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Healthcare Utilization UNIVERSIDAD DE CANTABRIA PROGRAMA DE DOCTORADO DE ECONOMÍA: INSTRUMENTOS DEL ANÁLISIS ECONÓMICO TESIS DOCTORAL Ensayos en Economía de la Salud: Utilización Sanitaria Realizada por: JAVIER ISAAC LERA TORRES Dirigida por: DAVID CANTARERO PRIETO MARTA PASCUAL SÁEZ Escuela de Doctorado de la Universidad de Cantabria Santander, Noviembre 2020 2 UNIVERSITY OF CANTABRIA PHD THESIS Essays on Health Economics: Healthcare Utilization Author: JAVIER ISAAC LERA TORRES Supervisors: DAVID CANTARERO PRIETO MARTA PASCUAL SÁEZ Santander, November 2020 3 4 AGRADECIMIENTOS Quisiera que estas líneas sirvieran para expresar mi más sincero agradecimiento y gratitud a todas aquellas personas que a lo largo del proceso de realización de esta tesis doctoral me han apoyado. En primer lugar, me gustaría mostrar mi más sincero agradecimiento a mis directores Prof. Dr. D. David Cantarero Prieto y Prof. Dra. Dª. Marta Pascual Sáez. Sé que sin su apoyo, sus consejos y su paciencia no habría sido posible llevar esta tesis a buen puerto. Muchas gracias por haber confiado en mí en el Máster en Economía y por haberme descubierto el universo de la Economía de la Salud. Como bien sabéis, al principio tenía demasiadas ideas que quería explorar, vosotros me ayudasteis a centrarme en este precioso camino. Gracias por estar ahí y guiarme. Quisiera añadir que cualquier error dentro de esta tesis doctoral es en exclusiva responsabilidad mía. En segundo lugar, quiero expresar mi gratitud a todos mis amigos/as. Gracias a “Los de Siempre”: Marcos, Héctor, Mario, Jose, Carla, Patri, Alba y Rosa. Cada semana habéis estado ahí para sacarme una sonrisa y hacer que me evadiera en los momentos más duros de este camino. La verdad es que el simple nombre de “Los de Siempre” lo dice todo. Gracias por estar ahí. Gracias a ti también Adrián por todo tu apoyo, por estar en esos momentos de bajón, por todas nuestras charlas y debates. Has sido una fuente de apoyo y sobre todo de inspiración. No puedo tampoco olvidarme de vosotros Mario, Carlos, Ana, Javi Tapia y Javi Pozo. Cada uno en una esquina del mapa, pero ni siquiera esa distancia puede romper lo que construimos ese último año de carrera. Seguís siendo una importante fuente de apoyo, risas, reflexión, y de cariño. Muchas gracias, de verdad. Por último, me gustaría dedicar unas palabras a mis padres, Javier y Yolanda. Gracias por apoyarme, gracias por aguantar esos malos momentos, gracias por estar ahí, gracias por educarme como lo habéis hecho, sois los mejores padres que se pueden tener. Este logro también es vuestro. No me olvido de ti, Hugo. Para mí siempre serás un pequeñin, es una suerte tener un hermano como tú. Siempre entendiéndome, escuchándome y aguantándome. No te imaginas lo importante que eres para mí, hermano. 5 6 A mi querida familia, 7 8 TABLE OF CONTENTS Introducción ............................................................................................................................... 19 1. Objetivo y motivación general de la Tesis: Economía de la salud y utilización sanitaria .................................................................................................................. 19 2. Metodología y fuentes de información ............................................................ 20 3. Contribuciones de la Tesis: Grado de innovación ............................................. 21 Introduction ................................................................................................................................ 29 1. Purpose and general motivation of the Research: Health economics and healthcare utilization ................................................................................................................. 29 2. Methodology and Data ................................................................................. 30 3. Research contribution: Degree of innovation ................................................... 31 Chapter 1. Healthcare utilization barriers for the transgender and gender nonconforming (TGNC) community: A systematic literature review ................................................................. 39 1.1. INTRODUCTION ................................................................................... 39 1.2. MATERIALS AND METHODS ............................................................... 41 1.3. RESULTS ............................................................................................... 42 1.3.1. Healthcare settings in general ............................................................. 43 1.3.2. Transition related care ....................................................................... 44 1.3.3. HIV related care ................................................................................ 47 1.3.4. Primary care ..................................................................................... 47 1.3.5. Mental Health ................................................................................... 48 1.4. DISCUSSION ......................................................................................... 50 1.5. CONCLUSIONS ..................................................................................... 51 9 Chapter 2. Socioeconomic inequalities in the use of long-term care among European older adults. An empirical approach using the SHARE .................................................................... 55 2.1. INTRODUCTION ................................................................................... 55 2.2. MATERIAL AND METHODS ................................................................. 58 2.3. RESULTS ............................................................................................... 64 2.4. DISCUSSION ......................................................................................... 68 2.5. CONCLUSIONS ..................................................................................... 70 Chapter 3. Physical activity and healthcare utilization among European older adults. A multi- valued treatment effects analysis ............................................................................................... 73 3.1. INTRODUCTION ................................................................................... 73 3.2. MATERIAL AND METHODS ................................................................. 76 3.3. RESULTS ............................................................................................... 81 3.4. DISCUSSION ......................................................................................... 84 3.5. CONCLUSIONS ..................................................................................... 86 Chapter 4. How does a healthy diet affect the healthcare utilization? An empirical approach for European older adults .......................................................................................................... 89 4.1. INTRODUCTION ................................................................................... 89 4.2. MATERIAL AND METHODS ................................................................. 90 4.3. RESULTS ............................................................................................... 97 4.4. DISCUSSION ....................................................................................... 100 4.5. CONCLUSIONS ................................................................................... 102 10 Chapter 5. Healthcare utilization and healthy lifestyles among elderly people living in Southern Europe: recent evidence from the SHARE ............................................................................. 107 5.1. INTRODUCTION ................................................................................. 107 5.2. MATERIAL AND METHODS ............................................................... 110 5.3. RESULTS ............................................................................................. 113 5.1. DISCUSSION ....................................................................................... 117 5.2. CONCLUSIONS ................................................................................... 119 Chapter 6. Humanization in palliative care utilization through art: A Social Return on Investment (SROI) analysis of ProArt .................................................................................... 123 6.1. INTRODUCTION ................................................................................. 123 6.2. MATERIAL AND METHODS ............................................................... 127 6.2.1. Study design ................................................................................... 127 6.2.2. Stakeholders ................................................................................... 128 6.3. RESULTS ............................................................................................. 129 6.3.1. Impact map .................................................................................... 131 6.3.2 SROI calculation ................................................................................ 135 6.1. DISCUSSION ....................................................................................... 138 6.2. LESSONS LEARNED ........................................................................... 139 6.3. CONCLUSIONS ................................................................................... 140 Conclusiones ............................................................................................................................
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