https://hdl.handle.net/10481/22289 Sat, 11 Apr 2026 10:11:14 GMT 2026-04-11T10:11:14Z https://hdl.handle.net/10481/105324 Social spending, child deprivation and family structure: a multilevel study in 31 European countries Pérez Corral, Antonio Luis; Moreno Mínguez, Almudena The purpose of this article is to examine the role of social spending policies in reducing child deprivation and inequality between family structures. In particular, based on the idea that the redistributive effects of such policies affect economic well-being in childhood, we analyse whether three functions of social spending (family/children, housing/social exclusion and sickness/disability) are associated with the reduction of different types of child deprivation (nutrition, clothing, education, leisure and social life) in Europe. We employ multilevel techniques for this purpose. Our findings are consistent with the hypothesis that greater social spending on sickness/disability benefits can reduce the risk of child deprivation, particularly for single-parent families, although we cannot exclude the possibility that this association is spurious. Family/children benefits and housing/social exclusion benefits seem to have a somewhat more limited effect but still contribute to reducing inequalities between single-parent and two-parent families in some types of deprivation. https://hdl.handle.net/10481/105324 https://hdl.handle.net/10481/95232 Freedom of choice and health services’ performance: Evidence from a national health system Fernández Pérez, Ángel; Jiménez Rubio, María Dolores; Robone, Silvana M. Public policies fostering the freedom of choice of provider in the healthcare sector are increasingly common in many countries and regions, where policymakers wish to empower patients and improve health service performance. However, in the literature there is not clear consensus about the impact of expanded patient choice on healthcare quality yet. This study investigates whether increasing patients' freedom of choice influences health system outcomes in terms of various non-clinical aspects of care, a dimension often overlooked by researchers in this field. Our study considers a “natural experiment” that took place within the Spanish National Health System in 2009 under which citizens of the Community (region) of Madrid were allowed to freely choose among any GP and/or specialist in their region. The empirical analysis was conducted by using Spanish microdata for the period 2002–2016 and used synthetic control estimation techniques. The key findings show the reform had a strong and long-lasting impact, reducing average waiting times and increasing patients' satisfaction with the specialist attention received. We did not detect any statistically significant impact of the reform on the other responsiveness domains analysed. Our analysis shows that freedom of choice policies could improve health system performance if they are combined with appropriate economic incentives for health providers. https://hdl.handle.net/10481/95232 https://hdl.handle.net/10481/95231 Shutting down to save lives: A regression discontinuity analysis of non-essential business closure Gaggero, Alessio; Mesa-Pedrazas, Ángela; Fernández Pérez, Ángel This article quantifies the impact of the non-essential business closure policy implemented in the Spanish region of Andalusia during the COVID-19 pandemic between January and May 2021. Taking advantage of the fact that municipalities were assigned a two-week closure of non-essential businesses on the basis of whether the 14-day infection rate (per 100,000 inhabitants) was above a predetermined cutoff value of 1,000, we use a regression discontinuity design to estimate the causal impact of the policy on new COVID-19 cases and deaths. Using weekly administrative data, the estimates suggest that, on average, the policy produced a 23 percent reduction in new COVID-19 cases and a 2 percent decrease in new COVID-19 deaths. Notably, the heterogeneity analysis reveals that the policy was more effective in rural areas than in urban areas. Overall, this study provides compelling evidence that shutting down businesses served as an effective tool to counter the COVID-19 pandemic. https://hdl.handle.net/10481/95231 https://hdl.handle.net/10481/87712 A systematic review of the impact of spinal cord injury on costs and health-related quality of life Epstein, David; Epstein, David Mark OBJECTIVES To systematically review the health-related quality of life (HRQoL) burden and costs of spinal cord injury (SCI) on health services, patients, and wider society. METHOD A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was conducted through Scopus, PubMed and Embase databases. Descriptive analyses, random-effects direct meta-analysis and random-effects meta-regression were conducted. RESULTS A total of 67 studies were eligible for inclusion. SCI individuals tend to report higher HRQoL in mental than physical dimensions of the Short-Form 36. Neurological level of SCI negatively affects HRQoL. Cross-sectional studies find employment is associated with better HRQoL, but the effect is not observed in longitudinal studies. The estimated lifetime expenditure per individual with SCI ranged from $0.5 million to $2.0 million, with greater costs associated with earlier age at injury, neurological level, United States (US) healthcare setting, and the inclusion of non-healthcare items in the study. CONCLUSION SCI, and neurological level of injury, are associated with low HRQoL on mobility and physical dimensions. Mental health scores tend to be greater than physical scores, and most dimensions of HRQoL appear to improve over time, at least over the first year. These conditions are associated with high costs which vary by country. https://hdl.handle.net/10481/87712 https://hdl.handle.net/10481/80488 Challenges for Economic Evaluations of Advanced Therapy Medicinal Products: A Systematic Review Olry de Labry Lima, Antonio; García Mochón, Leticia; Pérez Troncoso, Daniel; Epstein, David Mark Objectives: Advanced therapy medicinal products (ATMPs) are drugs for human use for the treatment of chronic, degenerative, or life-threatening diseases that are based on genes, tissues, or cells. This article aimed to identify and critically review published economic analyses of ATMPs. Methods: A systematic review of economic analyses of ATMPs was undertaken. Study characteristics, design, sources of data, resources and unit costs, modeling and extrapolation methods, study results, and sensitivity analyses were assessed. Results: A total of 46 economic analyses of ATMP (from 45 articles) were included; 4 were cell therapy medicinal products, 33 gene therapy medicinal products, and 9 tissue-engineered products. 30 therapies had commercial marketing approval; 39 studies were cost-utility analysis, 5 were cost-effectiveness analysis, and 2 were cost only studies. Four studies predicted that the ATMP offered a step change in the management of the condition and 10 studies estimated that the ATMP would offer a lower mean cost. Conclusions: Comparison with historical controls, pooling of data, and use of techniques such as mixture cure fraction models should be used cautiously. Sensitivity analyses should be used across a plausible range of prices. Clinical studies need to be designed to align with health technology assessment requirements, including generic quality of life, and payers should aim for clarity of criteria. Regulators and national payers should aim for compatibility of registers to allow interchange of data. Given the increasing reliance on industry-funded economic analyses, careful critical review is recommended. https://hdl.handle.net/10481/80488