How Corruption Influences Population Health

The study examines the link between corruption and mortality.

The authors find that corruption is associated with higher mortality, particularly in low-income countries. Corruption is also linked with weaker fiscal capacity, reduced government funding for health care, distorted resource allocation, and patterns consistent with misallocation of public funds. Additionally, the association between corruption and mortality varies across levels of public goods provision.

The study draws on country-level data from 102 countries spanning 2008-2018. They use econometric methods, including instrumental variables and the Mundlak approach. To mitigate endogeneity concerns, they employ an instrumental variable approach based on ancestry and oral tradition, using historical cultural factors plausibly related to contemporary corruption levels.

The study expands existing research on social determinants of health by highlighting the relevance of institutional and political factors for population health. Addressing corruption could be recognized as a public health priority, given its association with health financing and population health. The Sustainable Development Goals on combating corruption and improving health are found to be complementary. 

KYRIOPOULOS, I., MINOS, D., VANDOROS, S. and MOSSIALOS, E. (2026), How Corruption Influences Population Health. Milbank Quarterly., 104: 198-219. 

Open Access Article (2026)

photo Jordi Soldevila. Iteracions de la realitat en negre

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The future hospital in Global Health Systems

Future hospitals must be able to adapt in many ways to the changing demands on their roles and functions within evolving healthcare delivery infrastructures. These include changing population structures and needs, new models of healthcare provision, technological advances, and innovations in design, all while enhancing their environmental sustainability.

This article sets out the issues that those determining healthcare policy and designing future hospitals must consider if they are to become and remain fit for purpose within the wider health and social care system. It also examines the need for, and challenges to, strategic healthcare planning, creating future hospitals that are sustainable, net‐zero carbon organisations, and ensuring resilience in the face of a range of potential shocks.

Future hospitals play a crucial role in healthcare worldwide, regardless of the country's income level. Hospitals cannot be viewed without broader health system changes, infrastructure, community and cultural factors, staffing and other considerations. Future hospitals will enhance population health in all settings and support the move towards more consumer‐centric healthcare. The authors urge clinical and policy planners to consider the factors discussed carefully to maximise the benefits.

Article (2025) open access

Sebire NJ, Adams A, Celi L, Charlesworth A, Gorgens M, Gorsky M, Landeg O, Nagasawa Y, Nimako KT, Onoka C, Roder-DeWan S, Watts N, McKee M. The Future Hospital in Global Health Systems: The Future Hospital Within the Healthcare System. Int J Health Plann Manage. 2025 May;40(3):741-751. doi: 10.1002/hpm.3891. Epub 2025 Jan 15. PMID: 39815953; PMCID: PMC12045726.

Photo Jordi Soldevila. Posidònies. Cicatriu 1

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When you see your neighbor's beard peeling, soak yours.

The NHS turns 77 this year 2025. Until recently, it has been widely regarded as the “crown jewel” of the British welfare state. Throughout its history, the NHS has achieved significant successes, including providing financial protection against the costs of ill health, incorporating formal assessments of new medical technologies, and delivering generally well-received care once accessed. Moreover, the NHS has been a driving force in medical research and innovation, pioneering advancements in treatments, healthcare delivery, and disease prevention. However, over a decade of austerity funding, compounded by the impact of the COVID-19 pandemic, has exposed its vulnerabilities. The NHS has shown limited resilience to external shocks and appears increasingly unsustainable in the face of growing demand.

Waiting lists are at an all-time high, population health outcomes in the UK are worsening, staff shortages and dissatisfaction remain persistent, and public confidence in the institution is wavering. In short, the NHS is in crisis.

The Labour government has increased NHS funding, but not to a level that several experts—including the LSE-Lancet Commission—deem sufficient to meet rising demands. The government has also announced a new 10-year plan. But will these measures be enough?

This event organized by the LSE last june explored the current state of the NHS, assessed whether the government's responses are adequate, and discussed whether more radical reforms are necessary. The discussion provided both critical reflection and potential solutions to address the crisis.

• Podcast to listen to.
• Video of the event to watch
• Slides and Speakers: to download here.

Photo Jordi Soldevila. Homenatge a Toni Catany Mandarina

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Marmot places. An initiative that must be implemented in Catalonia

"Social Injustice is killing people on a grand scale’. (M.Marmot)

Health inequalities are the systematic differences in health between social groups. Where they are judged to be avoidable differences they are inequitable, unfair. 

