Suchergebnisse

Se exponen unas reflexiones acerca de lo que son hoy y pueden ser en el futuro los marcos regulatorios para el sector del medicamento. Éste es un sector que se mueve en las coordenadas del esfuerzo innovador a largo plazo y de la limitación del gasto en el corto. Lejos de contar con un marco estable, el farmacéutico ha devenido un ámbito poliédrico y controvertido como el que más. Desde el análisis económico y la mirada subjetiva de la experiencia «tal como lo veo», se perfilan algunas oportunidades a partir del gran reto que implica la descentralización y se derivan algunas prescripciones de política sanitaria. Aunque no hay futuros ciertos, la idea fundamental es que la descentralización sanitaria territorial y de proveedores puede ser parte de la solución y no el problema en sí para nuestro sistema de salud, tal como ha funcionado hasta ahora. ; The paper comments on present and future scenarios for the pharmaceutical sector in Spain, framed a highly regulated system. So far the drug industry has evolved under the short term public financial constraints for additional health care spending and the long term efforts to innovate. This has not proved to offer a stable setting for the relationship between the industry and Health Authorities. The author offers from the economic analysis and a subjective appraisal from his experience some recommendations for regulatory changes in order to better align the incentives of the parts for improving the health system as a whole. The basic point is that 'consumption levels' (quantities) and not «prices» (unit costs) are the main challenge to tackle today in our Public Health Care system, and for this the decentralisation of financial responsibility is not in itself 'the' problem but it may well be a part of the solution.

Más que la sostenibilidad financiera del sistema sanitario debiera de preocuparnos hoy su 'solvencia'; esto es, su capacidad para solventar retos nuevos y situaciones cambiantes. La descentralización, al permitir diversidad en las capacidades de respuesta, experimentación, evaluación y benchmarking es un activo para un sistema de salud. Frente al uniformismo, la innovación puede venir de la mano de la descentralización: territorial-política (favorecedora de la responsabilidad fiscal); funcional –a proveedores (pago por resultados) y de compromiso individual (usuarios contribuyentes; copagos/impuestos generales) En este sentido, el 'lío' autonómico lo sufre y no lo crea, la descentralización sanitaria. En este sentido, visualizar la desigualdad no es generarla. Los marcos constitucionales debieran de delimitar mejor las lecturas políticas de las diferencias. Y es que las desigualdades relevantes en salud son las personales y no las territoriales y tienen que ver más con la gestión 'intra' que con la 'inter' de los recursos utilizados. ; As well as the financial sustainability of the healthcare system, we should now be worried about its 'solvency'; i.e. its capacity to resolve new challenges and changing situations. Decentralisation, in allowing for diversity in the capacity to respond, experiment, evaluate and benchmark, is an asset for the healthcare system. When dealing with uniformity, innovation can go hand in hand with decentralisation: territorial-political (favouring fiscal responsibility); functional- to providers (payment for results) and with respect to individual commitment (user contributions; co-payments/general taxes). In this regard, the mess of the autonomous system suffers from healthcare decentralisation, rather than creating it. Seeing inequality is not the same as generating it. Constitutional frameworks should better define the political understanding of the differences. This is because relevant healthcare inequalities are personal, not territorial, and relate better to the 'intra' and not the 'inter' management of resources used.

The hypotheses we intended to contrast were, first, that the most deprived neighborhoods in Barcelona, Spain, present high exposure to environmental hazards (differential exposure) and, secondly, that the health effects of this greater exposure were higher in the most deprived neighborhoods (differential susceptibility). The population studied corresponded to the individuals residing in the neighborhoods of Barcelona in the period 2007–2014. We specified the association between the relative risk of death and environmental hazards and socioeconomic indicators by means of spatio-temporal ecological regressions, formulated as a generalized linear mixed model with Poisson responses. There was a differential exposure (higher in more deprived neighborhoods) in almost all the air pollutants considered, when taken individually. The exposure was higher in the most affluent in the cases of environmental noise. Nevertheless, for both men and women, the risk of dying due to environmental hazards in a very affluent neighborhood is about 30% lower than in a very depressed neighborhood. The effect of environmental hazards was more harmful to the residents of Barcelona's most deprived neighborhoods. This increased susceptibility cannot be attributed to a single problem but rather to a set of environmental hazards that, overall, a neighborhood may present ; This work was partly funded by the CIBER of Epidemiology and Public Health (CIBERESP) through the strategic subprogram 'Crisis and Health', by the AGAUR, Catalan Government Project 'Compositional and Spatial Analysis' (COSDA), 2014SGR551 and by the Research Grant to Improve the Scientific Productivity of the Research Groups of the University of Girona 2016-2018 (MPCUdG2016/69)

