title: [Health services supply and the economic crisis: either we fund goods and services according to their value or we become bankrupt. SESPAS report 2014].
abstract: Health policy has reacted to the financial crisis by overemphasising measures targeted at reducing unit costs, increasing barriers to access (waiting lists) or closing premises. It is too soon for scientific assessment of the impact of this reshaping of supply on equity, quality and safety, and on individual and population health. Nevertheless, the emergency measures taken to achieve fiscal stabilization have shifted the focus to resolving budget problems at the expenses of sounder and deeper initiatives aimed at deciding what must be funded and how. This article advocates a policy based on selective funding of services and benefits on the basis of their value. Other countries' experiences can serve as a useful guide, including robust methods to identify technologies (or their uses) of questionable value, prioritization criteria, and careful consideration of limitations associated with the elimination of a certain benefit, especially if it affects the founding values of the system. The necessary tools are available to the Spanish health system: the regulatory framework and technical bodies able to identify lower value care, support for decision-making, and timely evaluation of such decisions. Despite the numerous hurdles, maintaining the status quo is too expensive a choice, given the opportunity costs of effectiveness and safety losses, measured in terms of equity and the economic efficiency of the Spanish health system, which may ultimately translate into worsening of the population's health status.
authors.affiliation: Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISECC), España. Electronic address: ebernal.iacs@aragon.es.
authors.forename: Enrique
authors.initials: E
authors.lastname: Bernal-Delgado
authors.affiliation: Servicio de Salud de las Islas Baleares, Islas Baleares, Zaragoza, España.
authors.forename: Carlos
authors.initials: C
authors.lastname: Campillo-Artero
authors.affiliation: Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISECC), España; Fundación ARAI + D, Zaragoza, España.
authors.forename: Sandra
authors.initials: S
authors.lastname: García-Armesto
mesh_terms: D016361:Bankruptcy; D057172:Economic Recession; D006291:Health Policy; D006296:Health Services / Q000191:economics* / Q000600:supply & distribution*; D006801:Humans; D013030:Spain
keywords: Crisis; Desinversión; Disinvestment; Financial crisis; Health care reform; Reformas sanitarias; Sistema Nacional de Salud; Sostenibilidad; Spanish National Health Service; Sustainability; Valor de los servicios; Value for money