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

Costa-Font, Joan ORCID: 0000-0001-7174-7919 and Gil, Joan (2009) Exploring the pathways of inequality in health, health care access and financing in decentralized Spain. Journal of European Social Policy, 19 (5). 446 - 458. ISSN 0958-9287

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Identification Number: 10.1177/0958928709344289


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 The Authors
Divisions: Social Policy
Centre for Economic Performance
LSE Health
Subjects: H Social Sciences > HJ Public Finance
H Social Sciences > HT Communities. Classes. Races
H Social Sciences > HV Social pathology. Social and public welfare. Criminology
R Medicine > RA Public aspects of medicine
Date Deposited: 09 Nov 2009 20:32
Last Modified: 20 Sep 2021 03:39

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