Putting them right is a matter of social justice. Reducing these inequities requires actions to improve the social determinants of health – the social, economic, political, physical and cultural conditions that shape our lives and our behaviours.

 
The UCL Institute of Health Equity  established in 2011 and being led by Professor Sir Michael Marmot leads and collaborates on work that addresses the social determinants of health and improves health equity. The IHE created the concept of Marmot Places. 

A Marmot Place recognises that health and health inequalities are shaped by the social determinants of health (SDH) and takes action on these social determinants at a local level. 

Sometimes called the building blocks of health, these social determinants are the conditions in which people are born, grow, live, work and age, such as education, employment and housing, and lead to wide differences in people’s health and in their life expectancy. Many places across England and Wales have become Marmot Places putting health equity at the heart of their local strategies.

Becoming a Marmot Place: 

Marmot Places develop and deliver interventions and policies to improve health equity based on eight principles:

1. Give every child the best start in life. 
2. Enable all children, young people and adults to maximise their capabilities and have control over their lives. 
3. Create fair employment and good work for all. 
4. Ensure a healthy standard of living for all. 
5. Create and develop healthy and sustainable places and communities. 
6. Strengthen the role and impact of ill health prevention. 
7. Tackle racism, discrimination and their outcomes. 
8. Pursue environmental sustainability and health equity together.

Article: Public health and health inequalities: a half century of personal involvement Michael Marmot Journal of Public Health, 2022

LSE Health's Annual Lecture:: Social justice and health equity March 2025, M.Marmot

 

Photo Jordi Soldevila. Geometries de la injustícia II

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València. Building Disaster Resilience: A Systems Approach to Leadership Communication

 

This commentary published by Rand  by Millard McElwee and Monika Cooper last November the 4th (2024), can serve the Spanish authorities (local, autonomous communities and national) to reflect on how to improve the communication of possible disasters such as the one that occurred in València.

Some thoughts: 

"The future of disaster resilience requires us to learn from past political failures, such as the response to Hurricane Katrina, where the lack of clear communication and cohesive narratives deepened mistrust and fragmented communities. 

The inability to align messages across federal, state, and local levels not only delayed critical aid but also exposed the consequences of failing to address social and political divides. 

To move forward, policies must integrate AI and green infrastructure with a focus on rebuilding trust through transparent, unified narratives that guide communities in understanding risks and empowering them to act. Only by bridging these divides can the resilience needed to confront future climate threats be built".

Acces to the commentary: Building disaster resilience

Photo Jordi Soldevila. Geometries de la injustícia

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What builds good health? An introduction to the building blocks of health

Health is our most precious asset. Good health and wellbeing enable us to live happy, fulfilling lives and free us up to achieve our potential, supporting positive social and economic outcomes for individuals and society. But we don’t all have the same opportunities to live healthy lives. Right now, in our country, some people are dying years earlier than they should. This isn’t inevitable. There is much we can do to reduce these unfair differences by improving the things that underpin our health.

Many aspects of our lives impact our health and how long we live. These include our jobs and homes, our access to education, public transport and safe green spaces with clean air, and whether we experience poverty or discrimination. These things are often referred to as the ‘wider determinants of health’, and they are all essential building blocks of our health.

Building a healthy society is like constructing a building. To succeed, we need all the right blocks in place. The building blocks of health are: the food we eat; the work; the family, friends and communities; the transport; the housing; the money and resources; the education and skills; and the surroundings.

The The Health Foundation from the UK has published a guide that it is a brief introduction to the building blocks of health. It explains how a person’s opportunity for health is influenced by much more than the NHS, and why people in the UK don’t all have the same chance to be healthy. It also sets out how action to strengthen the building blocks of health can lead to improvements in the health of the whole population, for the benefit of individuals, society and the economy.

Guide (pdf)

Photo Jordi Soldevila. Èxode. Geometries de la injustícia

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Human resources in the National Health System. SESPAS Report 2024 (part 3)

The Spanish Society of Public Health and Health Administration publishes in Gaceta Sanitaria its biennial SESPAS 2024 Report, which shows a series of artices analysing the current situation of the National Health System in terms of Human Resources.

