Using Higher-Order Constructs to Estimate Health-Disease Status: The Effect of Health System Performance and Sustainability

This article aims to provide information to public agencies and policymakers on the determinants of health systems and their relationships that influence citizens' health-disease status. A total of 61 indicators for each of 17 Spanish autonomous communities were collected from the Spanish Ministry of Health, Social Services, and Equality between 2008 and 2017. The applied technique was partial least squares structural equation modeling (PLS-SEM). Concerning health-disease status, an influence of sustainability and performance on the health system was hypothesized. The findings revealed that health system sustainability had a negative effect on health-disease status, measured in terms of disease incidence. However, the relationship between health system performance and health-disease status is positive. Furthermore, health system performance mediates the relationship between sustainability and health-disease status. According to our study, if we consider the opposite poles that make up the definition of health-disease status (well-being and disease), this concept is defined more by the incidence of the negative aspect.