wow-inequalities/02-data/intermediate/wos_sample/eb29a4d0ab0b841c767ac9d4c541ec9e-pena-sanchez-antoni/info.yaml

abstract: 'The general objective of this work is to study the level of

  socio-economic development of an economy as an explanatory factor for

  public health expenditure. To do so, this general objective will be

  broken down into three specific ones: firstly, the Spanish position in

  terms of health expenditure in the countries of the Economic and

  Monetary Union as a whole will be studied; secondly, the relationship

  between public health expenditure per capita and GDP per capita will be

  analysed; and thirdly, the level of convergence experienced by public

  health expenditure at a regional level in the Spanish economy will be

  studied.

  This analysis allows us to observe whether territorial public spending

  has evolved in a similar way in all Spanish regions, placing the

  country''s inhabitants in the same situation in this respect, or if, on

  the contrary, the evolution of health spending has been more unequal in

  the period analysed. This would show whether disparities in health

  expenditure are occurring between people living in the same country,

  according to the region in which they reside, establishing a pattern

  which allows us to distinguish whether health expenditure is and has

  been greater in regions with a higher socio-economic level or the

  opposite. In this way, it will be possible to define the level of

  socio-economic development (measured by the GDP per capita) as a

  determining factor of health expenditure per capita in all the Spanish

  regions in the period analysed (in principle 2000-2018), since it covers

  the last two decades and there is sufficient data to carry out a serious

  and rigorous study.

  The availability of databases on health expenditure implies that several

  statistical sources can be used. The aim of this research was to have a

  variety of statistical sources to enable a sufficiently long period of

  time to be covered for the study to be focused on structural issues, and

  not just on purely conjunctural aspects. This undoubtedly favours the

  achievement of more rigorous and timely reflections in studies of this

  type.

  The statistical sources used in this paper are as follows: Satellite

  Accounts on Public Health Expenditure (Ministry of Health, Consumption

  and Social Welfare of the Government of Spain); Satellite Accounts on

  Public Health Expenditure (Spanish Regional Accounts of the National

  Statistics Institute); Data on Health, Dependency and Pensions

  (Foundation for Applied Economic Studies); Public Health Expenditure

  (Valencian Institute of Economic Research); General State Budgets

  General Intervention of the State Administration (Ministry of Finance of

  the Government of Spain); and Health Accounts System (Ministry of

  Health, Consumption and Social Welfare of the Government of Spain); and

  Macroeconomic Data (Expansion Edition).

  With regard to the methodology used to address the proposed objectives,

  in addition to the description of the data presented, based on a

  territorial approach, the evolution of these variables and the possible

  relationship between them will be analysed, based on the correlation

  between them. Furthermore, an attempt has been made to establish the

  link between territorial economic development and the level of regional

  health expenditure by means of an econometric estimate. Similarly,

  another attempt will be made to measure the evolution of existing

  territorial disparities on the basis of indicators such as sigma

  convergence, beta convergence, the Theil index, and other indices that

  will make it possible to examine whether regional differences have been

  reduced or, on the contrary, intensified in the period analysed.

  An analysis of the evolution of public health expenditure per inhabitant

  and its link with the level of socio-economic development of the Spanish

  regions shows that the levels of public health expenditure per capita

  and socio-economic development are closely linked in these regions. The

  conclusions drawn from the study are presented below.

  Public health expenditure is an aspect that has a relevant influence on

  the whole population, so it guarantees equal opportunities and its

  distribution undoubtedly allows for social and territorial cohesion. In

  general, the public administrations of the countries with the highest

  level of income in the Economic and Monetary Union tend to make a

  greater effort to invest in public health, which may reflect the fact

  that health expenditure is closely linked to the level of economic

  development of the countries. Public health expenditure in Spain has

  accounted for around 70\% of total public expenditure over the period

  analysed, and is, therefore, an element that can be used by territorial

  public administrations to try to stimulate the equalisation of

  opportunities for the population in each of the Autonomous Communities,

  as well as to promote the socio-economic cohesion of the Spanish

  regions. The distribution of public health expenditure among the Spanish

  geographical areas has been closely related to the territorial

  distribution of the population in the period analysed, but there are

  still strong regional differences in public health expenditure per

  inhabitant, which makes it somewhat difficult to achieve socio-economic

  equality among the Spanish Autonomous Communities.

