In Spain, regional health systems (universal access) depend on each Autonomous Communities (ACs). The management of the 2008 economic crisis has been different in the ACs, which may have led to an increase in inequities in the use of health services. The objective of this study was to analyse the impact of individual and regional characteristics on public hospitalisation inequities in Spain for the period 2003–2017. We developed a repeated cross-sectional study through Spanish National Health Surveys (2003, 2006, 2011 and 2017) and the Spanish European Health Survey (2014; n = 118,499 subjects). Multilevel and Oaxaca decomposition analyses were conducted to analyse the effect of individual and regional factors in hospitalisation inequities. The results showed that the prevalence of hospitalisation was higher for women (2003: 11.2%; 2017: 9.0%) than for men (2003: 10.7%; 2017: 8.8%) and it decreased with time. Multilevel analyses showed that, after adjustment for variables related to healthcare demand, there were inequities in the probability of hospitalisation, mainly in women. The decomposition analyses showed a higher effect of the number of hospital beds available on hospitalisation in men than in women. There is a direct relationship between the number of hospital beds and the probability of hospitalisation in both sexes. In conclusion, a progressive decrease in hospitalisation use was observed in Spain in the context of the economic recession. Individual-level and regional-level factors were associated with hospitalisation inequities. It is necessary to guarantee equitable access to health services according to the need even in recession times.

中文翻译：

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南欧国家住院治疗的不平等：从上次欧洲经济衰退中吸取的教训

在西班牙，区域卫生系统（普遍可及）依赖于每个自治社区 (AC)。2008 年经济危机的管理在 AC 中有所不同，这可能导致卫生服务使用不公平的增加。本研究的目的是分析个人和地区特征对 2003-2017 年期间西班牙公立住院不公平的影响。我们通过西班牙国家健康调查（2003 年、2006 年、2011 年和 2017 年）和西班牙欧洲健康调查（2014 年；n = 118,499 名受试者）。进行了多级和瓦哈卡分解分析，以分析个体和区域因素对住院不公平的影响。结果显示，女性的住院率（2003 年：11.2%；2017 年：9.0%）高于男性（2003 年：10.7%；2017 年：8.8%），并且随着时间的推移而下降。多层次分析表明，在调整与医疗保健需求相关的变量后，住院概率存在不平等，主要是女性。分解分析表明，可用病床数量对男性住院率的影响高于女性。病床数量与男女住院概率之间存在直接关系。综上所述，在经济衰退的背景下，西班牙的住院人数逐渐减少。个人层面和地区层面的因素与住院不公平有关。即使在经济衰退时期，也有必要根据需要保证公平获得卫生服务。