Understanding the Effect of Economic Recession on Healthcare Services: A Systematic Review
-
Raquel Sánchez Recio
,
Juan Pablo Alonso Pérez De Ágreda
,
María José Rabanaque
,
Isabel Aguilar Palacio
Abstract
Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe.
Methods: We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed.
Results: Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services.
Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health.
1. Parmar D, Stavropoulou C, Ioannidis JPA (2016). Health outcomes during the 2008 financial crisis in Europe: systematic literature review. BMJ, 354:i4588.
2. Marmot M, Bell R (2012). Fair society, healthy lives. Public Health, 126 Suppl 1:S4-S10.
3. Rajmil L, de Sanmamed M-JF, Choonara I, et al (2014). Impact of the 2008 economic and financial crisis on child health: a systematic review (2014). Int J Environ Res Public Health, 11(6):6528–46.
4. Suhrcke M, Stuckler D, Suk JE, et al (2011). The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One, 6(6):e20724.
5. Hessel P, Vandoros S, Avendano M (2014). The differential impact of the financial crisis on health in Ireland and Greece: a quasi-experimental approach. Public Health, 128(10):911–9.
6. Juričič M, Dobrin PT, Paulin S, et al (2016). Health Care System for Children and Adolescents in Slovenia. J Pediatr, 177S:S173–86.
7. McHugh SM, Tyrrell E, Johnson B, et al (2015). Health workforce planning and service expansion during an economic crisis: A case study of the national breast screening programme in Ireland. Health Policy, 119(12):1593–9.
8. Granados JAT, Rodriguez JM (2015). Health, economic crisis, and austerity: a comparison of Greece, Finland and Iceland. Health Policy, 119(7):941–53.
9. Ruhm CJ (2000). Are recessions good for your health? Q J Econ, 115(2):617–50.
10. Birch S, Eyles J, Newbold KB (1993). Equitable access to health care: methodological extensions to the analysis of physician utilization in Canada. Health Econ, 2(2):87–101.
11. Tacconelli E (2010). Systematic reviews: CRD’s guidance for undertaking reviews in health care. Lancet Infect Dis, 10(4):226.
12. Cerniauskaite M, Quintas RUI, Boldt C, et al (2011). Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil, 33(4):281–309.
13. López de Argumedo M, Reviriego E, et al (2017). Actualización del Sistema de Trabajo Compartido para Revisiones Sistemáticas de la Evidencia Científica y Lectura Crítica (Plataforma FLC 3.0). Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación de Tecnologías Sanitarias del País Vasco. Informes de Evaluación de Tecnologías Sanitarias: OSTEBA. Available in: http://www.lecturacritica.com/es/acerca.php
14. Von Elm E, Altman DG, Egger M, et al (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med, 4(10):e296.
15. Stige B, Malterud K, Midtgarden T (2009). Toward an agenda for evaluation of qualitative research. Qual Health Res, 19(10):1504–16.
16. Joffe H, Yardley L (2004). Content and thematic analysis. Research methods for clinical and health psychology. (pp. 56-68). London: Sage.
17. Lavis J, Davies H, Oxman A, et al (2005). Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy, 10 Suppl 1:35–48.
18. Perelman J, Felix S, Santana R (2015). The great recession in Portugal: impact on hospital care use. Health Policy,119(3):307–15.
19. Legido-Quigley H, Karanikolos M, Hernandez-Plaza S, et al (2016). Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal. Health Policy, 120(7):833–9.
20. Rodrigues R, Zolyomi E, Kalavrezou N, Matsaganis M (2013). The Impact of the Financial Crisis on Unmet Needs for Healthcare. Research Note.
21. Cylus J, Pearson M (2015). The crisis and its implications for household financial security, government resources and health expenditure. https://www.euro.who.int/__data/assets/pdf_file/0008/289610/Economic-Crisis-Health-Systems-Health-Europe-Impact-implications-policy.pdf
22. Kentikelenis AE (2017). Structural adjustment and health: a conceptual framework and evidence on pathways. Soc Sci Med, 187:296–305.
23. Correia T, Dussault G, Pontes C (2015). The impact of the financial crisis on human resources for health policies in three southern-Europe countries. Health Policy, 119(12):1600–5.
24. Phua K-L (2011). Can we learn from history? Policy responses and strategies to meet health care needs in times of severe economic crisis. Open Public Health J, 4:1–5.
25. Carney M (2010). Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland. J Nurs Manag, 18(5):509–14.
26. Milionis C (2013). Provision of healthcare in the context of financial crisis: approaches to the Greek health system and international implications. Nurs Philos, 14(1):17–27.
