![]() ![]() Wellness, as defined for the first time in Dunn ( 13), refers to a special state of individual health which sees man as consisting of body, spirit and mind, and which depends on his environment. However, choosing one of them is an extremely difficult task. In this research, we initially selected the concepts of wellness and well-being as the “response variable,” because they are two overarching concepts, which incorporate practically all the individual or partial responses (dimensions) cited in the literature. The selection of the optimal “response variable” is an intellectual challenge and remains a hot topic, with contributions from multiple, widely differing scientific disciplines ( 7– 12). In the earliest literature on the topic, a variety of answers can be found, including wellness, well-being, psychological well-being, flourishing, mental health, quality of life, life satisfaction, and hedonic well-being ( 1– 6). Finally, a principal component analysis reveals that “healthiness” and “basic spending” are the optimal factors for mapping well-being and health spending in Spain.Ī key question when approaching research on health spending is what modern societies are primarily seeking to achieve with such spending. In addition, a cluster analysis of the indicators for the constructs included in this research reveals the existence of three clearly differentiated groups of autonomous communities: the northern part of the country plus Extremadura (characterized by the lowest well-being and the highest mortality rates), Madrid (with the best results in well-being and mortality, the lowest public health expenditure per inhabitant and percentage of pharmaceutical spending, and the highest percentage in specialty care services and medical staff spending), and the rest of the country (south-eastern regions, with similar well-being values to those of the first group but with less health expenditure). From the estimation of this model, it can be concluded that mortality, expenditure and resources are the factors that have the greatest impact on well-being. These constructs are proxied by a set of 26 indicators, for which annual values at a regional scale were used for the period 2005–2018. ![]() Given that the factors involved in the complex direct, indirect, and second-order relationships between well-being and health spending are latent in nature, and that there are more hypotheses than certainties regarding these relationships, we propose a partial least squares structural equation modeling specification to test the research hypotheses and to estimate the corresponding impacts. Spain is an optimal study area to carry out research on this topic because it is considered to have one of the best health systems in the world, it is one of the top-ranking countries in terms of life expectancy rates (the indicators we use for well-being), and it has a decentralized public health system with significantly different regional healthcare expenditure public policies. Well-being inequalities arising from different healthcare expenditure public policies is currently a hot topic at a national scale, but especially so at a sub-national level because the inequalities in question are among citizens of the same country. 2Department of Political Economy and Public Finance, Economic and Business Statistics, and Economic Policy, University of Castilla-La Mancha, Toledo, Spain.1European Research Center on Economics and Sustainable Development, Economics and Business Department, University of Almería, Almería, Spain. ![]() María del Carmen Valls Martínez 1 * †, Mayra Soledad Grasso 1 † and José-María Montero 2 † ![]()
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