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To estimate the prevalence of catastrophic health expenditure due to dental healthcare (CHED) in Spain, quantify its intensity and examine the related sociodemographic household characteristics.Data from the Spanish Household Budget Survey, which addresses more than 20,000 households each year for the period 2008-2015 were included, and the methodology proposed by Wagstaff and van Doorslaer was followed. The prevalence (number of households that devote more than a certain threshold of their income to such payments) and intensity (amount that exceeds a certain percentage of income) were estimated. Ordered logistic regression models were estimated to analyse the sociodemographic factors associated with the prevalence of catastrophic payments.The prevalence and intensity remained stable during the period under analysis. In terms of prevalence, a mean proportion of 7.36% of the population dedicated, in terms of intensity, more than 10% of their resources to dental care payments [mean: €292.75 per year (SD €2144.14)] and 2.05% dedicated more than 40% [mean: €143.02 per year (SD €1726.42)]. This represents 36.32% and 51.34% (for the thresholds of 10% and 40%) of the total catastrophic expenditure derived from out-of-pocket payments for dental healthcare in Spain.This study shows that a significant proportion of catastrophic healthcare payments correspond to dental services. Being male, aged over 40 years, unattached (single, separated, divorced or widowed), having a low level of education, a low household income, being unemployed and living in an urban area are all associated with a greater risk of CHED. This finding highlights the need to establish policies aimed at increasing dental care coverage to mitigate related financial burdens on a large part of the Spanish population.

The aim of this paper is to assess the industry-wide impact of Long-Term Care (LTC) spending on the Spanish economy. LTC spending includes beneficiaries’ copayment and the impact is quantified in terms of output, employment and value added. To this purpose, we use an input–output model of the Spanish economy that allows us to further describe how the value added generated is distributed throughout the economy according to the existing benefit-mix (in kind services, cash benefit for informal care and cash benefit for personal assistance). Additionally, the model provides results on how the return on LTC spending would improve by using only in-kind services instead of the benefit mix currently in place. The 2012 Spanish Input–Output Table at current prices was extracted from the WIOD Database’s 2016 Release. Consumption data for dependent, employed, and unemployed households were collected from the Spanish Household Budget Survey for 2012. The findings reveal that the total annual costs are 7,205.43 million €, with total costs from in-kind services being almost 71% higher than total costs from cash benefits. Each million euros invested in in-kind services and CBPA would create 41.91 jobs (68.41% direct, 9.16% indirect and 22.43% induced). However, each million euros spent on cash benefits would result in 16.88 jobs overall (53.02% direct, 24.53% indirect and 22.45% induced). The total number of jobs is 151,353 at the aggregate level, being 46,840 depending on cash-benefits and 104,513 on in-kind services. Supplementary Information The online version contains supplementary material available at 10.1007/s10754-021-09310-9.

Objective: To assess the amount of employment generated from the effective development of the Dependency Act in 2012, by evaluating the number of jobs depending on whether in-kind services or cash benefits were applied. Methods: The level and total costs of dependency were obtained by using the Survey on Disability, Personal Autonomy and Dependency Situations of 2008. The consumption of dependent households was collected from the Household Budget Survey of 2012 carried out by the Spanish Statistics Institute. The impact on employment was estimated using an extended Input-Output model based on Symmetric Input-Output Tables and labour data from the Spanish National Accounts Base. Results: The total estimated costs of dependency in 2012 were 4,545 million Euros for in-kind services and 2,662 for cash benefits. One hundred and ninety-five thousand, six hundred and sixty-eight jobs were generated in 2012 from dependency costs, and132,997 were linked to in-kind services and 62,671 to cash benefits. Every million Euros allocated for dependency by the Government returned 53.33 jobs linked to in-kind services and 46.21 to cash benefits. Furthermore, 341,505 jobs would have been created if dependency benefits had been exclusively offered via in-kind services. Conclusions: Dependency benefits were equally distributed between in-kind services and cash benefits in 2012. Given that two out of three job positions generated from dependency benefits are linked to in-kind services, while the remaining third is generated by cash benefits, we conclude that around 146 thousand more jobs would have been generated if benefits had been offered as in-kind services instead of overusing cash benefits. Resumen: Objetivo: Estimar la creación de empleo generada por la implantación de la Ley de Dependencia en 2012, evaluando el número de puestos de trabajo vinculados a servicios y a prestaciones económicas. Métodos: Los grados y los costes totales de la dependencia se han obtenido de la Encuesta sobre Discapacidades, Autonomía Personal y Situaciones de Dependencia de 2008. El consumo de los hogares dependientes proviene de la Encuesta de Presupuestos Familiares realizada por el Instituto Nacional de Estadística en 2012. La creación de empleo se ha estimado con un modelo ampliado input-output basado en las tablas simétricas input-output y en datos de empleo de la Contabilidad Nacional de España. Resultados: Los costes totales de dependencia estimados en 2012 fueron de 4545 millones de euros en servicios y 2662 millones de euros en prestaciones económicas. Se generaron 195.668 empleos vinculados a prestaciones de dependencia en 2012, 132.997 asociados a servicios y 62.671 a prestaciones económicas. Cada millón de euros asignados a prestaciones de dependencia por la Administración generó 53,33 empleos vinculados a servicios y 46,21 a prestaciones económicas. Además, se habrían creado 341.505 empleos si las prestaciones de dependencia hubieran sido asignadas únicamente como servicios. Conclusiones: Los costes de dependencia se distribuyeron por igual entre servicios y prestaciones económicas en 2012. Dado que dos de cada tres empleos generados por las prestaciones de dependencia están vinculados a servicios, mientras que el tercio restante a prestaciones económicas, se habrían generado 146.000 empleos más si todas las prestaciones hubieran sido asignadas como servicios en lugar de la masiva utilización de prestaciones económicas. Keywords: Dependency, Employment, Long-term care, Social services, Spain, Palabras clave: Dependencia, Empleo, Cuidados de larga duración, Servicios sociales, España

