of their financial capacity. Developing appropriate information infrastructure, restructuring and consolidating the hospital sector and moving toward a tax-based national health insurance could offer valuable benefits to the system.