COVID-19 and Public Health Spending; Effects on the Economic Sustainability of the Spanish Private Healthcare System
Abstract
:1. Introduction
2. Materials and Methods
2.1. The Dataset
2.2. Variable Description
2.3. Statistical Analysis
3. Results
3.1. Regression Analysis
3.1.1. Descriptive Statistics and Bivariate Relationships
3.1.2. Multivariate Analysis
3.1.3. Robustness Checks
3.2. Cluster Analysis
3.3. Factor Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Data Availability Statement
Conflicts of Interest
Appendix A. Average Annual ROA
Appendix B. Pearson Correlations between the Continuous Variables
ROA | EMP | TUR | IND | AGE | EXP | GDP | |
EMP | −0.0293 (0.6326) | ||||||
TUR | 0.1283 ** (0.0355) | −0.1879 *** 0.0020 | |||||
IND | −0.1465 ** (0.0162) | 0.1263 ** (0.0384) | 0.0225 (0.7136) | ||||
AGE | −0.1261 ** (0.0387) | −0.1271 ** (0.0373) | −0.1313 ** (0.0313) | −0.2258 *** (0.0002) | |||
EXP | −0.1592 *** (0.0089) | −0.1642 *** (0.0070) | 0.0225 (0.7134) | −0.0745 (0.2234) | 0.2184 *** (0.0003) | ||
GDP | 0.0001 (0.9985) | 0.1035 * (0.0902) | 0.1044 * (0.0875) | 0.1836 ** (0.0025) | −0.0419 (0.4937) | −0.0347 (0.5714) | |
BGD | −0.2717 *** (0.0000) | 0.1229 ** (0.0440) | −0.0407 (0.5061) | 0.0892 (0.1447) | 0.1108 * (0.0695) | 0.1181 * (0.0531) | 0.0658 (0.2819) |
***, ** and * indicate less than 1% significance level, less than 5%, and less than 10%, respectively. Number of observations: 269. |
Appendix C. Differences of Means in the Value of the Explanatory Dummy Variables and ANOVA Test
Difference of Means Test (t-Test) | ANOVA Test | ||||
Variable | Mean Group 0 | Mean Group 1 | Difference(+) | F(+) | Adjust R2 |
COV | 5.242972 | 2.399293 | 2.843679 *** (0.0023) | 9.46 *** (0.0023) | 0.0306 |
CSR | 3.252319 | 5.024938 | −1.772618 * (0.0504) | 3.86 * (0.0504) | 0.0106 |
LEG | 5.681170 | 3.771688 | 1.909482 ** (0.0220) | 5.31 ** (0.0220) | 0.0158 |
***, ** and * indicate less than 1% significance level, less than 5%, and less than 10%, respectively. Number of observations: 269. |
Appendix D. Robustness Checks
Variable | OLS (Model 2) | OLS Robust | OLS Winsorized † |
Intercept | 0.224872 (0.993) | 0.224872 (0.993) | −0.554904 (0.983) |
ROA (1lag) | 0.747980 *** (0.000) | 0.747980 *** (0.000) | 0.746386 *** (0.000) |
COV | −2.019761 *** (0.002) | −2.019761 *** (0.007) | −1.997233 *** (0.003) |
EXP | −2.599006 (0.366) | −2.599006 (0.330) | −2.500266 (0.382) |
GDP | 2.031580 (0.156) | 2.031580 (0.165) | 2.022805 (0.155) |
CSR | 0.498630 (0.466) | 0.498630 (0.451) | 0.498439 (0.464) |
BGD | −3.273693 * (0.088) | −3.273693 * (0.090) | −3.345440 (0.464) |
EMP | −0.400910 (0.353) | −0.400910 (0.418) | −0.382390 (0.375) |
TUR | 0.643189 (0.122) | 0.643189 (0.151) | 0.650638 (0.120) |
IND | 0.021153 (0.118) | 0.021153 * (0.098) | 0.021462 (0.111) |
AGE | 0.0020243 (0.904) | 0.0020243 (0.912) | 0.002925 (0.861) |
LEG | 0.038242 (0.956) | 0.038242 (0.954) | 0.041600 (0.952) |
Adjusted R2 | 0.6157 | 0.6374 | 0.6154 |
F-statistic | 29.25 *** (0.0000) | 29.84 *** (0.0000) | 29.22 *** (0.0000) |
Observations | 195 | 195 | 195 |
AIC | 1111.556 | 1111.556 | 1109.865 |
BIC | 1150.832 | 1150.832 | 1149.141 |
*** and * indicate less than 1% significance level and less than 10%, respectively. † winsorized variables at the 0.01 level. OLS: Ordinary Least Square regression. AIC and BIC: Akaike and Bayesian, respectively, Information Criteria. |
Appendix E. Average of Variables by Cluster for the Period 2017–2020