27. Marmot M, Bloomer E, Goldblatt P (2013). The role of social determinants in tackling health objectives in a context of economic crisis. Public Health Rev, 35:9.
28. Quaglio G, Karapiperis T, Van Woensel L, et al (2013). Austerity and health in Europe. Health Policy, 113(1–2):13–9.
29. Lopez-Valcarcel BG, Barber P (2017). Economic crisis, austerity policies, health and fairness: lessons learned in Spain. Appl Health Econ Health Policy, 15(1):13–21.
30. Garcia-Subirats I, Vargas I, Sanz-Barbero B, et al (2014). Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis. Int J Environ Res Public Health, 11(10):10182–201.
31. Barros PP (2012). Health policy reform in tough times: the case of Portugal. Health Policy, 106(1):17–22.
32. Kondilis E, Giannakopoulos S, Gavana M, et al (2013). Economic crisis, restrictive policies, and the population’s health and health care: the Greek case. Am J Public Health, 103(6):973–9.
33. Antonanzas F (2013). The impact of the economic downturn on healthcare in Spain: consequences and alternatives. Expert Rev Pharmacoecon Outcomes Res, 13(4):433–9.
34. Gené-Badia J, Gallo P, Hernández-Quevedo C, García-Armesto S (2012). Spanish health care cuts: penny wise and pound foolish? Health Policy, 106(1):23–8.
35. Karanikolos M, Mladovsky P, Cylus J, et al (2013). Financial crisis, austerity, and health in Europe. Lancet, 381(9874):1323–31.
36. Majeed A (2012). Primary care in Europe: entering the age of austerity. J Ambul Care Manage, 35(3):162–6.
37. Cortès-Franch I, López-Valcárcel BG (2014). Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014. Gac Sanit, 28 Suppl 1:1-6.
38. De Belvis AG, Ferrè F, Specchia ML, et al (2012). The financial crisis in Italy: implications for the healthcare sector. Health Policy, 106(1):10–6.
39. Legido-Quigley H, Otero L, la Parra D, et al (2013). Will austerity cuts dismantle the Spanish healthcare system? BMJ, 346:f2363.
40. Detollenaere J, Hanssens L, Vyncke V, et al (2017). Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need. PLoS One, 12(1):e0169274.
41. Kert S, Švab I, Sever M, Makivić I, Pavlič DR (2015). A cross-sectional study of socio-demographic factors associated with patient access to primary care in Slovenia. Int J Equity Health, 14:39.
42. Burström B (2015). The attack on universal health coverage in Europe: different effects in different parts of Europe. Eur J Public Health, 25(3):366–7.
43. Bosch X, Moreno P, López-Soto A (2014). The painful effects of the financial crisis on Spanish health care. Int J Health Serv, 44(1):25–51.
44. Cervero-Liceras F, McKee M, Legido-Quigley H (2015). The effects of the financial crisis and austerity measures on the Spanish health care system: a qualitative analysis of health professionals’ perceptions in the region of Valencia. Health Policy, 119(1):100–6.
45. Heras-Mosteiro J, Sanz-Barbero B, Otero-Garcia L (2016). Health care austerity measures in times of crisis: the perspectives of primary health care physicians in Madrid, Spain. Int J Health Serv, 46(2):283–99.
46. McKee M, Karanikolos M, Belcher P, Stuckler D (2012). Austerity: a failed experiment on the people of Europe. Clin Med (Lond), 12(4):346–50.
47. Russo G, Pires CA, Perelman J, et al (2017). Exploring public sector physicians’ resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal’s capital city area. BMC Health Serv Res, 17(1):207.
48. Alves Da Costa, Filipa Alves, et al (2017). Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal. Int J Clin Pharm, 39(1): 104-112.
49. Elstad JI (2016). Income inequality and foregone medical care in Europe during the Great Recession: multilevel analyses of EU-SILC surveys 2008–2013. Int J Equity Health, 15(1):101.
50. Israel S (2016). How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries. Int J Equity Health, 15:41.
51. Karanikolos M, Gordeev VS, Mackenbach JP, McKee M (2016). Access to care in the Baltic States: did crisis have an impact? Eur J Public Health, 26(2):236–41.
52. Borra C, Pons-Pons J, Vilar-Rodriguez M (2020). Austerity, health care provision, and health outcomes in Spain. Eur J Health Econ, 21(3):409-423.
53. Urbanos-Garrido RM (2001). Explaining inequality in the use of public health care services: evidence from Spain. Health Care Manag Sci, 4(2):143–57.
54. Urbanos Garrido R, Puig-Junoy J (2014). Políticas de austeridad y cambios en las pautas de uso de los servicios sanitarios. Informe SESPAS 2014. Gac Sanit, 28 Suppl 1:81–8.
