¿A qué incentivos responde la utilización hospitalaria en el Sistema Nacional de Salud?

Abstract

Background Geographic variations in medical practice have been widely described and different underlying causes have been proposed. Basically, when evidence about effectiveness is strong variations are lower and, probably, it reflects patient needs differences; nevertheless, when either uncertainty or ignorance about effectiveness dominates, medical decision making is particularly sensitive to supply. In this paper we argue about the factors (incentives) influencing hospital utilization in the Spanish National Health Service (sNHS). Matherial and method We have compared both sNHS utilization rates and those in MEDICARE (US Federal Health System for elderly and handicapped population). Results 1) Utilization rates in Spain were lower than in MEDICARE for most of the conditions and procedures under study. However, knee or hip replacement and cholecystectomy rates were similar; 2) unlike what happened in MEDICARE, supply, as total beds per 1,000 inhabitants, showed either negative or no correlation with utilization rates; however, those populations which get more interventions get more of whatever the surgery performed; 3) High tech hospitals, in terms of tertiary and teaching hospitals, perform less «common» interventions; on the other hand, «innovative surgery» utilization rates were closed to those in MEDICARE. Conclusions Differences between both Health Care Systems suggest a different structure of incentives working under variations. Here in Spain, instead of supply, «high tech fascination » is becoming the alternative explanation. If true, «technology fascination» hypothesis entails a model of National Health Service focused on technology instead of patient needs.