The President of the Independent Authority for Fiscal Responsibility (AIReF), Cristina Herrero, today gave a plenary session speech at the 43rd Conference on Health Economics organised by the Health Economics Association (Spanish acronym: AES) at the University of La Laguna in Tenerife, in which she reviewed the consolidation of AIReF’s evaluation and the main evaluations related to health services performed within the framework of the Spending Review and for the Autonomous Regions (ARs). The findings identified in these evaluations, as the President stated, have given rise to proposals to improve efficiency, some of which have already been implemented by the different authorities.
Cristina Herrero noted that AIReF was set up under the umbrella of the European drive to guarantee the sustainability of public finances. It was created in 2013 with a main function focused on fiscal supervision and as a unique institution in terms of its configuration and functions. It was created by means of an Organic Law and is endowed with the legal force to have authority over all General Government sub-sectors. The institution also has its own financing system through a supervisory tax paid by all General Government authorities and single-member management, which requires broad support from the Spanish Parliament. And it has a broad mandate to supervise ex ante each and every General Government authority and all authorities as a whole, playing a very important role in risk warning with a view to the medium and long term.
These unique features, as Cristina Herrero pointed out, have been very important for incorporating the evaluation function into the institution and explain the European backing received to achieve this. In 2017, ECOFIN recommended Spain to carry out a comprehensive Spending Review, which was commissioned to AIReF. And in 2021, this new function was consolidated with the new impetus received in Component 29 of the Recovery, Transformation and Resilience Plan (RTRP), which led to the creation of the Public Spending Evaluation Division at AIReF, the continuity of the Spending Reviews and the setting up of a team at the Ministry of Finance to monitor AIReF’s proposals.
AIReF, a key player in evaluation
According to Cristina Herrero, AIReF is an institution that is well-positioned to take on the challenges of evaluation in a highly decentralised country like Spain. It has fundamental institutional strengths, such as its independence, its influence over all GG authorities and the synergies that exist between evaluation and supervision. This makes AIReF the only institution with the capacity to assess cross-cutting policies with jurisdiction shared between different General Government sub-sectors. AIReF also carries out ex-post evaluations that are evidence-based and useful for public decision-makers, with findings and proposals for improving the efficiency and effectiveness of spending. These principles of effectiveness and efficiency are recognised in Spanish law, but they have not been implemented through specific regulations, so there is still some way to go to give them content and generate “expertise” in the General Government.
Cristina Herrero noted that the incorporation of the evaluation function has been a challenge that has required learning, adaptation and continuous evolution at AIReF. Over the years, the institution has made a lot of progress in terms of human resources, infrastructure and data management, methodology and approach to the evaluations. Today AIReF has its own revenue, offers guarantees to the General Government on the use of data and directs its evaluations towards improving effectiveness and efficiency, a key orientation in a context in which the commitment to the quality of public finances is fundamental for the design of a fiscal strategy that helps reduce the vulnerability of public finances.
Evaluations in the health sector
Lastly, the President referred to health spending, which has always been in the spotlight, despite the fact that it is not easy to evaluate. She recalled that the Central Government has asked AIReF for several evaluations related to healthcare services since the start of the Spending Review, such as the study on prescription medication and the study on hospital pharmacy and capital goods, which have already been carried out and delivered, or the healthcare of the administrative mutual insurance scheme, which is being developed as part of the first phase of the Spending Review 2022-2026 and the analysis of Temporary Disability benefits, which will be dealt with in the second phase.
In addition, the Autonomous Regions, which initially asked AIReF for commissions on matters related to the Spending Review, have been showing their own interest in areas such as human resources policy and public procurement. At present, four ARs have already commissioned AIReF to carry out various evaluations in the field of healthcare. All these AIReF evaluations, which have evolved from aggregate descriptive analysis to micro analysis, have generated findings that have given rise to proposals to improve the efficiency of public policies and some have already been implemented by the different authorities or are under study, which shows the usefulness of the studies conducted by the institution.