In this paper we estimate the relationship between the growth rate of Spanish regions' GDP and the level of regional redistribution. We will do so considering the period 2002–2016 using a panel of 17 Spanish regions. Our estimates suggest that regional redistribution has a negative impact on regional GDP growth rates, regardless of whether the region is recipient or donor of fiscal transfers. This suggests that territorial redistribution as it comes out from the central transfers is harmful for growth. A policy implication of our results is that donor regions do find in the Spanish context a solid argument for secession, especially in a framework where regional governments, or regional interests, are not well represented in the Spanish institutions in order to modify the present state of affairs. ; En este artículo se estima la relación entre la tasa de crecimiento del PIB de las regiones españolas y el nivel de redistribución regional. Para ello se toma en cuenta el período 2002‐2016 y se utiliza un panel de 17 regiones españolas. Las estimaciones sugieren que la redistribución regional tiene un impacto negativo en las tasas de crecimiento del PIB regional, independientemente de que la región sea receptora o donante de transferencias fiscales. Esto sugiere que la redistribución territorial, tal como surge de las transferencias centrales, es perjudicial para el crecimiento. Una implicación política de estos resultados es que las regiones donantes encuentran en el contexto español un argumento sólido para la secesión, especialmente en un marco en el que los gobiernos regionales, o los intereses regionales, no están bien representados en las instituciones españolas para modificar la situación actual.

The hypotheses we intended to contrast were, first, that the most deprived neighborhoods in Barcelona, Spain, present high exposure to environmental hazards (differential exposure) and, secondly, that the health effects of this greater exposure were higher in the most deprived neighborhoods (differential susceptibility). The population studied corresponded to the individuals residing in the neighborhoods of Barcelona in the period 2007–2014. We specified the association between the relative risk of death and environmental hazards and socioeconomic indicators by means of spatio-temporal ecological regressions, formulated as a generalized linear mixed model with Poisson responses. There was a differential exposure (higher in more deprived neighborhoods) in almost all the air pollutants considered, when taken individually. The exposure was higher in the most affluent in the cases of environmental noise. Nevertheless, for both men and women, the risk of dying due to environmental hazards in a very affluent neighborhood is about 30% lower than in a very depressed neighborhood. The effect of environmental hazards was more harmful to the residents of Barcelona's most deprived neighborhoods. This increased susceptibility cannot be attributed to a single problem but rather to a set of environmental hazards that, overall, a neighborhood may present. ; This work was partly funded by the CIBER of Epidemiology and Public Health (CIBERESP) through the strategic subprogram 'Crisis and Health', by the AGAUR, Catalan Government Project 'Compositional and Spatial Analysis' (COSDA), 2014SGR551 and by the Research Grant to Improve the Scientific Productivity of the Research Groups of the University of Girona 2016-2018 (MPCUdG2016/69). Authors acknowledge the unrestricted grant from 'Obra Social de la Caixa' 2016 to CRES-UPF. None of the funders participated in the design of the study, collection, analysis and interpretation of data or in writing the manuscript.

In a panel setting, we analyse the speed of (beta) convergence of (cause-specific) mortality and life expectancy at birth in EU countries between 1995 and 2009. Our contribution is threefold. First, in contrast to earlier literature, we allow the convergence rate to vary, and thereby uncover significant differences in the speed of convergence across time and regions. Second, we control for spatial correlations across regions. Third, we estimate convergence among regions, rather than countries, and thereby highlight noteworthy variations within a country. Although we find (beta) convergence on average, we also identify significant differences in the catching-up process across both time and regions. Moreover, we use the coefficient of variation to measure the dynamics of dispersion levels of mortality and life expectancy (sigma convergence) and, surprisingly, find no reduction, on average, in dispersion levels. Consequently, if the reduction of dispersion is the ultimate measure of convergence, then, to the best of our knowledge, our study is the first that shows a lack of convergence in health across EU regions. ; This work was partly funded by the Short Term Grant Abroad for PhD European, CIBER of Epidemiology and Public Health (CIBERESP), Spain, benefiting Laia Maynou, who is also a beneficiary of the Grant for Universities and Research Centres for the Recruitment of New Research Personnel (FI-DGR 2012), AGAUR, Government of Catalonia (Generalitat de Catalunya).

Background There is considerable evidence demonstrating socioeconomic inequalities in mortality, some of which focuses on intraurban inequalities. However, all the studies assume that the spatial variation of inequalities is stable over the time. We challenge this assumption and propose two hypotheses: (i) have spatial variations in socioeconomic inequalities in mortality at an intraurban level changed over time? and (ii) as a result of the economic crisis, has the gap between such disparities widened? In this paper, our objective is to assess the effect of the economic recession on the spatio-temporal variation of socioeconomic inequalities in mortality in Barcelona (Catalonia, Spain). Methods We used a spatio-temporal ecological design to analyse mortality inequalities at small area level in Barcelona. Mortality data and socioeconomic indicators correspond to the years 2005 and 2008–2011. We specified spatio-temporal ecological mixed regressions for both men and women using two indicators, neighbourhood and year. We allowed the coefficients of the socioeconomic variables to differ according to the levels and explicitly took into account spatio-temporal adjustment. Results For men and women both absolute and, above all, relative risks for mortality have increased since 2009. In relative terms, this means that the risk of dying has increased much more in the most economically deprived neighbourhoods than in the more affluent ones. Conclusions Although the geographical pattern in relative risks for mortality in neighbourhoods in Barcelona remained very stable between 2005 and 2011, socioeconomic inequalities in mortality at an intraurban level have surged since 2009. ; This work was partially supported by the European Union, DG-SANCO, Second Programme of Community action in the field of Health (2008-2013), project A/101156 and by the FIS (Health Research Fund), Spanish Ministry of Economy and Competitiveness, project FIS-08/0142.