Equity in the Use of Health Care Services by Immigrants in the Spanish National Health Care System

The increasing proportion of immigrants in the Spanish society is creating pressures for the National Health Care System to accommodate the needs of this population group while keeping their costs under control. The Spanish health care system establishes that all people, regardless of their nationality, should be entitled to use health care services with the same conditions as Spanish citizens provided that they are registered in the local population census. Empirical evidence about differences in health status or utilisation between immigrant and Spanish-born population is however insufficient. This study uses the 2003 Spanish National Health Survey to explore whether non-Spaniards, for the same level of need, use health care services at the same rate as national citizens. The findings suggest that the nationality of an individual is an important predictor of health care utilisation, independent of other factors. These results may indicate horizontal inequity in the utilisation of health care with respect to nationality.

THU0547 ESTIMATION OF THE IMPACT OF A STRATEGY TO OPTIMIZE COSTS ON NATIONAL HEALTH-CARE SYSTEM IN PATIENTS WITH RHEUMATOID ARTHRITIS: A DIRECT COST ANALYSIS

Background:Rheumatoid arthritis (RA) is a disease associated with a high and increasing direct cost to the health-care resources. It is estimated that about 250,000 persons may have RA in Colombia. The characteristic joint damage and disability associated to RA increase slowly over many years (10–20 years).Objectives:To assess the development of RA in Colombian-population over the next five-years and to estimate the impact of a strategy to reduce direct-costs on the national health-care system.Methods:We use a population-based approach of epidemiological type to analyze the development of the disease over time. We design a continuous mathematical model for the transmission and evolution of RA in a population. The description of a biological phenomenon (disease), by differential equations is called mathematical modeling and allows us not only to study and analyze the dynamics of the disease, but also to predict its future development. The system is formed by eight ordinary differential-equations, explaining the influence of the epidemiological parameters considered in the evolution of RA. This mathematical modeling-approach has been extensively used to study the dynamical behavior of diseases in populations from an epidemiological point of view. The parameters of the mathematical-model are estimated using real-data from RA-prevalence. Total population was divided into eight groups as follows: general population, prevalent (at risk), pre-clinical (asymptomatic), symptomatic (tender/swollen joints), diagnosed without treatment (fulfilling classification-criteria), starting early treatment (before two years of symptoms), starting late treatment (after two years of symptoms), and chronic RA patients (disease duration more than 2 years). Numerical simulations allow to explain the RA-epidemiology and predict the disease over the next five-years.Results:In the next five-years there will be 129,000 new RA-patients in Colombia, with an estimated cost on the national health-care system of about $4125 million (USD). The analysis of the proposed mathematical model allows us to recommend an action-strategy to optimize and reduce direct-costs. The strategy is related to the implementation of the optimal clinical-diagnosis of RA and starting timely-treatment of patients with the most effective approaches available. Applying this strategy would allow the health-care system to reduce about 20% of its direct costs over the next five-years, reducing costs from $4125 million to $3337 million with estimated savings of $789 million. Figure 1Figure 1Comparison of direct-costs associated to rheumatoid arthritis over timeConclusion:We investigated the development of RA over the next five-years and were able to predict the number of new patients. The impact of the implementation of a strategy based on optimal-diagnosis and timely-treatment may reduce about 20% of its direct costs over the next five-years.Disclosure of Interests:None declared