Public health care budget. A ten-year overview (part 2)

1 Oct

Joan-PonsJoan MV Pons, Head of Evaluation AQuAS

If in the previous post we examined the public health care budget evolution in the last decade (2005-2015) and we compared its distribution by major service lines, in this second part we will look at diseases (health problems) as described by the WHO International Classification of Diaseases (ICD) where they categorize conditions by the affected organs (apparatus or systems) or by origin (in the graphic: pressupost = budget)

Sense títol

There are two main things to comment on. On the one hand, the reduction in terms of percentage of overall budget spending on circulatory diseases (which goes from 17.3% to 11.5%) and, on the other hand, the increase in care spending for central nervous system diseases (CNS) and sense organs (6.4% to 10.6%). In a way, we can understand that the CNS pathologies (which should also include cataract surgery, cochlear implants and treatment of re-canalization –angioplastics or thrombolytics- in acute cerebral stroke) have reached the level that corresponds and ended up among those pathologies involving an expenditure of around 10% (8.5% to 11.5%) of the overall budget of CatSalut. Among these we have the following: neoplasm, mental disorders (because in this field ‘disease’ is never spoken of, we use ‘disorder’ instead), cardiovascular diseases and respiratory diseases. Below 8%, we’d find diseases of genital and urinary apparatus, digestive and musculoskeletal system and connective tissue, not to mention injuries and poisonings.

Cancer care is also growing along with the attention to injuries and poisoning, genitourinary system, endocrine and metabolic diseases and complications of pregnancy, childbirth and postpartum. Interpretative speculations may be numerous, but let’s allow the reader to make those.

Finally, we should mention the limitations of comparative analysis of such data. There may be differences in methodology, no doubt, because while in the scientific article this was explicit, the other data come from a presentation of a preliminary draft budget (2015), that not only describes the manner in which this budget allocation has been written, but in our case we have had to apply some combinations where the employed categories are not always accurate, particularly in terms of lines and type of care. Another deficiency in comparing the two timeframes is that while the first, 2005, is about the consolidated budget of CatSalut (the spending has been executed by the end of the year), the data of 2015 comes, as we said before from a draft budget and in the health world, it is well known that between what is projected and what the final expenditure may be ultimately, there is a great difference.

In theory, the fact of using percentages of overall spending and assuming that there is an acceptable cost accounting and that the attributions are correct, allow us to dodge any question relating to inflation (and the inflation in the health sector is usually higher than in other productive sectors) or currency depreciation (which, initially doesn’t happen with the euro, hence the suffered wage devaluation). The major limitation, however, is in the undertaken superficial analysis. Now we’d require a more detailed analysis to explain, for example, the reduction in spending on care for circulatory diseases (the patents for widely consumed drug acting on the cardiovascular risk factors are over, changes in the incidence of acute coronary syndrome, increase in primary angioplasty, etc.) or what factor explains better the reduction in spending on pharmacy, and when the trend turns.

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