key: cord-1001231-5xek6voc
authors: Elola-Somoza, F. J.; Bas-Villalobos, M. C.; Pérez-Villacastín, J.; Macaya-Miguel, C.
title: Public healthcare expenditure and COVID-19 mortality in Spain and in Europe. Response to the Letter from the Editor by Velasco et al
date: 2021-10-28
journal: Rev Clin Esp (Barc)
DOI: 10.1016/j.rceng.2021.09.002
sha: 15e404b02f1bce24edf2b5c4e29b6f3c31720ac2
doc_id: 1001231
cord_uid: 5xek6voc

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It is true that we did not include models adjusted for other sociodemographic, economic, or other variables because our aim was to analyze whether the widespread and uncritically accepted relationship between the "scarcity" of resources and outcomes 2,3 was able to be verified empirically.

It is possible, but not probable, that the lack of a relationship between public healthcare expenditure and mortality due to COVID-19 may change after adjusting for other variables. After adjustment, Medeiros et al. did not find an association between healthcare expenditure and the mortality rate 4 whereas Khan et al. paradoxically found that the higher healthcare expenditure is as a percentage of GDP (%HE/GDP), the higher the case fatality rate. 5

The development of adjusted models requires that the variables introduced have a clinicalepidemiological significance and show an independent association with robust outcome variables. The case fatality rate is dependent on the efficacy of epidemiological surveillance and %HE/GDP does not indicate the real expenditure. Nevertheless, if we are able to develop suitable adjustment models, we will attempt to take on the challenge proposed by Velasco Montes et al. 1 

Grupo de Trabajo Sanidad y Salud Pública. Informes, documentos y actas taquigráficas

The need for an independent evaluation of the COVID-19 response in Spain

Letalidad del COVID-19: ausencia de patrón epidemiológico

Healthcare capacity, health expenditure, and civil society as predictors of COVID-19 case fatalities: A global analysis. Front Public Health