• Pay for performance in public directly managed healthcare centers. Part 1: General framework.  José-Ramón Repullo y JM Freire

• Pay for performance in public directly managed healthcare centers. Part 2: The Spanish National Health System.  José-Ramón Repullo y JM Freire

• Dual practice in the Spanish health system: problem or solution? Ariadna García-Prado, Paula González

• Recruitment, selection and retention of health professionals in indirect management and private management entities Olga Pané Mena y Pau Gomar Sánchez

• Health and well-being of healthcare workers: employment and working conditions beyond the pandemic Fernando G. Benavides et. al

Video: Rosa Urbanos entrevista a J.R.Repullo y J.M Freire

Video: Vicente Ortún entrevista a R.Meneu, O.Pané, P. González, P.Gomar 

Photo Jordi Soldevila. Geometries de la injustícia. Navalni

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Back to basics. Victor Fuchs (1924-2023)

Victor Fuchs was the Henry J. Kaiser, Jr., Professor of Economics and of Health Research and Policy, emeritus in Standford University.

He used economic theory to provide a framework for the collection and analysis of healthcare data. He wrote extensively on the cost of medical care and on determinants of health, with an emphasis on the role of socioeconomic factors. He spent more than five decades diagnosing the ills of the American health system, specially the health costs per capita: "The highest in the world". He also was particularly interested in the role of physician behavior and financial incentives in determining healthcare expenditures.

He was described as the dean of American health economists,

Standford obituary

Victor_Fuchs-CV (pdf)

Photo by Becky Bach

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Health Care 2030: the transition from hospital-based systems to primary care, community, and social care–based systems.

Health Care 2030: The Coming Transformation (2021) by Eyal Zimlichman, Wendy Nicklin, Rajesh Aggarwal, and David W. Bates

The problems in our health care systems include subpar quality and patient safety, a misplaced focus on acute care rather than on prevention and population health, inadequate person centeredness, and unsustainable cost.

The next decade will see considerable transformation in how health systems are designed, propelled by opportunities such as digital health, growing consumerism, and mounting financial constraints.

The Covid-19 pandemic has also necessitated and accelerated significant transformations.

The authors discuss gaps and barriers in the current design of health and health systems, and the needed escalation of transformation including transition from hospital-based systems to primary care, community, and social care–based systems.

They also assess the future evolution of payment systems leading toward sustainable health, changes in provider roles, and the entrance of new nontraditional players

Photo Jordi Soldevila. Homenatge a Toni Catany Austeritat

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Health is wealth? Can we substitute UK by Catalonia or Spain?

Andrew Haldane, Chief Executive of the RSA and former Chief Economist at the Bank of England, was invited by the REAL Centre to deliver the 2022 REAL Challenge lecture to generate fresh ideas and debate.

Health is wealth? explores why health is best seen as a societal asset before outlining some of the ways in which the resilience of health outcomes and systems might be strengthened for the benefit of all.

The UK continues to feel the consequences of the COVID-19 pandemic, both through its impact on the nation’s health, as well as the prolonged impact on the UK economy. The lecturer drew lessons from the pandemic and argued for a more holistic economic growth strategy where health and wealth are inextricably linked.

He believes... "the UK is suffering from a weakened, and weakening, societal immune system. As with biological immune systems, this is constraining both our capacity to grow and our resistance to shocks. A weak societal immune system explains why the UK has suffered anaemic growth, has been more prone to shocks and why it has had longer subsequent periods of convalescence than elsewhere – and than in the past. This weakened societal immune system in turn reflects a prolonged period of underinvestment in the sub-systems we rely on for growth and strength: from education and health care to housing and communities, to skills and innovation.

Rebuilding the resilience of these sub-systems holds the key to a strengthened societal immune system overall and, with it, improved growth, greater shock resistance and higher wellbeing for individuals. As society’s sub-systems are tightly coupled, each needs to be strengthened to secure system-wide success. The UK’s health system’s lack of resilience has contributed to the UK’s weakened immune system. But without a strengthening of other economic and social systems this, while necessary, will by itself be insufficient to strengthen society’s immune system".

How this resilience might be bolstered? He proposes a set of directions of travel for policy debate.

• Mesurement
• Stress testing
• Devolution
• Policy integration
• Placemaking
• Food standards
• Education
• Business
• Fiscal finance
• The social safety net

Article (pdf)  
Slides and Video


Photo Jordi Soldevila. Els Monstres d'Ingres. L'hivern

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Back to basics: Michael Grossman

The Health Economics journal publishes the Michael Grossman editorial related to the 50th anniversary of the publication of the demand for health model in “On the Concept of Health Capital and the Demand for Health,” Journal of Political Economy 80(2): 223–255, and in The Demand for Health: A Theoretical and Empirical Investigation, NBER Occasional Paper 119 New York: Columbia University Press for the NBER.

