[Health spending in Spain, 2002-2008. Does the Primary Care budget rescue begin?]

To determine the distribution of the public health spending (PHS) among health sectors from 2002 to 2008, and the eventual regional inequalities related to the regional income level and the ageing population.

A longitudinal and retrospective study.

Spain.

The 17 Autonomous Communities.

The relationship between health expenditure and income and ageing population in the regions, their growth and participation in PHS was analysed.

Primary Care (PC) expenditure has increased 25% more than the PHS; hospital spending has grown 18% more than the PC and hospital staff spending has grown 5% more than the PC staff. Hospital participation in PHS is twice (10%) that of PC participation (5%). Hospital expenditure variables were positively correlated with income but barely, or negatively, with ageing population. PC expenditure variables were positively correlated with ageing but negative with income. The richest regions spend less on drugs (r=0.56, p=0.02), more on hospitals (r=0.52, p=0.03) but not more on PC (r=0.07). Regions with more ageing populations spend more on PC (r=0.39, P=.12) and drugs (r=0.63, P<.01) but just more on hospitals (r=0.15). The income level barely correlates with ageing population (r=0.15).

Between 2002 and 2008 the differences detected during the previous years in the budget growth between hospitals and PC were reduced. The growth of spending on hospitals is higher than on PC, but this is higher than PHS. The centralising of care in hospitals is notable in the richest regions.