Regional inequality in the provision of health care in Spain

Whereas studies on regional inequality tend to focus on income disparities, we investigate regional inequality in Spain with respect to health facilities. In this study we examine trends in regional inequality over the period 1964 to 1991 during which fundamental changes in health policies were implemented. We follow a multidimensional approach in the sense that several indicators of health facilities are considered. Regional inequality is measured by means of Theil's second measure of multidimensional inequality. The partial common principal components (PCPC) model is used to construct the weights for this measure whenever appropriate, and principal component analysis (PCA) is used when otherwise. The PCPC model is a generalisation of the classical method of PCA for several samples (years). Component coefficients are estimated by assuming that the first component is common for all years. Spatial inequality between regions as well as within regions is analysed to highlight the role of policy and other regional characteristics. Spatial spillovers are analysed by including the effects of health facilities in neighbouring regions. The analysis shows that the health policies of the Spanish government in the 1980s and decentralisation of power may have helped to reduce regional inequality, although no firm conclusions can be drawn yet.