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

Costa-i-Font, Joan and Gil, Joan (2009) Exploring the pathways of inequality in health access and financing in decentralised Spain. Journal of European Social Policy, 19 (5). pp. 446-458. ISSN 1461-7269

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The regional organization of the Spanish national health system offers a ‘unique field’ for exploring the sources of health inequalities as well as for testing the effects of political decentralization on health and healthcare inequalities. Drawing from the results of an empirical analysis where inequalities in three dimensions of health (outcome), healthcare (access) and healthcare payments (financing) are estimated, this article first explores the association between three such inequality dimensions alongside other system and socio-economic controls. Second, we examine whether the first wave of asymmetric healthcare devolution which took place in Spain between (1980—2001) — whereby health policy responsibilities were transferred to a few region states (autonomous communities [ACs]) — correlates with higher inequalities in health, healthcare and health financing. Our findings suggest that inequalities in health and healthcare appear to be driven by income inequalities and inequalities in use but not by inequalities in financing and health expenditure. Region states politically responsible for the organization of healthcare did not exhibit significant differences in health and healthcare inequalities and tend to exhibit a better equity performance.

Item Type: Article
Official URL:
Additional Information: © 2009 SAGE Publications
Library of Congress subject classification: R Medicine > RA Public aspects of medicine
Sets: Departments > Social Policy
Departments > European Institute
Research centres and groups > LSE Health
Identification Number: ISI:000271567400005
Date Deposited: 09 Nov 2009 20:32

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