Article

How is the use and expenditure of public healthcare services distributed?

Utilization grows and changes with age, while spending is distributed very unevenly: 5% of the population makes more than 50% of spending

Anna García-Altés, Catalan Agency for Health Quality and Evaluation (AQuAS); Emili Vela, Montse Clèries and Cristina Adroher, CatSalut; Vincenzo Alberto Vella, CIBERESP; Adapted by Xavier Aguilar

The use of public healthcare services increases and changes according to the age of the population. The expenditure involved in using these services is extremely unequally distributed: 5% of the population originates more than 50% of the total budget, while 3.6% of health expenditure is allocated to half of the users of the public health system. This gap in health spending is clear from the initial analysis conducted in this area (Vela et al., 2017), which was based on the microdata of use generated by the 7.5 million inhabitants of Catalonia. The results can be extrapolated to other similar contexts (Wammes et al., 2018) and also indicate the fact that the men spend more resources than women, but both display similar behaviour with regard to this expenditure, which increases with age.
Key points
  • 1
       The individual distribution of health expenditure is extremely unequal: half of the population originated expenditure of 71 euros per year, while almost 23,000 euros per person were needed with regard to 1% of the population.
  • 2
       Hospital, primary and pharmaceutical care are the healthcare areas most used by users of public healthcare services, while hospital pharmacy outpatient dispensing is on the rise.
  • 3
       Health expenditure increases with age and is higher for men than for women, except when the latter are of childbearing age.
  • 4
       The use of the healthcare system changes with age: young people use primary care and emergencies more and older people use hospitalisation and pharmaceutical care.
  • 5
       Diabetes is one of the pathologies that represent the lowest cost per user, but it is the disease that consumes the most resources due to its high prevalence among the population.
A small part of the population spends the most part of the healthcare budget

The vast majority of the population (95%) makes use of healthcare services that is lower than half of the budget earmarked for medical care. However, the remaining percentage of society (5%) generates the majority of the expenditure: 51%. The accumulation of chronic diseases and use of high-cost treatments are two factors that explain these striking differences.

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