Template-Type: ReDIF-Article 1.0
Author-Name: Javier Cano Fernández
Author-Name: Marisol Esteban Galarza
Title:  EL RETO DEL SOSTENIMIENTO DEL GASTO SANITARIO PÚBLICO EN EL PAÍS VASCO: ENVEJECIMIENTO Y CRECIMIENTO ECONÓMICO
Abstract: Resumen:El
envejecimiento poblacional, además de constituir un problema demográfico,
afecta negativamente al sostenimiento del Sistema Sanitario Público. Por tanto,
para conservar el nivel de las prestaciones sanitarias resulta necesario
aumentar los recursos económicos para afrontar el incremento del gasto
sanitario resultante. El objetivo del artículo será doble: primero, estimar el
incremento de dicho gasto; segundo, determinar cuál es el crecimiento económico
necesario para su sostenibilidad, representado por el PIB. Se concluye que
mantener las prestaciones, en las circunstancias actuales, requiere un
crecimiento económico suficiente, fruto del incremento de la productividad
laboral unitaria de la población activa, necesarios para financiar dicho gasto.
El marco geográfico se circunscribe a la Comunidad Autónoma del País Vasco
(Euskadi).  Abstract:In
addition to being a demographic problem, the ageing of the population has a
negative impact on the sustainability of the public health system. Therefore,
in order to maintain the level of health services, it is necessary to increase
the economic resources to face the increase in health expenditure. The
objective of the article, therefore, will be twofold: first, to estimate the
future increase in healthcare spending; second, to determine what economic
growth, represented by the Gross Domestic Product (GDP), is necessary for the
sustainability of the Basque Country's public healthcare system. The scenario
of the study goes from 1988 to 2031 and is based on a retrospective analysis of
economic, labour and demographic data from 1988 to 2016, which is then
extrapolated prospectively between 2017 and 2031 and is based on three
premises: - The impact of the ageing population as a consequence of increased
life expectancy has traditionally been considered by the scientific literature
as the most influential determinant of health expenditure, although there are
others, such as the rise in the cost of new medical technologies, which may
also have an impact. - Relationship between health expenditure and economic
growth: other research has shown a positive correlation between health
expenditure and economic growth represented by the Gross Domestic Product
(GDP). - The influence of unit labour productivity on economic growth, the former
being understood as a measure of the yield obtained by each unit of work
applied to the production process, is the aggregate factor that most influences
productivity. The methodology has been based on a multivariate statistical
analysis of data, all of which refer to the Basque Country, including the age
cohort structure of its population and its average age, public health
expenditure and GDP. All of this has been analysed by means of a simple
regression or, where appropriate, a multiple one, the preliminary hypothesis
being that it is possible to draw up an estimate of public health expenditure
for a future period, by extrapolating the information prospectively. The
variable dependent on (explained by) the correlation is, in all cases, the
estimated public health expenditure, at constant prices with base year 2017,
transferring the effects of inflation retrospectively to previous years. The
level of economic growth (GDP) required to maintain a level of public health
expenditure and equivalent per capita economic resources for this purpose has
also been determined, calculated using unit labour productivity per person
employed, based on three scenarios (pessimistic, normal and optimistic)
depending on the employment rate. The statistical analysis offers the following
results, which will later be discussed and conclusions formulated: - The
profile of health expenditure in terms of the ageing population and age cohorts
does not differ substantially between the Basque Country and the National
Health System as a whole, perhaps evidenced in the graphic representation, in
the case of the Basque Country, of the more extended "J"-shaped
characteristic curve. - The result of the statistical analysis, by multiple
regression, using age cohorts as an independent variable and public health
expenditure as a dependent is not conclusive because it is affected by
multicollinearity by correlation between the independent variables. - The
alternative to the previous point is a simple regression using as an
independent variable the average age of the population and public health
expenditure as a dependent variable. The result is that the adjusted
coefficient of determination is high, indicating a high positive correlation
between the variables, making it possible to extrapolate health spending with
the ageing estimate. It can also be seen that in the first years of the study,
with real data, (1988-2002), the increase in the average age and therefore
ageing, is much higher than in the following years (2003-2018). - Between
public health expenditure and economic growth, there is evidence that both
parameters are evolving in positive symmetry. One grows when the other does
too. - In the long term, the trend in unit labour productivity, per person
employed, in the area of study and the Basque Country, has been increasing,
regardless of the situation of the labour market. The main conclusions of the
study are: - The ageing of the population has been empirically established as
one of the main causes of the increase in public health expenditure, although
it has certainly not been the only one. - The average age of the population
will continue to increase, at least with the current demographic paradigm; long
life expectancy, coupled with a low number of births. This ageing process will
lead to the need for a sharp increase in public health expenditure. - GDP is of
fundamental importance in the evolution of public health expenditure and in
fact it is foreseeable that this expenditure will continue to increase in the
future, regardless of the average age of the population, provided that GDP and
public revenue can allow it to be financed. - Contrary to the previous point,
if in the future GDP were to enter the path of a prolonged decline, even if the
age of the population continues to increase, public health expenditure will be
cut and will also decline. Austerity policies such as health co-payments,
removal of health benefits from the service portfolio, restrictions on the
universality of the NHS and salary reductions for public health personnel will
probably be applied again. - The GDP needed to maintain public health
expenditure and economic resources per capita, despite the expected ageing of
society, can be achieved with sustained unit labour productivity per person
employed over time, as has been the case so far in the field of study. -
Notwithstanding the above, unit labour productivity per person employed, while
a necessary condition, is not in itself sufficient. It is also essential to
keep the [employed population/total population] ratio sufficiently high, since
in the labour market, for the purposes of GDP growth and sustaining public
health spending and beyond the average of ageing and the available active
population, the most important data to consider have been and are those of the
employed population. The summary of all the conclusions is that in order to
maintain health services in the current circumstances, sufficient economic
growth is required, as a result of the increase in the unit labour productivity
of the working population, which is necessary to finance this expenditure. If
the increase in unit labour productivity is maintained, the resulting economic
growth will be able to finance health expenditure even with the increase in the
ageing population.
Classification-JEL: R1
Keywords: Gasto sanitario, Envejecimiento Poblacional, Producto Interior Bruto (pib), Productividad Laboral, Mercado laboral, Health expenditure, Population Aging, Gross Domestic Product (gdp), Workforce Productivity/Labor Productivity, Active labour market policies
Pages: 45-84
Volume: 3
Year: 2022
File-URL: http://www.revistaestudiosregionales.com/documentos/articulos/pdf-articulo-2637.pdf
File-Format: Application/pdf
Handle: RePEc:rer:articu:v:3:y:2022:p:45-84