Evaluation of Spanish Health System during the COVID-19 Pandemic: Accountability and Wellbeing Results

2. Materials and Methods
The methodology used in this research follows a quantitative approach using both
descriptive analysis and bi-variable analysis, which allow observing of the territorial
differences among the variables for this study. The configuration of the Spanish health
system requires the research to be carried out from a regional perspective, that is, to
examine the different factors of health management in each of the autonomous health
systems, including those of national government management when necessary. In line with
this, and in accordance with the hypotheses put forward, four variables to be examined in
the decentralized Spanish health system are identified.
The first variable is the transparency of the health system. This variable is measured
by means of the transparency index of the autonomous health services carried out by
Dynamic Transparency Index-Dyntra (applied to Spanish Healthcare system [53]. This
indicator is made up of a total of 193 indicators divided into six groups: institutional
transparency (53 indicators), public communication (20 indicators), citizen participation
and collaboration (22 indicators), economic–financial transparency (25 indicators), service
contracting (14 indicators), and healthcare transparency (59 indicators). These data will
make it possible to examine the transparency of the regional healthcare systems before the
arrival of the COVID-19 pandemic (in 2019).
Similarly, in order to analyze the transparency of the regional health systems during
the management of the COVID-19 pandemic, as well as that of the central government’s
management in this respect, the transparency index on COVID-19, also carried out by
Dyntra, is used for health systems and its transparency [54]. This index (2020) is made up of
40 indicators distributed into four groups: transparency in health resources (10 indicators),
transparency on infections (9 indicators), actions to mitigate the impact of COVID-19
(9 indicators) and economic transparency in the management of COVID-19 (12 indicators)

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