Cluster | Public Expenditure per Inhabitant | Gross Domestic Product per Inhabitant | COVID-19 Cases in 2020 | Population Density |
1 | 1292.16 | 18,717.50 | 205.28 | 96.29 |
2 | 1631.48 | 28,978.58 | 300.95 | 154.42 |
3 | 1626.77 | 21,533.19 | 217.94 | 112.72 |
4 | 1344.69 | 34,318.00 | 1957.94 | 826.30 |
Appendix F. Scatter Plot of the Four Resulting Clusters
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Abbreviation | Variable | Definition | |
---|---|---|---|
Dependent variable | ROA | Return on Assets | Earnings before interest and taxes divided by total assets. |
Independent variables | COV | COVID-19 | Dummy variable, which takes the value 1 in 2020 and 0, otherwise. |
EXP | Public expenditure | Logarithm of the public health expenditure per inhabitant in the autonomous community where the hospital is located. | |
Control variables | GDP | Gross domestic product | Logarithm of the gross domestic product per capita in the autonomous community where the hospital is located. |
CSR | Corporate Social Responsibility | Dummy variable, which takes the value 1 if the hospital informs about corporate social responsibility policies and 0, otherwise. | |
BGD | Board gender diversity | Percentage of women on board of directors. | |
EMP | Size | Logarithm of the number of employees. | |
TUR | Asset turnover | Operating income divided by total assets. | |
IND | Indebtedness | Liabilities divided by total assets. | |
AGE | Age | Age of the hospital in years. | |
LEG | Legal form | Dummy variable, which takes the value 1 for public limited companies (hospitals) and 0 for private limited companies (hospitals) |
Variable | Mean | SD * | Minimum | Maximum |
---|---|---|---|---|
ROA | 4.52412 | 6.69511 | −11.72604 | 24.6529 |
EXP | 7.31093 | 0.10926 | 7.08944 | 7.55951 |
GDP | 10.15304 | 0.22366 | 9.76698 | 10.49263 |
BGD | 0.21166 | 0.16199 | 0.00000 | 0.60000 |
EMP | 5.96000 | 0.74774 | 4.34380 | 8.00470 |
TUR | 1.31038 | 0.77716 | 0.33626 | 4.36441 |
IND | 52.63843 | 24.02508 | 5.37252 | 99.17978 |
AGE | 30.53147 | 20.97856 | 1.29315 | 86.54521 |
Variable | OLS Model 1 | OLS Model 2 | Fixed Effect Model 3 | Random Effect Model 4 |
---|---|---|---|---|
Intercept | 32.29106 (0.325) | 0.224872 (0.993) | −144.8449 (0.327) | 60.444250 (0.157) |
ROA (1lag) | 0.747980 *** (0.000) | |||
COV | −2.055239 ** (0.024) | −2.019761 *** (0.002) | 1.104898 (0.624) | −1.937761 *** (0.004) |
EXP | −5.692013 (0.130) | −2.599006 (0.366) | −10.70588 (0.110) | −8.118934 * (0.064) |
GDP | 1.602603 (0.384) | 2.031580 (0.156) | 22.44289 (0.129) | 0.436807 (0.885) |
CSR | 1.743331 ** (0.046) | 0.498630 (0.466) | ||
BGD | −9.309939 *** (0.000) | −3.273693 * (0.088) | ||
EMP | 0.236134 (0.668) | −0.400910 (0.353) | 1.882596 (0.524) | 0.183161 (0.840) |
TUR | 1.190069 ** (0.021) | 0.643189 (0.122) | 3.815806 ** (0.013) | 1.601277 ** (0.040) |
IND | −0.046549 *** (0.006) | 0.021153 (0.118) | −0.053214 (0.249) | −0.053979 ** (0.032) |
AGE | −0.009181 (0.662) | 0.0020243 (0.904) | −0.456028 (0.433) | −0.032926 (0.329) |
LEG | −2.345456 *** (0.009) | 0.038242 (0.956) | ||
Adjusted R2 | 0.1521 | 0.6157 | 0.6817 | |
F-statistic | 5.81 *** (0.0000) | 29.25 *** (0.0000) | 5.84 *** (0.0000) | |