  Furthermore, the growth of public health expenditure has been more

  positive than that of the Gross Domestic Product in the Spanish economy

  in the period studied, which has meant that public health expenditure

  per GDP has advanced positively not only at a national level, but also

  in all Spanish regions. However, it is necessary to point out that the

  intensity of growth at a regional level has not been equitable, but

  rather has been very uneven.

  It is also noted that the level of economic development is a determining

  factor in public health expenditure per capita. Logically, this has a

  fundamental impact on the process of territorial cohesion and equal

  opportunities that the Spanish economy is seeking. Regional disparities

  in public health expenditure per inhabitant have increased in the period

  1995-2017 in the Spanish economy, as shown by the sigma convergence

  indicator, the Theil index and the applied inequality index. The

  breakdown of the Theil index shows how the increase in territorial

  differences in public health expenditure has been due to an increase of

  almost 30\% in the regional investment effort in public health

  expenditure per GDP and almost 70\% in the level of economic development

  of the Spanish regions. Moreover, according to the indicator of

  contribution to inequality, the regions with the highest share of

  inequality are Andalusia, the Basque Country and Madrid.

  The study shows that it would be desirable to reduce the range of

  dispersion between regions in the level of public health expenditure per

  inhabitant. Moreover, it is essential to identify the determinants of

  these interregional differences since they are a real obstacle to

  guarantee equal opportunities in the access to this type of services and

  to achieve higher levels of welfare in the population. Furthermore, it

  is crucial to establish a system that adequately protects the public

  health services provided by the territorial administrations in the face

  of the economic crisis and the fall in public revenue experienced in

  Spain over the last decade.

  Four key issues for the future are considered necessary: a) the

  sustainability of public health expenditure requires medium and

  long-term financial planning that is prudent and complemented by

  predictable funds provided in years of economic prosperity; b) the high

  territorial disparities in public health expenditure need to be

  carefully monitored and reviewed as they call into question equal

  opportunities policies; c) institutional loyalty must be adequately

  promoted so that territorial public administrations share the priority

  of these policies and can provide them with the corresponding funds; in

  this sense, a serious and rigorous debate on the level of sustainable

  public health expenditure must be addressed as soon as possible, taking

  into account the restrictions established by the high public deficit and

  the high public debt of the Spanish economy; and d) the regional

  financing systems must be adapted to the constitutional commitments to

  inter-territorial equity.

  In any case, it is suggested to maintain the economic growth that allows

  contracting the economic disparities of the Spanish regions, in order to

  reduce the current differences in the public health expenditure per

  inhabitant.'
affiliation: 'Sanchez, ARP (Corresponding Author), Univ Cadiz, Cadiz, Spain.

  Pena Sanchez, Antonio Rafael; Jimenez Garcia, Mercedes; Ruiz Chico, Jose, Univ Cadiz,
  Cadiz, Spain.'
author: Pena Sanchez, Antonio Rafael and Jimenez Garcia, Mercedes and Ruiz Chico,
  Jose
author_list:
- family: Pena Sanchez
  given: Antonio Rafael
- family: Jimenez Garcia
  given: Mercedes
- family: Ruiz Chico
  given: Jose
da: '2023-09-28'
files: []
issn: 0213-7585
journal: REVISTA DE ESTUDIOS REGIONALES
keywords: 'Pubic health expenditure; Level of economic development; Sigma

  convergence; Theil index; Regional analysis'
keywords-plus: CARE EXPENDITURE; GROWTH; SPAIN; DETERMINANTS; CONVERGENCE
language: Spanish
month: MAY-AUG
number: '124'
number-of-cited-references: '83'
pages: 157-199
papis_id: 0474f7c1841f85bc6fff43850d24adec
ref: Penasanchez2022publicspending
times-cited: '0'
title: 'Public spending in health and socio-economic development in the Spanish Regions:
  Evolution of disparities in last decades'
type: article
unique-id: WOS:000885976800006
usage-count-last-180-days: '1'
usage-count-since-2013: '2'
web-of-science-categories: Environmental Studies
year: '2022'