A single-case research on the impact of spending cuts on the quality of care of a regional health service

Abstract

Background. To apply single-case research methods to evaluate the impact of the Regional Government of Galicia’s spending cuts on certain aspects of the quality of healthcare. Methods. In our study, we consider average surgical wait indicators, a Generic Healthcare Deficiency Index (GHDI) of our own design, and rates of perceived improvement based on the Healthcare Barometer. Our analysis combines bottom-up approaches (both visual inspection and non-overlapping measures) with top-down approaches (parametric techniques). Results. In the quinquennial period of cutbacks, we detect several adverse impacts on the quality of healthcare. The tendency to shorten the average surgical wait is reversed and this effect is statistically significant (p<0.01), according to the three estimated ARIMA models. The GHDI increases more than before, with a total effect inferred from regression analyses by both generalized least squares, using the Cochran-Orcutt procedure with the Prais-Winsten adjustment (p<0.1), and non-linear least squares (p<0.05). Indices of perceived improvement fall in primary and specialized care, as well as in hospitalization, with the effect being moderate (NAP, non-overlap of all pairs) or large (SMD, standardized mean difference). The C statistic confirms a significant change. Conclusions. In this empirical application with single-case research techniques, we notice a certain deterioration in the analyzed indicators, which primarily affect aspects of quality that are not shielded by the doctor-patient relationship, aspects more connected to the conditions of service provision and its overall perception.