Tavares Aida Isabel, Si Abdallah Noureddine
CEISUC - Centre for Health Studies and Research, University of Coimbra, Portugal; CiBB - Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Portugal; ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Portugal.
Department of Applied Mathematics, University of Alicante, Spain.
PLoS One. 2025 May 30;20(5):e0324756. doi: 10.1371/journal.pone.0324756. eCollection 2025.
In 2011, Portugal signed a bailout programme to be implemented over a 3-year period, from 2011 to mid-2014. This programme included a set of measures to control and reduce the public sector, which included interventions in areas such as public spending and financing, the labour market, education, and health, among other structural budget measures. The aim of this research is to determine the long-run causal impact of implementing this Economic Adjustment Programme on several population health outcomes. Data was collected for the period 1990-2019 for Portugal. Health outcome indicators account for DALY and HLY, among other general health indicators, but also for some specific mortality rates like those for stroke and cancer. Control variables include percentage of population older than 65, percentage of people with a university degree, CO2 emissions for Portugal, and also health outcomes data for Denmark, Netherlands, Norway and Sweden. The analytical method used is based on a Bayesian structural time series model, which builds a contrafactual scenario representing the absence of the Economic Adjustment Programme for comparison with observed data. The most significant result is the negative long-run causal impact arising from the implementation of the Economic Adjustment Programme in 2011 in Portugal; in other words, health improvements would have been better and faster had the bailout programme not been implemented, despite some level of uncertainty regarding the results. Findings reinforce the idea for the implementation of social and health policies that complement IMF bailout programmes to mitigate negative impacts on population health in the long-run.
2011年，葡萄牙签署了一项为期三年（从2011年至2014年年中）实施的救助计划。该计划包括一系列控制和缩减公共部门的措施，其中涵盖公共支出与融资、劳动力市场、教育及卫生等领域的干预措施，以及其他结构性预算措施。本研究的目的是确定实施这一经济调整计划对若干人群健康结果的长期因果影响。收集了葡萄牙1990 - 2019年期间的数据。健康结果指标包括伤残调整生命年（DALY）和健康生命年（HLY）等一般健康指标，也包括一些特定死亡率，如中风和癌症的死亡率。控制变量包括65岁以上人口百分比、拥有大学学位的人口百分比、葡萄牙的二氧化碳排放量，以及丹麦、荷兰、挪威和瑞典的健康结果数据。所采用的分析方法基于贝叶斯结构时间序列模型，该模型构建了一个代表不存在经济调整计划的反事实情景，以便与观测数据进行比较。最显著的结果是2011年葡萄牙实施经济调整计划所产生的长期负面因果影响；换句话说，尽管结果存在一定程度的不确定性，但如果没有实施救助计划，健康改善情况本会更好、更快。研究结果强化了实施社会和卫生政策的理念，这些政策可补充国际货币基金组织的救助计划，以长期减轻对人群健康的负面影响。