Uno de los temas más analizados en las últimas décadas ha sido el catastrofismo financiero debido a los Pagos de Bolsillo (PDB) que realizan los hogares por el acceso y utilización de los sistemas de salud. En este trabajo se persiguen fundamentalmente dos objetivos. El primero, se centra en predecir la tasa de catastrofismo financiero y obtener la importancia de las variables para predecir la tasa de catastrofismo para un nivel de renta alto, medio o bajo de las diferentes Comunidades Autónomas. Para ello, se establecerá una comparativa entre dos algoritmos machine learning, uno basado en regresiones elastic-net para estimar modelos lineales generalizados; y, otro basado en algoritmos random forest, que permite captar las posibles no linealidades e interacciones que se pueden producir en los datos. Los resultados muestran que es más adecuado el random forest. A partir de estos resultados, el segundo objetivo, se centra en establecer un ordenamiento entre las diferentes Comunidades Autónomas según su nivel de renta para las diferentes categorías de las tasas de catastrofismo mediante la utilización de un modelo de decisión multicriterio discreto (método PROMETHEE).

The financial catastrophe resulting from the out-of-pocket payments necessary to access and use healthcare systems has been widely studied in the literature. The aim of this work is to predict the impact of the financial catastrophe a household will face as a result of out-of-pocket payments in long-term care in Spain. These predictions were made using machine learning techniques such as LASSO (Least Absolute Shrinkage and Selection Operator) penalized regression and elastic-net, as well as algorithms like k-nearest neighbors (KNN), MARS (Multivariate Adaptive Regression Splines), random forest, boosted trees and SVM (Support Vector Machine). The results reveal that all the classification methods performed well, with the complex models performing better than the simpler ones and showing no evidence of overfitting. Detecting and defining the profiles of individuals and families most likely to suffer from financial catastrophe is crucial in enabling the design of financial policies aimed at protecting vulnerable groups.

Background. The financial effect of households’ out-of-pocket payments (OOP) on access and use of health systems has been extensively studied in the literature, especially in emerging or developing countries. However, it has been the subject of little research in European countries, and is almost nonexistent after the financial crisis of 2008. The aim of the work is to analyze the incidence and intensity of financial catastrophism derived from Spanish households’ out-of-pocket payments associated with health care during the period 2008–2015. Methods. The Household Budget Survey was used and catastrophic measures were estimated, classifying the households into those above the threshold of catastrophe versus below. Three ordered logistic regression models and margins effects were estimated. Results. The results reveal that, in 2008, 4.42% of Spanish households dedicated more than 40% of their income to financing out-of-pocket payments in health, with an average annual gap of EUR 259.84 (DE: EUR 2431.55), which in overall terms amounts to EUR 3939.44 million (0.36% of GDP). Conclusion. The findings of this study reveal the existence of catastrophic households resulting from OOP payments associated with health care in Spain and the need to design financial protection policies against the financial risk derived from facing these types of costs.