The editorial focuses on the history of the model and its impacts on the field of health economics.

Editorial:  The demand for health turns 50: Reflections Michael Grossman

Michael Grossman and the Demand for Health Model

The Demand for Health introduced a new theoretical model for determining the health status of the population. His work uniquely synthesized economic and public health knowledge and has catalyzed a vastly influential body of health economics literature.

The demand for health is somewhat more complicated than the demand for a typical product. Here, the individual demands health and not health care. The demand for health care is, therefore, a derived demand.

The central idea behind Grossman’s model of demand for health is how age, education, health status, income etc. affect the production of health through the demand for health capital. Michael Grossman defined health both as a consumption good as well as a production good. He provided two reasons behind this; one health is consumed directly i.e. people are happier when they are healthier. Second, health is an investment i.e. good health permits people to do other things. Thus, the individual is both the consumer and the producer of health.

This model introduces the idea of investing in human capital (health and education) to improve outcomes in both the market (work) and non-market (household) sectors. The goal is to improve the earnings. Health is characterized as a capital good because it can be seen as lasting over time periods and depreciating at a non-constant rate.

Grossman bases his approach on Gary S. Becker's household production function model and his theory of investment in human capital. Consumers demand health, which can include illness-free days in a given year or life expectancy, and then produce it through the input of medical care services, diet, other market goods and services, and time.

Grossman also treats health and knowledge as equal parts of the durable stock of human capital. Consumers therefore have an incentive to invest in health to increase their earnings in the future. 

Grossman examines complementarities between health capital and other forms of human capital, the most important of which is knowledge capital earned through schooling and its effect on the efficiency of production.

He concludes that the rate of return on investing in health by increasing education may exceed the rate of return on investing in health through greater medical care. Higher income may not lead to better health outcomes, as wealth enables the consumption of goods and services with adverse health effects.

photo Jordi Soldevila. Homenatge a Toni Catany. Ampolles silencioses  

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Recessions and health

Recessions are complex events that affect personal health and behavior via various potentially opposing mechanisms. While recessions are known to have negative effects on mental health and lead to an increase in suicides, it has been proven that they reduce mortality rates.

A general health policy agenda in relation to recessions remains ambiguous due to the lack of consistency between different individual- and country-level approaches. However, aggregate regional patterns provide valuable information, and local social planners could use them to design region-specific policy responses to mitigate the negative health effects caused by recessions.

Pros

1. Substantial country-level research shows that mortality declines (i.e. people live longer) during recessions.
2. Recessions can make more time available for individuals to lead a healthy lifestyle.
3. Motor vehicle deaths have been shown to decrease during recessions.
4. Some studies suggest that during recessions the stigma of being unemployed decreases.

Cons

1. A plethora of individual-level studies show that recessions lead to adverse mental health, especially for working-age and low-income people.
2. The number of suicides appears to increase during periods of recession.
3. Income loss due to recessions decreases investments in health-enhancing goods and services.
4. Austerity measures that may be common during recessions, such as budget cuts to social welfare, mainly affect vulnerable population groups and the long-term unemployed.

AUTHOR’S MAIN MESSAGE

Evaluations of the health-related impacts of economic recessions have shown inconsistent results. However, if recessions cause a greater deterioration in individuals’ mental health and a larger number of suicides, then governments should be motivated to work even harder to recover the world’s economies after downturns occur. 

Governments should acknowledge that the potential impact of recessions on people’s health depends on the extent to which people are protected from vulnerability. Welfare policies, such as labor market programs, debt relief programs, and access to health and mental health services, should thus play a significant role as a mediator in the relationship between recessions and health.

Nick Drydakis Professor in Economics and Director of the Centre for Pluralist Economics, Anglia Ruskin University, UK 

Article

photo: Joan Miró Couple d'amoureux aux jeux de fleurs d'amandier

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Economic leaders call for gender equality in pandemic recovery, june 2021

"Only if we seize on this opportunity to prioritise gender equality can we build a more prosperous world for all"

LSE Director Minouche Shafik has joined leaders from the International Monetary Fund, European Central Bank, World Trade Organisation, European Commission and United Nations to call on governments around the world to prioritise gender equality as they seek to recover from the economic impact of COVID-19.