55. Stuckler D, Reeves A, Loopstra R, et al (2017). Austerity and health: the impact in the UK and Europe. Eur J Public Health, 27(suppl_4):18–21.
56. Sánchez-Recio R, Alonso JP, Rabanaque MJ Aguilar-Palacio I (2021). Further information about the research “Understanding the effect of economic recession on healthcare services: a systematic review“. https://doi.org/10.6084/m9.figshare.13507836
57. Winters M, Rechel B, de Jong L, Pavlova M (2018). A systematic review on the use of healthcare services by undocumented migrants in Europe. BMC Health Serv Res, 18(1):30.
58. Graetz V, Rechel B, Groot W, et al (2017). Utilization of health care services by migrants in Europea systematic literature review. Br Med Bull, 121(1):5–18.
59. de Jong L, Pavlova M, Winters M, Rechel B (2017). A systematic literature review on the use and outcomes of maternal and child healthcare services by undocumented migrants in Europe. Eur J Public Health, 27(6):990–7.
60. Kiil A, Houlberg K (2014). How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011. Eur J Health Econ, 15(8):813–28.
61. McIntyre D, Mooney G (2007). The economics of health equity. Cambridge University Press. https://doi.org/10.1017/CBO9780511544460
62. Almeida APSC, Nunes BP, Duro SMS, Facchini LA (2017). Socioeconomic determinants of access to health services among older adults: a systematic review. Rev Saude Publica, 51:50.
63. Antunes V, Moreira JP (2011). Approaches to developing integrated care in Europe: a systematic literature review. J Manag Mark Healthc, 4(2):129–35.
64. Coll-Benejam T, Bravo-Toledo R, Marcos-Calvo MP, Astier-Peña MP (2018). Impacto del sobrediagnóstico y sobretratamiento en el paciente, el sistema sanitario y la sociedad. Aten Primaria, 50 Suppl 2(Suppl 2):86-95.
2. Marmot M, Bell R (2012). Fair society, healthy lives. Public Health, 126 Suppl 1:S4-S10.
3. Rajmil L, de Sanmamed M-JF, Choonara I, et al (2014). Impact of the 2008 economic and financial crisis on child health: a systematic review (2014). Int J Environ Res Public Health, 11(6):6528–46.
4. Suhrcke M, Stuckler D, Suk JE, et al (2011). The impact of economic crises on communicable disease transmission and control: a systematic review of the evidence. PLoS One, 6(6):e20724.
5. Hessel P, Vandoros S, Avendano M (2014). The differential impact of the financial crisis on health in Ireland and Greece: a quasi-experimental approach. Public Health, 128(10):911–9.
6. Juričič M, Dobrin PT, Paulin S, et al (2016). Health Care System for Children and Adolescents in Slovenia. J Pediatr, 177S:S173–86.
7. McHugh SM, Tyrrell E, Johnson B, et al (2015). Health workforce planning and service expansion during an economic crisis: A case study of the national breast screening programme in Ireland. Health Policy, 119(12):1593–9.
8. Granados JAT, Rodriguez JM (2015). Health, economic crisis, and austerity: a comparison of Greece, Finland and Iceland. Health Policy, 119(7):941–53.
9. Ruhm CJ (2000). Are recessions good for your health? Q J Econ, 115(2):617–50.
10. Birch S, Eyles J, Newbold KB (1993). Equitable access to health care: methodological extensions to the analysis of physician utilization in Canada. Health Econ, 2(2):87–101.
11. Tacconelli E (2010). Systematic reviews: CRD’s guidance for undertaking reviews in health care. Lancet Infect Dis, 10(4):226.
12. Cerniauskaite M, Quintas RUI, Boldt C, et al (2011). Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation. Disabil Rehabil, 33(4):281–309.
13. López de Argumedo M, Reviriego E, et al (2017). Actualización del Sistema de Trabajo Compartido para Revisiones Sistemáticas de la Evidencia Científica y Lectura Crítica (Plataforma FLC 3.0). Ministerio de Sanidad, Servicios Sociales e Igualdad. Servicio de Evaluación de Tecnologías Sanitarias del País Vasco. Informes de Evaluación de Tecnologías Sanitarias: OSTEBA. Available in: http://www.lecturacritica.com/es/acerca.php
14. Von Elm E, Altman DG, Egger M, et al (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med, 4(10):e296.
15. Stige B, Malterud K, Midtgarden T (2009). Toward an agenda for evaluation of qualitative research. Qual Health Res, 19(10):1504–16.
