Diagnosis-related groups (DRGs) are gaining prominence in healthcare systems worldwide to standardize potential payments to hospitals. This study, conducted across public hospitals, investigates the impact of DRG implementation on human resource allocation and management practices. The research findings reveal significant changes in job roles and skill requirements based on a mixed-methods approach involving 70 healthcare professionals across various roles. 50% of respondents reported changes in daily responsibilities, and 42% noted the creation of new roles in their organizations. Significant challenges include inadequate training (46%), and coding complexity (38%). Factor analysis revealed a complex relationship between DRG familiarity, job satisfaction, and staff morale. The study also found a moderate negative correlation between the impact on morale and years of service in the current hospital, suggesting that longer-tenured staff may require additional support in adapting to DRG systems. This study addresses a knowledge gap in the human resource aspects of DRG implementation. It provides healthcare administrators and policymakers with evidence to inform strategies for effective DRG adoption and workforce management in public hospitals.

The starting point is the presence of a widespread feeling of political confrontation and division among Spanish citizens. This is compounded by dissatisfaction with and distrust in a system that is perceived by many as elitist and out of touch with real needs. Several factors related to this perception of politics are explained and quantified. On the one hand, there are economic elements, such as the stagnation of GDP per capita, the persistence of a relatively high at-risk-of-poverty rate, and the rates of material deprivation. And in all these elements, a significant territorial inequality can be observed. There are significant differences between Spain, France and Germany over the period considered. On the other hand, political factors determine much of the public debate in Spain: Historical memory and the Spanish Civil War, as well as the terrorism of ETA and other terrorist groups. The emergence of new parties is analyzed, especially VOX. Finally, the enormous difficulty of finding a territorial structure of political power that would bring together the consensus of most political forces. It is necessary to find formulas for fiscal federalism that will make it possible to move away from the current decentralization of spending without the Autonomous Communities having their own tax capacity. This study concludes by pointing out the relevance of all these problems and the need to find solutions through democratic debate and deliberation with agreements.