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Exploring the pathways of inequality in health, access and financing in decentralised Spain

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The extent to which equality in accessing and financing health care reduces inequalities in health is a key policy question for health-care reform. Cross-country studies, when they exist, suffer from marked comparability limitations due to data heterogeneity and differences between organisational and financing systems. The Spanish devolved national health system offers a “unique field” for exploring these issues, and also for testing the effects of institutional reform, in the context of political decentralisation. This study uses data from 2001, the last year before decentralisation was extended to all regional governments or Autonomous Communities (ACs) in Spain. This Working Paper contributes to the literature by examining two questions. First, we evaluate the heterogeneity within regional inequalities in health, health-care access and health financing and examine whether these are associated with the political decentralisation of health care responsibilities. Second, we explore whether inequalities in health care between regional health services can be explained by inequalities in health-care use and health-care financing, using cross-correlation analysis along with other relevant variables. The results of the study suggest that inequalities in health are not associated with the regional uptake of health-care responsibilities. Instead they appear to be driven by income inequalities and regional health care capacity whilst the influence of inequalities in health-care use depends on quality of life adjustments.

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en

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application/pdf

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http://eprints.lse.ac.uk/28790/1/LSEHWP9.pdf

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