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Revista Española de Salud Pública

On-line version ISSN 2173-9110Print version ISSN 1135-5727


CABALLER TARAZONA, Vicent; GUADALAJARA OLMEDA, Natividad; VIVAS CONSUELO, David  and  CLEMENTE COLLADO, Antonio. Impact of population morbidity on health care costs in a health district. Rev. Esp. Salud Publica [online]. 2016, vol.90, e40013.  Epub June 07, 2021. ISSN 2173-9110.


Risk adjustment systems based on diagnosis stratify the population according to the observed morbidity. The aim of this study was to analyze the total health expenditure in a health area, relating to age, gender and morbidity observed in the population.


Observational cross-sectional study of population and area of health care costs in the Health District of Denia-Marina Salud (Alicante) in 2013. Population (N=156,811) were stratified by Clinical Risk Groups into 9 states of health, state 1 being healthy, and state 9 the highest disease burden. Each inhabitant was charged with the hospital costs, primary care and outpatient pharmacy to obtain the total costs. Health status and severity by age and gender, as well as the costs of each group were analysed. The statistical tests, student t and χ2 were applied to verify the existence of significant differences between and intra groups.


The average cost per inhabitant was 983 euros which increased from 240 euros to 42,881 at the state 9 and severity level 6. Patients of health states 5 and 6 caused the largest expenditure by concentration of the population, but health states 8 and 9 had the highest average expenditure, with 80% of hospitalised cost.


A different composition of health expenditure per individual morbidity was corroborated, with an exponential growth in hospital spending.

Keywords : Cost analysis; Risk adjustment; Hospital costs; Emergency service; Primary health care; Pharmaceutical economics; Morbidity; Health Economics; Health planning; Spain.

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