Objective An increasing number of persons across the world require long-term care (LTC). In Spain, access to LTC involves individuals incurring out-of-pocket (OOP) expenditure. There is a large body of literature on the incidence of catastrophic OOP payments in access and participation in health systems, but not in the field of LTC nor the determinants of these expenses. Our aim was to analyse the socio-demographic and economic factors associated with different levels of catastrophic LTC expenditure in the form of private out-of-pocket payments among dependent persons in Spain. Materials and methods The study used the Spanish Disability and Dependency Survey (SDDS) conducted by the Spanish National Statistics Institute to obtain the socioeconomic, demographic and health profiles. The households were classified into those below the poverty threshold and those above the threshold of catastrophe, using measures of impoverishment and catastrophe. We estimated two logistic regression models, one binary (impoverishment) and one ordinal (catastrophe). Results The results show that OOP expenditure on LTC increases the probability of impoverishment by 18.90%. The factors associated with higher probability of experiencing catastrophe were age, being single, widowed or separated, lower levels of household income and education, higher level of dependence and living in an autonomous community with lower per capita income. Conclusions These findings highlight the need to include exemptions or insurance in the design of LTC policies to protect dependent persons from the risk of financial burden.

Since the end of the last century, demographic aging has led to an increased demand for new social protection services. Universalizing these to meet the needs of the most vulnerable requires the design of policies that ensure the sustainability of the system. Consequently, the economic structure of a country and its productive fabric are affected. Assessing the impact of this growing demand is not an easy task, although extended input-output models can help. With this aim, we determine the spillover effects of the demand shocks arising from the increase in public spending allocated for the imple- mentation of the Spanish long-term care system. The results reveal that such spending proves efficient in sustaining 116,000 jobs, most of which are in social work activities, entailing a large amount of direct but low-skilled employment. In addition, 5,000 million euros are generated in value added, including a fiscal return of 1,400 million euros.

Background A large part of the long-term care is provided by non-professional caregivers, generally without any monetary payment but a value economic of time invested. The economic relevance of informal caregivers has been recognized in Spain; however, public provision may still be scarce. The objective of this paper is to estimate the economic burden associated with informal long-term care that should assume the families through a new concept of cost sharing that consider opportunity costs of time provided by informal caregivers. Methods The study sample includes all dependent adults in Spain. Socioeconomic information and the number of hours of informal care was collected through the Spanish Disability and Dependency Survey. The terms of shadow and extended shadow cost sharing were defined as the difference between the maximum potential amount of money that families could receive for the provision of informal care and the amount that actually they received and the value of informal care time with respect to the amount received, respectively. Results 53.87% of dependent persons received an economic benefit associated to informal care. The average weekly hours of care were 71.59 (92.62 without time restrictions). Shadow cost sharing amounted to, on average, two thirds, whereas the State financed the remaining third. In terms of extended shadow cost sharing, the State financed between 3% and 10% of informal care provided by caregivers. Conclusions This study reveals the deficient support received for the provision of informal care in Spain. More than 90% of informal care time is not covered by the economic benefits that families receive from the State.

Small and medium enterprises (SMEs) are a powerful economic engine in many European countries. Moreover, tourism SMEs are particularly important in the economies of countries in southern Europe due to the climate and sociodemographic situation, among other reasons. In Spain, specifically, these enterprises are a vital economic asset. Nonetheless, neither the importance of SMEs in the tourism industry nor the main factors that influence their capital structure have been sufficiently studied. We used panel data methodology with a regression model to analyse the capital structure of SMEs in the tourism sector at the onset of the 2008 financial crisis. Our results show the significance of SMEs within the tourism industry as well as the need to take into account the main factors that influence their capital, which are type (micro, small or medium enterprise), profitability, number of employees and size (logarithm of total assets). Furthermore, despite the robustness of these companies, they have been affected by the crisis. This study is of great interest as it provides indicators to understand the strength of tourist SMEs to confront potential crises.

Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. Methods: The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. Results: The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached &euro, 3955, 1 million (0.38% of GDP). Conclusion: This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.

espanolLos sistemas sanitarios y de cuidados de larga duracion (CLD) conforman dos pilares esenciales del estado de bienestar en Espana. Si bien el sistema de CLD nacio como independiente del sanitario, su caracter y objetivos implican su necesaria integracion, o al menos, coordinacion con el sistema sanitario. La estrategia de atencion integrada al paciente podria permitir un ahorro de recursos, realizar una optima asignacion de estos, ahorrar tiempos de espera y mejorar la calidad de vida de las personas con dependencia. En este trabajo se contextualiza la situacion actual y se propone un conjunto de politicas publicas para el avance del estado de bienestar. EnglishBoth, the health care system and the long-term care system (LTC) are important pillars of the Spanish welfare state. Although Spanish LTC system was born independent of the health care system, its own nature and objectives suppose a necessary integration, or at least, coordination between both. This strategy would save resources, allocate them optimally, reduce waiting times and improve the quality of life of people with long-term care needs. In this chapter the current situation is contextualized and a set of public policies are proposed to achieve progress in the welfare state.

Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappear ance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value=9 €/h). Informal caregivers are a struc tural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.

Objectives This study analyses the financial burden associated with the introduction of copayment for long-term care (LTC) in Spain in 2012 for dependent individuals. Material and methods We analyse and identify households for which the dependency-related out-of-pocket payment exceeds the defined catastrophic threshold (incidence), and the gap between the copayment and the threshold for the catastrophic copayment (intensity), for the full population sample and for subsamples based on the level of long-term care dependency and on regional characteristics (regional income and political ideology of party ruling the region). Results The results obtained show there is a higher risk of impoverishment due to copayment among relatively well-off dependents, although the financial burden falls more heavily on less well-off households. Our findings also reveal interesting regional patterns of inequity in financing and access to long-term care services, which appear to be explained by an uneven development of LTC services (monetary transfers versus formal services) and varying levels of copayment across regions. Conclusions The new copayment for long-term care dependency in Spain is an important factor of catastrophic risk, and more attention should be addressed to policies aimed at improving the progressivity of out-of-pocket payments for LTC services within and between regions. In addition, formal services should be prioritised in all regions in order to guarantee equal access for equal need.

Introducción: los buenos hábitos de alimentación, como el consumo de frutas y verduras, permiten tener una mejor salud y, consecuentemente, minorar el consumo de recursos sanitarios. Es importante establecer una asociación entre consumo de frutas y verduras y el uso de los servicios sanitarios en la población española para considerar la necesidad de intervenir. Métodos: se empleó la Encuesta Europea de Salud en España del año 2014 y, mediante la utilización de modelos Hurdle, se valoró si existían diferencias en el acceso y la frecuentación al médico de familia, especialista y urgencias, dependiendo de los hábitos de consumo de frutas y verduras. Posteriormente, mediante la técnica propensity score matching se generaron dos grupos con los que poder comparar las diferencias en la frecuentación de los servicios sanitarios dependiendo del consumo de frutas y/o verduras y otras covariables de ajuste. Finalmente, se estima el coste de dichas diferencias por grupos de consumo. Resultados: se revela la existencia de diferencias en el acceso al servicio de urgencias, tanto por los sujetos que no consumen nunca fruta como por parte de los sujetos que no consumen nunca verdura. En el primer caso hay un incremento de 420 visitas al año por cada 1.000 personas con un coste atribuible de 75.000 €, mientras que en el segundo caso se observa un incremento de 780 visitas al año por cada 1.000 personas, con un coste equivalente de 139.000 €. Conclusiones: determinados hábitos de alimentación de la población española como no consumir nunca fruta o verdura producen importantes gastos evitables en el sistema sanitario. Es de gran interés implementar políticas de prevención para minorar dichos gastos y emplear los recursos de forma adecuada./ Introduction: healthy eating habits, such as the consumption of fruits and vegetables, allow better health and, consequently, reduce the con sumption of health resources. It is important to establish a relationship between fruit and vegetable consumption and the use of health services in the Spanish population to consider the need to intervene. Methods: the European Health Survey in Spain for 2014 was used, and the possible existence of differences in access and visit frequency to the family physician, specialist physician and emergency services depending on fruits and vegetables consumption habits was assessed through Hurdle models. Subsequently, two groups were generated through the propensity score matching technique in order to compare the differences in the frequenting of services depending on the consumption of fruits and/or vegetables and other adjustment covariates. Finally, the cost generated by such differences was estimated according to consumption groups. Results: there are differences in access to the emergency services, both in subjects who never consume fruit and in subjects who never consume vegetables. In the fi rst case, there is an increase of 420 visits per year for every 1,000 persons with attributable costs of €75,000, whereas in the second case, an increase of 780 visits per year for every 1,000 persons, with a cost of €139,000, is observed. Conclusions: certain eating habits of the Spanish population, such as never consuming fruits or vegetables, produce important avoidable expenses in the health system. It would be of interest to implement prevention policies to reduce such costs and use resources appropriately.

