Establecimiento de prioridades, opinión pública y sistema sanitario en España

Abstract

To examine the determinants of attitudes towards some "general criteria" guiding the financing, provision and satisfaction of the Spanish health system. First we examine the degree of acceptance of a publicly funded health system such as the use of an intergenerational equity criteria for health care rationing based on patient's age. Second, employing the same sample we analyse the determinants of citizen's satisfaction with the health system in order to identify the profile that defines attitudes of Spanish population to their health system. We undertake a quantitative analysis of the public opinion survey Eurobarometer 49.1 (1998) for a subsample of the Spanish population. The Eurobarometer is a periodical public opinion survey representative of European Union (EU) citizens. Due to the categorical nature of individual responses to public opinion surveys, the model estimated is an ordered probit. The explanatory variables used refer to socio-economic status and political attitudes. There appears to be a consensus on the criteria that public sector should go a way forward from what the public envisages as "essential health care". 73.5% of the populations rejects a libertarian criteria that sustains that individuals are self responsible for funding non-essential health care. This attitude is especially supported by male with leftists political tendencies and high education achievement. The use of age-related criteria to ration health care (fair innings) is rejected by a 81.5% of the population. However, we find that self interest is the main criteria guiding this attitude since elderly and middle and high income individuals tend reject the use of this criteria more than other groups. Satisfaction with the Spanish health system is higher than other southern EU countries, as Italy and Greece but still far from the levels achieved by Scandinavian and northern EU countries. Political attitudes, age and socio-economic status are positively associated with a higher satisfaction. Health systems reforms that significantly reduce the collective funding of health systems would not be accepted by the majority of the population. As it happens in other EU countries, attitudes on the financing and provision of health care are influenced by political attitudes. Health reforms reducing the extent of health care funding would be rejected by the population. The use of and age-related criteria for health care rationing would be envisaged as discriminatory against the elderly. Health system satisfaction is in an intermediate position and its sensitive to demographic and socio-economic composition of the Spanish population, still far from the levels achieved by Scandinavian and northern EU countries. This results show a particular general criteria when evaluating health systems key elements, and may be expected to vary when applied to the concrete decision making scenario. Finally, it should be noted that quantitative analysis of general surveys is subject to large limitations. Thus, caution should be posed when interpreting these results, always should be seen as complementary of other studies using alternative methodologies (those using qualitative and experimental methodologies).