Wald Chi2 | 40.69 *** (0.0000) | |||
Hausman test | 6.70 (0.4613) | |||
Observations | 269 | 195 | 269 | 269 |
AIC | 1752.717 | 1111.556 | 1402.289 | |
BIC | 1792.259 | 1150.832 | 1431.046 |
Autonomous Community | Public Expenditure per Inhabitant (€) | Gross Domestic Product per Inhabitant (€) | COVID-19 Cases in 2020 per 100,000 Inhabitants | Population Density by km2 |
---|---|---|---|---|
Andalucía | 1292.16 | 18,717.50 | 205.28 | 96.29 |
Aragón | 1666.86 | 27,594.75 | 161.94 | 27.70 |
Asturias | 1737.20 | 22,250.25 | 232.91 | 96.42 |
Islas Baleares | 1529.13 | 26,380.00 | 306.77 | 237.72 |
Islas Canarias | 1576.87 | 20,053.50 | 169.48 | 295.06 |
Cantabria | 1629.31 | 23,217.25 | 150.82 | 109.29 |
Castilla-León | 1681.79 | 23,874.00 | 56.23 | 25.54 |
Castilla-La Mancha | 1549.59 | 20,065.50 | 114.72 | 25.63 |
Cataluña | 1550.60 | 29,807.25 | 681.17 | 235.36 |
Valencia | 1539.71 | 22,080.00 | 506.66 | 215.09 |
Extremadura | 1702.33 | 18,659.00 | 140.78 | 25.58 |
Galicia | 1576.11 | 22,803.75 | 151.68 | 91.29 |
Madrid | 1344.70 | 34,318.00 | 1957.94 | 826.30 |
Murcia | 1647.99 | 20,795.50 | 438.16 | 131.63 |
Navarra | 1714.47 | 30,716.25 | 276.81 | 62.48 |
País Vasco | 1799.55 | 32,396.50 | 269.27 | 301.05 |
La Rioja | 1528.26 | 26,976.75 | 109.74 | 62.22 |
Variable | Factor 1 | Factor 2 |
---|---|---|
COVID-19 | 0.961 | −0.025 |
Public expenditure | −0.540 | 0.788 |
Gross domestic product | 0.665 | 0.658 |
Population density | 0.950 | 0.012 |
Total variance explained | 90.379% |
PANEL A. Pearson Correlations | ||||
---|---|---|---|---|
COVID | Public Expenditure | GDP | ||
Public expenditure | −0.4831 ** (0.0495) | |||
GDP | 0.5602 ** (0.0194) | 0.0555 (0.8326) | ||
Population density | 0.9112 *** (0.0000) | −0.4365 * (0.0799) | 0.5576 ** (0.0200) | |
PANEL B. COVID-19 Regression Analysis | ||||
Model a | Model b | Model c | Model d | |
Public expenditure | −1.638065 ** (0.049) | −0.538591 (0.242) | ||
GDP | 0.051108 ** (0.019) | 0.013179 (0.323) | ||
Population density | 2.088758 *** (0.000) | 1.745240 *** (0.000) | ||
Intercept | 2956.895 ** (0.029) | −915.9493 * (0.082) | −3.006629 (0.962) | 586.2097 (0.394) |
Adjusted R² | 0.1822 | 0.2680 | 0.8190 | 0.8171 |
F-statistics | 4.57 ** (0.0495) | 6.86 ** (0.0194) | 73.39 *** (0.0000) | 24.83 *** (0.0000) |
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Share and Cite
Valls Martínez, M.d.C.; Santos-Jaén, J.M.; Valls-Úbeda, R.F.; Soriano Román, R. COVID-19 and Public Health Spending; Effects on the Economic Sustainability of the Spanish Private Healthcare System. Int. J. Environ. Res. Public Health 2023, 20, 1585. https://doi.org/10.3390/ijerph20021585
Valls Martínez MdC, Santos-Jaén JM, Valls-Úbeda RF, Soriano Román R. COVID-19 and Public Health Spending; Effects on the Economic Sustainability of the Spanish Private Healthcare System. International Journal of Environmental Research and Public Health. 2023; 20(2):1585. https://doi.org/10.3390/ijerph20021585
Chicago/Turabian StyleValls Martínez, María del Carmen, José Manuel Santos-Jaén, Rafael Félix Valls-Úbeda, and Rafael Soriano Román. 2023. "COVID-19 and Public Health Spending; Effects on the Economic Sustainability of the Spanish Private Healthcare System" International Journal of Environmental Research and Public Health 20, no. 2: 1585. https://doi.org/10.3390/ijerph20021585