healthy eating habits, such as the consumption of fruits and vegetables, allow better health and, consequently, reduce the consumption of health resources. It is important to establish a relationship between fruit and vegetable consumption and the use of health services in the Spanish population to consider the need to intervene.the European Health Survey in Spain for 2014 was used, and the possible existence of differences in access and visit frequency to the family physician, specialist physician and emergency services depending on fruits and vegetables consumption habits was assessed through Hurdle models. Subsequently, two groups were generated through the propensity score matching technique in order to compare the differences in the frequenting of services depending on the consumption of fruits and/or vegetables and other adjustment covariates. Finally, the cost generated by such differences was estimated according to consumption groups.there are differences in access to the emergency services, both in subjects who never consume fruit and in subjects who never consume vegetables. In the first case, there is an increase of 420 visits per year for every 1,000 persons with attributable costs of €75,000, whereas in the second case, an increase of 780 visits per year for every 1,000 persons, with a cost of €139,000, is observed.certain eating habits of the Spanish population, such as never consuming fruits or vegetables, produce important avoidable expenses in the health system. It would be of interest to implement prevention policies to reduce such costs and use resources appropriately.Introducción: los buenos hábitos de alimentación, como el consumo de frutas y verduras, permiten tener una mejor salud y, consecuentemente, minorar el consumo de recursos sanitarios. Es importante establecer una asociación entre consumo de frutas y verduras y el uso de los servicios sanitarios en la población española para considerar la necesidad de intervenir.Métodos: se empleó la Encuesta Europea de Salud en España del año 2014 y, mediante la utilización de modelos Hurdle, se valoró si existían diferencias en el acceso y la frecuentación al médico de familia, especialista y urgencias, dependiendo de los hábitos de consumo de frutas y verduras. Posteriormente, mediante la técnica propensity score matching se generaron dos grupos con los que poder comparar las diferencias en la frecuentación de los servicios sanitarios dependiendo del consumo de frutas y/o verduras y otras covariables de ajuste. Finalmente, se estima el coste de dichas diferencias por grupos de consumo.Resultados: se revela la existencia de diferencias en el acceso al servicio de urgencias, tanto por los sujetos que no consumen nunca fruta como por parte de los sujetos que no consumen nunca verdura. En el primer caso hay un incremento de 420 visitas al año por cada 1.000 personas con un coste atribuible de 75.000 €, mientras que en el segundo caso se observa un incremento de 780 visitas al año por cada 1.000 personas, con un coste equivalente de 139.000 €.Conclusiones: determinados hábitos de alimentación de la población española como no consumir nunca fruta o verdura producen importantes gastos evitables en el sistema sanitario. Es de gran interés implementar políticas de prevención para minorar dichos gastos y emplear los recursos de forma adecuada.

A methodology based on group work to facilitate the assimilation of the concepts and competences to be acquired by university students is presented as part of the teaching activities in second and third courses in the Business and Management Administration Degree at University of Castilla-La Mancha (UCLM). This methodology allows that students benefit from synergies between group members and complete the training received with one system that permits, in a better way, the achievement of a series of important generic and specific competences.The present article is aimed at assessing student satisfaction after the completion of the group work activity in terms of motivation and involvement. The authors conclude that the degree of satisfaction is acceptable and good and that the activity per se is perceived as having a close relationship to the themes of the corresponding subject. An important collaboration between group members is observed, although there are students who shirk their responsibilities fully.The study concludes that group work is a good teaching and learning tool that facilitates the acquisition of a series of important specific and generic competencies to pass the subject and at a low investment of study time.

College years determine the essential academic and personal training for students future success. Certainly, higher education period is essential in the development of students as persons, setting out their emotional and intellectual capital and therefore determining their professional and personal life expectations. However, this process generally must be faced with few help and also sometimes students have to create, sometimes blindly, their own path. In this sense, Social Sciences Faculty of Cuenca (Spain) has created a Tutoring Action Program that is designed to provide more supportive, collegial and discipline-specific training for students. This plan defines also a new tutorial role for professors as personal mentors of students. The aim of this paper is to present the new methodology used for the implementation of the Tutorial Action Plan which includes the assignment of this new role attributed to professors, and that consist in advising and guiding the students in those questions that may arise throughout the university degree, as well as advising students to do those things that are most appropriate for their profiles relative to their future labor orientations.