16. Joffe H, Yardley L (2004). Content and thematic analysis. Research methods for clinical and health psychology. (pp. 56-68). London: Sage.
17. Lavis J, Davies H, Oxman A, et al (2005). Towards systematic reviews that inform health care management and policy-making. J Health Serv Res Policy, 10 Suppl 1:35–48.
18. Perelman J, Felix S, Santana R (2015). The great recession in Portugal: impact on hospital care use. Health Policy,119(3):307–15.
19. Legido-Quigley H, Karanikolos M, Hernandez-Plaza S, et al (2016). Effects of the financial crisis and Troika austerity measures on health and health care access in Portugal. Health Policy, 120(7):833–9.
20. Rodrigues R, Zolyomi E, Kalavrezou N, Matsaganis M (2013). The Impact of the Financial Crisis on Unmet Needs for Healthcare. Research Note.
21. Cylus J, Pearson M (2015). The crisis and its implications for household financial security, government resources and health expenditure. https://www.euro.who.int/__data/assets/pdf_file/0008/289610/Economic-Crisis-Health-Systems-Health-Europe-Impact-implications-policy.pdf
22. Kentikelenis AE (2017). Structural adjustment and health: a conceptual framework and evidence on pathways. Soc Sci Med, 187:296–305.
23. Correia T, Dussault G, Pontes C (2015). The impact of the financial crisis on human resources for health policies in three southern-Europe countries. Health Policy, 119(12):1600–5.
24. Phua K-L (2011). Can we learn from history? Policy responses and strategies to meet health care needs in times of severe economic crisis. Open Public Health J, 4:1–5.
25. Carney M (2010). Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland. J Nurs Manag, 18(5):509–14.
26. Milionis C (2013). Provision of healthcare in the context of financial crisis: approaches to the Greek health system and international implications. Nurs Philos, 14(1):17–27.
27. Marmot M, Bloomer E, Goldblatt P (2013). The role of social determinants in tackling health objectives in a context of economic crisis. Public Health Rev, 35:9.
28. Quaglio G, Karapiperis T, Van Woensel L, et al (2013). Austerity and health in Europe. Health Policy, 113(1–2):13–9.
29. Lopez-Valcarcel BG, Barber P (2017). Economic crisis, austerity policies, health and fairness: lessons learned in Spain. Appl Health Econ Health Policy, 15(1):13–21.
30. Garcia-Subirats I, Vargas I, Sanz-Barbero B, et al (2014). Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis. Int J Environ Res Public Health, 11(10):10182–201.
31. Barros PP (2012). Health policy reform in tough times: the case of Portugal. Health Policy, 106(1):17–22.
32. Kondilis E, Giannakopoulos S, Gavana M, et al (2013). Economic crisis, restrictive policies, and the population’s health and health care: the Greek case. Am J Public Health, 103(6):973–9.
33. Antonanzas F (2013). The impact of the economic downturn on healthcare in Spain: consequences and alternatives. Expert Rev Pharmacoecon Outcomes Res, 13(4):433–9.
34. Gené-Badia J, Gallo P, Hernández-Quevedo C, García-Armesto S (2012). Spanish health care cuts: penny wise and pound foolish? Health Policy, 106(1):23–8.
35. Karanikolos M, Mladovsky P, Cylus J, et al (2013). Financial crisis, austerity, and health in Europe. Lancet, 381(9874):1323–31.
36. Majeed A (2012). Primary care in Europe: entering the age of austerity. J Ambul Care Manage, 35(3):162–6.
37. Cortès-Franch I, López-Valcárcel BG (2014). Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014. Gac Sanit, 28 Suppl 1:1-6.
38. De Belvis AG, Ferrè F, Specchia ML, et al (2012). The financial crisis in Italy: implications for the healthcare sector. Health Policy, 106(1):10–6.
39. Legido-Quigley H, Otero L, la Parra D, et al (2013). Will austerity cuts dismantle the Spanish healthcare system? BMJ, 346:f2363.
40. Detollenaere J, Hanssens L, Vyncke V, et al (2017). Do We Reap What We Sow? Exploring the Association between the Strength of European Primary Healthcare Systems and Inequity in Unmet Need. PLoS One, 12(1):e0169274.
41. Kert S, Švab I, Sever M, Makivić I, Pavlič DR (2015). A cross-sectional study of socio-demographic factors associated with patient access to primary care in Slovenia. Int J Equity Health, 14:39.
42. Burström B (2015). The attack on universal health coverage in Europe: different effects in different parts of Europe. Eur J Public Health, 25(3):366–7.
