The Catalan health budget rationing problem

Abstract

The financial and economic crisis in Spain during recent years has induced public budget adjustments. The crisis has caused a great social impact due to the way the austerity measures have been implemented, affecting mainly key economic sectors such as the civil service, justice, education and health. Among all of these sector, the current paper focuses on the health budget distribution, since the changes in the provision of the health services induce faster and clearer impacts in the social welfare. Spain is divided into 17 regions, and each region manages its own health system. Specifically, we analyse the Catalan health budget assignment since Catalonia is one of the most populated regions and one where the restrictions have been more evident. We study the health budget distribution for the period 1998-2014, from the point of view of the conflicting claims problem (O'Neill, 1982). Accordingly, alternative allocations of the health budget are proposed by using some of the most used solutions in the body of literature. Finally, in order to choose the most appropriate solution, we require the fulfilment of (i) some commonly accepted social constraints, (ii) some criteria of fairness and stability, and (iii) low inequality indexes. Keywords: Distribution problems; Health; Axiomatic analysis; Public budget