ResumenObjetivoEstimar el coste de la dependencia y su financiación. En particular, determinar el copago de los usuarios tras la modificación introducida por la Resolución de 13 de julio de 2012, según el grado de dependencia y la comunidad autónoma de residencia.MétodosSe estimó el grado de dependencia a partir de la Encuesta sobre Discapacidades, Autonomía Personal y situaciones de Dependencia de 2008. El coste de la dependencia por grado y comunidad autónoma se calculó a partir de la información del Sistema para la Autonomía y Atención a la Dependencia. El copago se calculó a partir de la renta de las personas dependientes. La valoración monetaria de los servicios y la aportación de los usuarios se hizo de acuerdo a la normativa de 2012 y con indicadores de referencia comunes para todo el territorio nacional.ResultadosEl coste total estimado en 2012 es de 10.598,8 millones de euros (1,03% del producto interior bruto), y son Andalucía, la Comunidad Valenciana y Cataluña las que mayores cuantías presentan. El porcentaje del copago medio nacional por usuario es del 53,54%, con diferencias por grados y comunidades autónomas, aunque en general los usuarios financian más de la mitad del coste de las prestaciones en todas ellas.ConclusionesEl cambio legislativo ha supuesto que el copago sea superior al tercio inicial establecido en la Ley y a los copagos anteriores a 2012, que eran en torno al 20%. Si a ello se añaden las diferencias por comunidades autónomas, sería conveniente reflexionar acerca de la desigual aplicación de la Ley.AbstractObjectiveThe objective of this piece of work is to establish the cost of dependency and the cost of financing it. Specifically, we will determine the cost of co-payment for individual users following the modification introduced by the 13th of July 2012 Resolution as well as its allocation by the autonomous regions.MethodsThe degree and level of dependency was established using the Survey on Disability, Personal Autonomy and Dependency Situations, 2008. The cost of dependency according to degree and level and autonomous regions was established with information from the System for Personal Autonomy and Care of Dependent Persons. The co-payment was established according to applicants’ purchasing power. The rating of these services, and the contribution of individual users were done in agreement with 2012 legislation and with common indicators and benchmarks for the whole national territory.ResultsThe total estimated cost is 10,598.8 million euros (1.03% of GDP), and Andalusia, the Valencian Community and Catalonia are those regions with the greatest costs. The average national co-payment per individual user is 53.54%, with differences due to degrees and levels of disability and autonomous regions, although, generally speaking, all of the users fund more than half of the care they receive.ConclusionsThis change in legislation has meant that co-payment is higher than the 33% established by this law and that co-payments prior to 2012 were about 20%. If we add to this the differences in autonomous regions, it would be useful to reflect on the uneven application of the law.

There is a growing interest in incorporating informal care in cost-of-illness studies as a relevant part of the economic impact of some diseases. The aim of this paper was to review the recent literature valuating the costs of informal care in a group of selected diseases from 2005 to 2015. We carried out a systematic review on the economic impact of informal care, focusing on six selected diseases: arthritis or osteoarthritis, cancer, dementia, mental diseases, multiple sclerosis and stroke. We selected 91 cost-of-illness articles. The average weight attributed to the informal care cost over the total cost was highly relevant for dementia, stroke, mental diseases, cancer and multiple sclerosis. The most frequent valuation method applied was the opportunity cost method, followed by the proxy good method. The annual cost of informal care presented a high variability depending on the disease and geographic location. Distinguishing by type of illness, the disease with the highest annual value of informal caregiving was dementia, followed by mental illness and multiple sclerosis. The average hourly unit cost was €11.43 (2015 values), varying noticeably depending on the geographic location. This paper identifies several aspects that should be enhanced to promote comparability between studies and countries, and it sends key messages for incorporating informal care costs to adequately measure the economic impact of diseases.

The objective of this piece of work is to establish the cost of dependency and the cost of financing it. Specifically, we will determine the cost of co-payment for individual users following the modification introduced by the 13th of July 2012 Resolution as well as its allocation by the autonomous regions.The degree and level of dependency was established using the Survey on Disability, Personal Autonomy and Dependency Situations, 2008. The cost of dependency according to degree and level and autonomous regions was established with information from the System for Personal Autonomy and Care of Dependent Persons. The co-payment was established according to applicants' purchasing power. The rating of these services, and the contribution of individual users were done in agreement with 2012 legislation and with common indicators and benchmarks for the whole national territory.The total estimated cost is 10,598.8 million euros (1.03% of GDP), and Andalusia, the Valencian Community and Catalonia are those regions with the greatest costs. The average national co-payment per individual user is 53.54%, with differences due to degrees and levels of disability and autonomous regions, although, generally speaking, all of the users fund more than half of the care they receive.This change in legislation has meant that co-payment is higher than the 33% established by this law and that co-payments prior to 2012 were about 20%. If we add to this the differences in autonomous regions, it would be useful to reflect on the uneven application of the law.