43. Bosch X, Moreno P, López-Soto A (2014). The painful effects of the financial crisis on Spanish health care. Int J Health Serv, 44(1):25–51.
44. Cervero-Liceras F, McKee M, Legido-Quigley H (2015). The effects of the financial crisis and austerity measures on the Spanish health care system: a qualitative analysis of health professionals’ perceptions in the region of Valencia. Health Policy, 119(1):100–6.
45. Heras-Mosteiro J, Sanz-Barbero B, Otero-Garcia L (2016). Health care austerity measures in times of crisis: the perspectives of primary health care physicians in Madrid, Spain. Int J Health Serv, 46(2):283–99.
46. McKee M, Karanikolos M, Belcher P, Stuckler D (2012). Austerity: a failed experiment on the people of Europe. Clin Med (Lond), 12(4):346–50.
47. Russo G, Pires CA, Perelman J, et al (2017). Exploring public sector physicians’ resilience, reactions and coping strategies in times of economic crisis; findings from a survey in Portugal’s capital city area. BMC Health Serv Res, 17(1):207.
48. Alves Da Costa, Filipa Alves, et al (2017). Effects of economic recession on elderly patients’ perceptions of access to health care and medicines in Portugal. Int J Clin Pharm, 39(1): 104-112.
49. Elstad JI (2016). Income inequality and foregone medical care in Europe during the Great Recession: multilevel analyses of EU-SILC surveys 2008–2013. Int J Equity Health, 15(1):101.
50. Israel S (2016). How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries. Int J Equity Health, 15:41.
51. Karanikolos M, Gordeev VS, Mackenbach JP, McKee M (2016). Access to care in the Baltic States: did crisis have an impact? Eur J Public Health, 26(2):236–41.
52. Borra C, Pons-Pons J, Vilar-Rodriguez M (2020). Austerity, health care provision, and health outcomes in Spain. Eur J Health Econ, 21(3):409-423.
53. Urbanos-Garrido RM (2001). Explaining inequality in the use of public health care services: evidence from Spain. Health Care Manag Sci, 4(2):143–57.
54. Urbanos Garrido R, Puig-Junoy J (2014). Políticas de austeridad y cambios en las pautas de uso de los servicios sanitarios. Informe SESPAS 2014. Gac Sanit, 28 Suppl 1:81–8.
55. Stuckler D, Reeves A, Loopstra R, et al (2017). Austerity and health: the impact in the UK and Europe. Eur J Public Health, 27(suppl_4):18–21.
56. Sánchez-Recio R, Alonso JP, Rabanaque MJ Aguilar-Palacio I (2021). Further information about the research “Understanding the effect of economic recession on healthcare services: a systematic review“. https://doi.org/10.6084/m9.figshare.13507836
57. Winters M, Rechel B, de Jong L, Pavlova M (2018). A systematic review on the use of healthcare services by undocumented migrants in Europe. BMC Health Serv Res, 18(1):30.
58. Graetz V, Rechel B, Groot W, et al (2017). Utilization of health care services by migrants in Europea systematic literature review. Br Med Bull, 121(1):5–18.
59. de Jong L, Pavlova M, Winters M, Rechel B (2017). A systematic literature review on the use and outcomes of maternal and child healthcare services by undocumented migrants in Europe. Eur J Public Health, 27(6):990–7.
60. Kiil A, Houlberg K (2014). How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011. Eur J Health Econ, 15(8):813–28.
61. McIntyre D, Mooney G (2007). The economics of health equity. Cambridge University Press. https://doi.org/10.1017/CBO9780511544460
62. Almeida APSC, Nunes BP, Duro SMS, Facchini LA (2017). Socioeconomic determinants of access to health services among older adults: a systematic review. Rev Saude Publica, 51:50.
63. Antunes V, Moreira JP (2011). Approaches to developing integrated care in Europe: a systematic literature review. J Manag Mark Healthc, 4(2):129–35.
64. Coll-Benejam T, Bravo-Toledo R, Marcos-Calvo MP, Astier-Peña MP (2018). Impacto del sobrediagnóstico y sobretratamiento en el paciente, el sistema sanitario y la sociedad. Aten Primaria, 50 Suppl 2(Suppl 2):86-95.
| Files | ||
| Issue | Vol 51 No 3 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i3.8925 | |
| Keywords | ||
| Systematic review Economic recession Healthcare systems Inequities Inequalities | ||
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How to Cite
1.
Sánchez Recio R, Alonso Pérez De Ágreda JP, Rabanaque MJ, Aguilar Palacio I. Understanding the Effect of Economic Recession on Healthcare Services: A Systematic Review. Iran J Public Health. 2022;51(3):495-507.
