Semergen · 2026
[Healthcare expenditure and in-hospital mortality in the Spanish National Health System (2013-2023)].
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Escandell Rico F M, Pérez Fernández L
Аннотация
OBJECTIVE: To analyze the relationship between per capita healthcare expenditure and overall in-hospital mortality in the Spanish autonomous communities between 2013 and 2023.
METHOD: A longitudinal ecological study was conducted using official data from the Ministry of Health and regional healthcare expenditure statistics. Annual in-hospital mortality rates and per capita healthcare expenditure were calculated, and descriptive analyses, Pearson correlation, and multiple linear regression were applied. A significance level of p<0.05 was adopted.
RESULTS: The results showed a progressive increase in per capita healthcare expenditure between 2013 and 2019 and a significant increase during the pandemic (p<0.01). In-hospital mortality decreased until 2019 and increased markedly in 2020-2021 (p<0.01). A significant positive correlation was observed between per capita healthcare expenditure and in-hospital mortality (r=0.428 and p<0.001). However, in the year-adjusted regression model, expenditure ceased to be a significant predictor of mortality, showing that the bivariate association may be influenced by structural and demographic factors not included in the analysis.
CONCLUSIONS: Although per capita healthcare expenditure increased during the analyzed decade, no independent association between investment and mortality was identified. The observed positive correlation could reflect regional differences in population aging, healthcare complexity, and service structure, rather than a direct effect of expenditure.
METHOD: A longitudinal ecological study was conducted using official data from the Ministry of Health and regional healthcare expenditure statistics. Annual in-hospital mortality rates and per capita healthcare expenditure were calculated, and descriptive analyses, Pearson correlation, and multiple linear regression were applied. A significance level of p<0.05 was adopted.
RESULTS: The results showed a progressive increase in per capita healthcare expenditure between 2013 and 2019 and a significant increase during the pandemic (p<0.01). In-hospital mortality decreased until 2019 and increased markedly in 2020-2021 (p<0.01). A significant positive correlation was observed between per capita healthcare expenditure and in-hospital mortality (r=0.428 and p<0.001). However, in the year-adjusted regression model, expenditure ceased to be a significant predictor of mortality, showing that the bivariate association may be influenced by structural and demographic factors not included in the analysis.
CONCLUSIONS: Although per capita healthcare expenditure increased during the analyzed decade, no independent association between investment and mortality was identified. The observed positive correlation could reflect regional differences in population aging, healthcare complexity, and service structure, rather than a direct effect of expenditure.