ResumenEsta investigación analiza la presencia y las implicaciones del cuidador informal en la Ley de Dependencia, así como los factores sociodemográficos y sociosanitarios asociados a que las personas dependientes puedan recibir dicho cuidado informal. Para ello se realiza un estudio transversal observacional a partir de una muestra representativa de la población baremada como dependiente en febrero de 2009, obteniéndose información de personas con gradosII y III de dependencia. Se identifica el peso y el perfil del cuidador informal mediante tablas de contingencia. Se estima un modelo de regresión logística binaria para identificar los factores asociados a la recepción de cuidado informal de las personas dependientes. Los resultados muestran que el cuidado informal ostenta un rol importante en la Ley de Dependencia, dado que el 80% de las personas dependientes recibe atención informal junto a la prestación de dependencia. La edad, el estado civil casado, el lugar de residencia, las variables de salud enfermedades del aparato circulatorio, musculoesqueléticas e insuficiencia respiratoria, y el tratamiento higiénico-dietético incrementan la probabilidad de recibir cuidado informal. La predilección inicial de la prestación de servicios sobre la económica queda desvirtuada en la realidad, reduciendo los potenciales nichos de mercado relativos a las prestaciones de servicios y su repercusión sobre el mercado laboral.AbstractThis research analyzes the presence and implications of informal care in the Law of Dependency, and socio-demographic and health factors associated to dependent people may receive informal care. A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with levelII and III of dependence. The weight and profile of informal caregiver is identified by contingency tables. A binary logit regression model has been estimated to identify those factors related to the reception of informal care. The results show informal care holds an important role in the Law of Dependency, since 80% of dependents receive informal care. Age, marital status, to live in rural area and cardiovascular, musculoskeletal and respiratory diseases, and hygienic-dietetic treatment increase the probability of receiving informal care. The initial preference for service delivery versus economic delivery is invalidated in reality, resulting in a reduction of potential niche markets on the supply of services.

Fundamento: El análisis del efecto que diferentes variables tienen en la institucionalización de las personas dependientes es un tema escasamente estudiado en España. El objetivo del trabajo es analizar qué factores sociodemográficos y del estado de salud pueden influir en la probabilidad de que la persona dependiente viva en una residencia. Métodos: Se realizó un estudio transversal de la población dependiente de la provincia de Cuenca, a partir de una muestra representativa de la población baremada como dependiente en febrero de 2009, obteniéndose información de personas con grados II y III de dependencia. Se estimó un modelo de regresión logística binaria para identificar los factores asociados a la institucionalización de las personas dependientes. Resultados: Los individuos con edades comprendidas entre 65 y 74 años tienen prácticamente 6 veces más probabilidad de estar institucionalizados, frente a no estar institucionalizados, que los de edades inferiores a 65 años; probabilidad que aumenta hasta 16 veces para individuos de edad igual o superior a los 95 años. Vivir en zona urbana multiplica por 3 la probabilidad de institucionalización frente a residir en zona rural. Las personas que siguen tratamientos farmacológicos, tratamientos psicoterapéuticos, o tratamientos rehabilitadores, tienen entre 2 y 4 veces más probabilidad de estar institucionalizados que las que no los siguen. Conclusiones: La edad, el estado civil casado, el lugar de residencia, las variables de salud enfermedades del aparato circulatorio y musculoesqueléticas, y los cuatro tipos de tratamiento a seguir se convierten en las principales variables asociadas a la institucionalización de personas dependientes.

The Law of Dependence keeps the informal caregiver´s role, incorporating a specific economic benefit. The aims of this work are 1) to analyze the effect of the Law on informal care existence, and 2) to value the economic impact in the Law, disaggregated by financier.A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with level II and III of dependence. A care service delivery simulation is used to quantify the economic impact of informal care to Cuenca (sample), Castilla-La Mancha and Spain.Informal care delivery is assigned in 81,74% of dependency benefits. Total costs of care service delivery is reduced between 36,51% and 80,53% if informal care exits, disaggregated into savings of 122,97-251,04% for user and 23,30-54,47% for public administration. Average estimated copayment for user is 13,25% for real sample, and it rises to 25,77% when it is supposed informal care extinguishes.Informal care is widespread in the Law, and it implies an important household and public resources saving: for household due to the assumption a smaller copayment that theoretical established, which is assumed by Autonomous Communities; in turn, for public administration, because of the fact economic deliveries require fewer resources.

Fundamento: La Ley de Dependencia reconoce formalmente el papel del cuidador informal, incorporando una prestación económica para el mismo. El objetivo del trabajo es analizar el efecto de la instauración de la ley sobre la existencia del cuidado informal y evaluar el impacto económico de dicho cuidado en la ley dependiendo del financiador. Métodos: Se realizó un estudio transversal a partir de una muestra representativa de la población dependiente baremada de la provincia de Cuenca en febrero de 2009, obteniéndose información de personas con grados II y III de dependencia. Se cuantificó el impacto económico de la existencia del cuidado informal para Cuenca (muestra), Castilla-La Mancha y España mediante una simulación de prestaciones basada en el supuesto de no existencia de cuidado informal. Resultados: El 81,74% de las prestaciones de dependencia correspondió a la prestación diseñada para el cuidado informal. El coste total de las prestaciones de dependencia se redujo entre un 36,51% y un 80,53% debido a la existencia de cuidado informal, desagregado en un ahorro del 122,97-251,04% para el usuario y del 23,30-54,47% para el erario público. El copago medio estimado para el usuario fue de un 13,25% para la muestra, ascendiendo al 21,65-25,77% bajo el supuesto de extinción del cuidado informal. Conclusiones: El cuidado informal implica un importante ahorro de recursos familiares y públicos: los primeros al asumir un menor copago del teórico, trasladando dicha carga a las Comunidades Autónomas; los segundos, por el menor coste que suponen las prestaciones económicas respecto a las prestaciones de servicios.