The statement, published by LSE and shared by the Bill and Melinda Gates Foundation, has been signed by:

• Kristalina Georgieva, Managing Director of the International Monetary Fund
• Christine Lagarde, President of the European Central Bank
• Ursula von der Leyen, President of the European Commission
• Ngozi Okonjo-Iweala, Director-General of the World Trade Organisation
• Minouche Shafik, Director of The London School of Economics and Political Science;
• Vera Songwe, UN Under-Secretary General and Executive Secretary of the Economic Commission for Africa.

Within the statement, these leading figures highlight how women and girls from all parts of the world – both rich and poor – continue to face significant inequality, and bear the heaviest cost in times of economic hardship:

“From accepting gender pay gaps, to neglecting childcare, governments have not prioritised their needs. The result is a feeble, patchwork economic infrastructure - particularly in fields such as caregiving, retail, and tourism, where women are disproportionately represented - that leaves women struggling...

This inequality, they argue, has made countries weaker when faced with a crisis like a pandemic. But the response to COVID-19 also provides an opportunity to accelerate progress towards gender equality, and build stability and opportunity for everyone.

Three key policy areas
The statement calls for governments to focus on three key areas, “…to ensure that economic recovery prioritises women and girls, underpins an inclusive future, and ensures the world is prepared to withstand the next crisis.”

1. Governments must ensure that money, stimulus efforts, and social protection schemes get directly into the hands of women.
2. Countries must close gender data gaps and strengthen monitoring, evaluation, and data systems to support more effective public policy.
3. Governments must reduce the burden of unpaid care work and support better childcare to strengthen women’s labor force participation.

The statement concludes with a warning, “We have no time to waste … The risks of inaction cannot be overstated. Refusing to economically support women and girls will not just set this recovery back, it will leave our economies more vulnerable to future shocks.

Acces to the Full Statement (pdf) 

photo: Salvem lo Montsià rocblackblock

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false optimism not to be at risk of COVID-19

 

 

 

 

 

Koula Asimakopoulou et al. from King’s College London investigated comparative optimism for infection and recovery from COVID-19, and the implications this may have on the second wave and the possible lockdown. The study found that during the first lockdown period, most respondents believed that compared to others, they were unlikely to be at risk of COVID-19.

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. The paper reports UK data.

They found the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Researchers believe that comparative optimism may have brought out the anecdotally observed, lack of compliance with lockdown guidelines in the UK. People who believe COVID‐19 is less likely to happen to them than to others may infer that their actual risk is much smaller than that communicated in the media, and thus the strict adherence to lockdown restrictions is unnecessary in their case.

The results showed how participants overwhelmingly believed that as compared to people of their age and gender, they were somewhat or extremely unlikely to have accidentally infected people with COVID‐19 in the past and to infect others or get infected themselves in the next month. They were also comparatively optimistic, but to a lesser extent, about their likelihood of getting hospitalized due to COVID‐19, finding themselves in an ICU, being ventilated, and making a full recovery.

In contrast, participants showed comparative pessimism about COVID‐19 infections in the more distant future. As compared to the average person of their age and gender they felt likely to get infected by COVID‐19 in the next year and to develop COVID‐19‐related symptoms. The authors argued that this finding supports earlier research that shows that people who have experienced some ill health tend to unduly exaggerate their future risk of experiencing further ill health. One important difference between COVID‐19 and other risks is that controlling the pandemic was very much placed in the hands of individuals restricting their lives in the UK—as seen in the slogan urging people to ‘Stay at home’. It is reasonable that participants would reason that in the long term, staying at home would be less possible, plausible or practical. Feeling that compliance with social distancing rules cannot be maintained indefinitely may thus explain these perceptions, in line with research showing that high prevalence negative events may engender comparative pessimism.

The implication for a second lockdown is that where people's experience so far may be that they have not been ill with COVID, they are likely to be even more comparatively optimistic than they were in March. Thinking that COVID has not happened to you so far so it is unlikely to happen to you now, can be even more dangerous than it was earlier in the spring. Both comparative optimism and comparative pessimism may have important consequences for people’s psychological well‐being and their likelihood of engaging in risk behaviours or responding to further lockdown measures.

