New forms of management and their impact on health inequalities

In recent years in Spain the system of health foundations has been favoured among the so-called new ways of management, as a mechanism to increase the efficiency of public health centers. The purpose of our research is to compare the running of health foundations with hospitals managed in the traditional way who attend a population with similar characteristics. From the comparison between the two types of centers it has been deduced that foundations have less staff in all the categories (doctors, nurses, etc.), and offer fewer beds and operating theatres/1000 inhabitants. The numbers of admissions, surgical operations, emergencies services, and medical consultations/1000 inhabitants are all lower in the foundations, although only the latter case has statistical significance. Also, waiting lists for surgery are longer, and expenditure/1000 inhabitants per year is lower, in both cases statistically significant. From all this it has been deduced that the foundations spend less per inhabitant because they offer fewer health services to the reference population, something which creates access problems and is a source of inequality. The foundations exhibit a notable lack of transparency, which has limited the variables available for study and has made it difficult to carry out an investigation of quality between the two models.