To analyze the relationship between sociodemographic and health variables (including informal care) and the healthcare service delivery assigned in the individualized care plan.An observational cross-sectional study was conducted in a representative sample of the dependent population in Cuenca (Spain) in February, 2009. Information was obtained on people with level II and III dependency. Four different logistic regression models were used to identify the factors associated with the care service delivery assigned in the individualized care plan. Independent variables consisted of age, gender, marital status, annual income, place of residence, health conditions, medical treatment, and perception of informal care.A total of 83.7% of the sample was assigned economic benefits and 15.3% were assigned services. Eighty percent of the sample received informal care in addition to dependency benefits. People who received informal care were 3239 times more likely to be assigned economic benefits than persons not receiving informal care.For the period analyzed (the first phase of the implementation of the Dependency Act), the variables associated with receiving economic benefits (versus services) were being married, having a high annual income, the place of residence (rural areas versus urban area), and receiving hygiene-dietary treatment and informal care.

The analysis of the effect that different variables have in the probability that dependent people are institutionalized is a topic scantily studied in Spain. The aim of the work is to analyze as certain socio-demographic and health factors can influence probability of dependent person living in a residence.A cross-section study has been conducted from a representative sample of the dependent population in Cuenca (Spain) in February, 2009. We have obtained information for people with level II and III of dependence. A binary logit regression model has been estimated to identify those factors related to the institutionalization of dependent people.People with ages between 65-74 years old are six times more likely to be institutionalized than younger people (65 years old); this probability increases sixteen times for those individuals with ages equal or higher than 95 years. The probability of institutionalization of people who live in an urban area is three times the probability of people who live in a rural area. People who need pharmacological, psychotherapy or rehabilitation treatments have between two and four times more probability of being institutionalized that those who do not need those.Age, marital status, place of residence, cardiovascular and musculoskeletal diseases and four times of medical treatment are the principal variables associated with the institutionalization of dependent people.

Recent decades reveal increasing academic and practitioner interest in improving corporations social and ethical reputations. Efforts to promote ethics usually focus on the implementation of explicit, formal mechanisms, aimed at transmitting ethical and moral content and reflecting an interest in behavioural ethics. Although the efficacy of these mechanisms has been demonstrated, such efforts may fail if ethics does not exist in reality in the normal procedures and operations of the firm and in the treatment employees perceive from their employers. Organizational justice is an antecedent of ethical behaviour, though most research depicting this link has centred exclusively on assessing (un)ethical behaviours directed toward the organization. Other insights, however, might suggest a relationship between organizational justice perceptions and general ethical behaviour; therefore, this study conducts an empirical examination of survey data from 436 Spanish banking employees to discern their perceptions of organizational justice by top management and whether these perceptions are related to general ethical/unethical behaviours. Findings, finally, reveal that such perceptions have positive effects on workforce general ethics. That is, actions and efforts by top management that signal organizational justice can help promote ethics among a wider workforce. These findings have substantial practical implications, as well as insights for further research.

Higher education is constantly changing and looking for innovative educational solutions in order to increase the level of the students knowledge and skills. As an important part of this set of educational policies, a new process is emerging for the ideation, planning and implementation of multidisciplinary case studies for students with the aim of developing their knowledge, meaning learning, skills and abilities that necessary for a more complete picture of the problems. In this regard, this paper shows the main results obtained with the realization of joint innovative activity experience developed by multidisciplinary areas in the Business Administration Degree (Management, Corporate Finance and Statistics). This joint activity was proposed on a voluntary basis for those students interested in working in a complete practice with other students and also as a way of replacing the individual activities of each area of knowledge. Fourteen groups of 4-5 people have done this case study, on average, the percentage of participation is about 70% of the students. The design of this methodology with an evaluation system implies students receive a significant percentage of their continuous evaluation. Also, it has allowed the students to achieve at a practical level, the how to and knows how (versus levels, ordered from low to high level of knowledge: dos, shows how, knows how and knows) of a particular set of generic and specific skills.