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Austerity, healthcare provision, and health outcomes in Spain

Cristina Borra (), Jerònia Pons-Pons and Margarita Vilar-Rodríguez
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Jerònia Pons-Pons: Universidad de Sevilla
Margarita Vilar-Rodríguez: University of A Coruña

The European Journal of Health Economics, 2020, vol. 21, issue 3, No 8, 409-423

Abstract: Abstract 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.

Keywords: Healthcare provision; Mortality; Health cuts (search for similar items in EconPapers)
JEL-codes: I10 I18 (search for similar items in EconPapers)
Date: 2020
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Working Paper: Austerity, health care provision, and health outcomes in Spain (2017) Downloads
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DOI: 10.1007/s10198-019-01141-3

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