Acces article (pdf free) Comparative optimism about infection and recovery from COVID‐19; Implications for adherence with lockdown advice

photo: Càpsules de confinament. Museu Can Framis Fundació Vilacasas. 2020 

Obra 'Sense títol' d'Eulàlia Valldosera, (Vertical)

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stay at home

 

Image: Milo Manara 2020
https://www.milomanara.it/?lang=en 
Milo Manara is an Italian comic book writer and artist.
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poverty and health

Michaela Benzeval et al. published in 2014 in The Joseph Rowntree Foundation the report How does money influence health?

The study explores the association between income and health throughout the life course and within families. Researchers reviewed theories from 272 wide-ranging papers, most of which examined the complex interactions between people’s income and their health throughout their lives.

The research identifies four main ways money affects people’s wellbeing:

1. Material: Money buys goods and services that improve health. The more money families have, the better the goods they can buy.
2. Psychosocial: Managing on a low income is stressful. Comparing oneself to others and feeling at the bottom of the social ladder can be distressing, which can lead to biochemical changes in the body, eventually causing ill health.
3. Behavioural: For various reasons, people on low incomes are more likely to adopt unhealthy behaviours – smoking and drinking, for example – while those on higher incomes are more able to afford healthier lifestyles.
4. Reverse causation (poor health leads to low income): Health may affect income by preventing people from taking paid employment. Childhood health may also affect educational outcomes, limiting job opportunities and potential earnings.

These pathways are all likely to be important and interact across people’s lives in a complex web of links between income and health. The broader context is also important. Living on a low income in a country with a well-developed welfare state is unlikely to have the same health-damaging effects as living in one with poorer provision for healthcare and education.

Given this complexity of interconnection between people’s income and health, a broad approach to improving the health of those with limited resources is important.
Acces full report

photo: Toni Catany

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The Spanish National Health Service: chinese porcelain

 

The principles and goals of the Spanish National Health System focus on universality, free access, equity and fairness of financing. The evolution of performance measures over the last decade shows the resilience of the health system to the recent economic crisis. In terms of mortality and self perceived health it does not seem to have affected heavily at least in the sort term, although some structural reforms may be required in the medium and long term, specially to avoid the increasing income inequality, poverty, and risk of social exclusions that worsen the health indicators.

Here we have some ligth about some policy iniciatives and reforms that experts said should be adressed in the Spanish National Health System

• Cuadernos Económicos de ICE  scientific journal edited by the Secretariat of State for Trade (Government of Spain) since 1977. The current issue published in january 2019. Eight articles written by well known researchers from health economics and public health reviewing these hot topics: 

1. The arrival of new technologies with innovative mechanisms and health financing decisions.
2. Areas of public-private collaboration in health systems. focusing on continuing medical education, health research and health care management.
3. The healthcare management, its quality and the consideration of the impact of this quality on health outcomes.
4. The hospital expenditure and hospitalization evolution in the Spanish National Health System (SNS), during the period 2004-2009 and 2010-2015, analyzing their trends and medical practice variability between health areas.
5. Coordination between the health care system and the long-term care system.
6. Public health go beyond the performance of health care services. Health problems are global and require actions at a global level.
7. Good governance is a prerequisite for changing the health policy and the design of the National Health System in the right direction. Good governance in terms of: prioritization, comprehensive health policy, leadership, national health agency, and cultural and intellectual environment.
8. Economic crisis and health: lessons learned and recommendations for the future,

  Acces Full issue (pdf)  CICE Issue (2018)

• The European Observatory on Health Systems and Policies released a new health system review (HiT) on Spain.

Acces (pdf) Spain HiT (2018)

photo: "Homeless", 2005. google search words: name of the 25th richest people in the world in 2004 by Forbes (Joan Fontcuberta)  
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10 years of The Catalan Institute for the Evaluation of Public Policies (Ivàlua)

The Catalan Institute for the Evaluation of Public Policies (Ivàlua) was created 10 years ago. It's a public institution depending of the Government of Catalonia. The board of trustees is made up of the founding Academic Institutions (UPF), public institutions (Ministry of the Vice-presidency and of the Economy and Finance, DIBA, CTESC, CIC)

Ivalua promotes the evaluation of public policies among the Catalan public administrations, non-profit entities that pursue objectives that are of public interest and among citizens in general,

The evaluation is a tool for improving government performance and democratic accountability. To accomplish its mission, Ivàlua is guided by the following strategic lines:

• Evaluation of public policies and advisory activities
• Training and generation of training resources
• Promotion and dissemination of evaluation

Ivàlua has traditionally and naturally specialised in social policies, employment policies and educational policies (in this field jointly with Fundació Jaume Bofill they are promoting the #WhatWorks in Education movement)

All the activities done during these 10 years have been done with Independence, Technical Rigor to generate evidence and with maximum Transparency at all times. In their website you can download all the Evaluations carried.

