[Health expenditure in Spain, 1995-2002. Primary care, the Cinderella of the National Health Service]

To find the share-out of the public health budget from 1995 to 2002 by health sector (primary care, hospital care, and drugs) in autonomous communities (AC) in Spain and the eventual inequalities related to regional level of income and population aging.

A longitudinal, retrospective study.

Spain.

The 17 AC in Spain.

The socio-economic and health care public expenditure data came from official bodies (Spain's Ministry of Health, the National Statistics Institute). The growth in expenditure was described and the relationship of this with the income and aging levels of the regions was analysed.

Hospital expenditure variables grew more (or decreased less) than those of primary care. The share of primary care in public health care expenditure fell twice as much as the hospital share. Per cápita and real expenditure in public hospitals grew 36% more than in primary care; and hospital staff expenditure grew 146% more than primary care staff expenditure. Hospital expenditure variables related positively to AC income, but did not relate to, or related negatively to, population aging. Primary care expenditure variables related to aging positively, but not, or negatively, to income. The richest regions spent less on drugs (r=-0.62, P< .01) and more on public hospitals (r=0.39, P=.12), but did not spend more on primary care (r=0.06). The regions with most aging spent more on primary care (r=0.37, P=.15) and on drugs (r=0.36, P=.16), but not on hospitals (r=0.06). Income level correlated very little with population aging (r=-0.17).

A weighting towards hospitals in the public health care budget between 1995 and 2002 was confirmed, especially in the richest regions.