Congratulations!!!

photo: Ivalua Team; Marc Balaguer, Mireia Climent, Núria Comas, Marçal Farré, Laura Kirchner, Jordi Miras. Erika Pérez, Ramon Sabes-Figuera, Jordi Sanz, Anna Segura, Federico Todeschini, Frederic Udina.
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think big... or better not: what the evidence says to hospitals' scale?

One important source of potential inefficiency in the hospital sector relates to hospitals’ scale and scope.

• Big Hospitals: It might make good economic sense to enlarge the size and scope of a hospital to make better use of available expertise, infrastructure and equipment. However, at some point, a hospital departs from its optimal level of efficiency and begins to exhibit diseconomies of scale. Bigger organizations are harder to manage.
• Small Hospitals: At the other end of the scale, small hospitals might also be inefficient because the fixed infrastructural and administrative costs are shared across too small a caseload, thereby pushing up the cost of an average hospital visit.

Monica Giancotti, Annamaria Guglielmo, and Marianna Mauro did a huge systematic review from the last 50 years (1964-2014) of research "published in peer-reviewed scientific journals" to try to answer some of these questions:

• Have mergers contributed to enhance hospitals efficiency?
• Which is the optimal size of hospitals in terms of beds?
• Which factors influenced the hospitals scale efficiency?

According to the evidence the main conclusions are:

1. Studies analysed that economies of scale are present for merging hospitals. Results supported the current policy of expanding larger hospitals and restructuring/closing smaller hospitals
2. In terms of beds, studies reported consistent evidence of economies of scale for hospitals with 200–300 beds. Diseconomies of scale can be expected to occur below 200 beds and above 600 beds.
3. There is no evidence that the increase in size may lead to outcome improvements.
4. Teaching activities are an important cost-driving factor,
5. Hospitals that have a broader range of specialization are relatively more costly.
6. According to ownership, public hospitals are more efficiently than other types.
7. According to location, urban hospitals used resources more efficiently.

Access to the Article (free): (2017) Hospital Size: Systematic Review

photo: 1957. Chicago The LIFE Picture Collection
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Back to basics: the 7 enemies of evidence-based policy

Evidence-based policy is focused on research-based evidence to inform policymakers about “what works” and thereby produce better policy outcomes.

Graham Leicester in his 20th century article - 1999- brings us a number of factors that he suggests inhibits the adoption of the evidence based policy



What we could do against them?

1. Recognise that these enemies are everywhere not only in the governing machine. In the universities, research centres, ... 
2. We live in a risk society and the whole society is a laboratory. All the things that happen are real life experiences with risky technologies, not experiments conducted in laboratory controlled conditions. That means that when they go wrong—and it is axiomatic in the scientific model that they must go wrong if progress is to be made—they do so for real. There needs to be a much closer relationship therefore between government and research evidence. 
3. The political management of the evidence in our ‘risk society’ is even more important than the evidence itself. Researches have an obligation not only to be as rigorous as possible, but also to recognise that their research has a political dimension. What they choose to investigate, how and when they present the findings are part of the risk management process. They are all agents of change.
4. Technological advance is giving a new opportunities to get to grips with complexity. The increase in processing capacity makes all sorts of things possible in the management of complex systems. There is now a capacity for instant information gathering and analysis which makes all policy into a continuous real-time experiment. The researcher’s role will be to monitor, evaluate and adjust continuously. 
5. We must work harder to develop better data, and true indicators of what really matters to us as a society. We need data that answers the question ‘why’ as well as ‘how much’ or ‘how many’? We need indicators which can stand proxy for the general health of society, measures of the vital signs.

It is important for researchers not only to gather the evidence to describe what is happening and how society is changing, but to provide explanations about why these changes are occurring, and then ideally to suggest things that might be done to adjust the system accordingly.

As a Citizens we want evidence-based policy NOT "policy-based evidence": where evidence is typically used as a weapon — mangled and used selectively in order to claim that it supports a politician’s predetermined position

Acces to the article (restricted): The seven enemies (1999)

photo: Game of Thrones. Jon Snow: You know nothing and Book
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