Journal Articles


Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E. Public-private partnerships in the Spanish National Health System: The reversion of the Alzira model. Health Policy. 2019 Apr;123(4):408-411. doi: 10.1016/j.healthpol.2019.01.012. Epub 2019 Feb 2.

Catalá-López F, Ridao M, Bernal-Delgado E, Moher D, Repullo JR. Endorsement of guidelines for reporting economic evaluation studies by Spanish biomedical journals. Gac Sanit. 2019 May – Jun;33(3):255-258. doi: 10.1016/j.gaceta.2018.12.006. Epub 2019 Mar 14. Spanish.

Tanke MAC, Feyman Y, Bernal-Delgado E, Deeny SR, Imanaka Y, Jeurissen P, Lange L, Pimperl A, Sasaki N, Schull M, Wammes JJG, Wodchis WP, Meyer GS. A challenge to all. A primer on inter-country differences of high-need, high-cost patients. PLoS One. 2019 Jun 19;14(6):e0217353. doi: 10.1371/journal.pone.0217353. eCollection 2019.


Comendeiro-Maaløe M, Ridao-López M, Gorgemans S, Bernal-Delgado E. A comparative performance analysis of a renowned public private partnership for health care provision in Spain between 2003 and 2015. Health Policy. 2019 Apr;123(4):412-418. doi: 10.1016/j.healthpol.2018.11.009. Epub 2018 Nov 27.

Ridao-López M, Comendeiro-Maaløe M, Martínez-Lizaga N, Bernal-Delgado E. Evolution of public hospitals expenditure by healthcare area in the Spanish National Health System: the determinants to pay attention to. BMC Health Serv Res. 2018 Sep 10;18(1):696.

Gorgemans S, Comendeiro-Maaløe M, Ridao-López M, Bernal-Delgado E. Quality and technical efficiency do not evolve hand in hand in Spanish hospitals: Observational study with administrative data. PLoS One. 2018 Aug 2;13(8):e0201466.


Librero, J., Ibanez-Beroiz, B., Peiro, S. Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas. BMC Health Serv Res 16(a): 367.

Hernandez Miguel, M. V., Martin Martinez, M. A., Corominas, H. et a. Variability in Rheumatology day care hospitals in Spain: VALORA study. Reumatol Clin 13(1): 10-16.

Espallardo, O., Busutil, R., Torres, A., et al. The Impact of Severe Obesity on Healthcare Resource Utilisation in Spain. Obes Surg 27(8): 2058-2066.

Ibañez-Beroiz B, Librero J, Martinez-Lizaga N, Peiró S, Bernal-Delgado E. Applying Spatio-Temporal Models to Assess Variations across Health Care Areas and Regions: Lessons from the Decentralized Spanish National Health System. Plos One 2017 Feb 6;12(2):e0170480. doi: 10.1371/journal.pone.0170480. eCollection 2017.

Angulo-Pueyo E, García-Armesto S, Martínez-Lizaga N, Riado-López M, Peiró S, Bernal-Delgado E. Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish health care system. BMJ Open 2017 Feb 24;7(2):e011844. doi: 10.1136/bmjopen-2016-011844.

Gutacker N, Bloor K, Cookson R, Gale CP, Maynard A, Pagano D, Pomar J Bernal-Delgado E. Hospital surgical volumes and mortality after coronary artery bypass grafting: using international comparisons to determine a safe threshold. Health Services Research 2017 Apr;52(2):863-878. doi: 10.1111/1475-6773.12508


Perez-Romero, S., Gascon-Canovas, J. J., Salmeron-Martinez, D. et al. Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care. Rev Calid Asist 31(5): 300-308.

Librero J, Peiró S, Ibañez-Beroiz B, Ridao-López M, Rodríguez-Bernal CL, Bernal-Delgado E. Trends and area variations in Potentially Preventable Admissions for COPD in Spain (2002-2013): a significant decline and convergence between areas.  BMC Health Serv Res. 2016; 16: 367.


Bernal-Delgado E, Christiansen T, Bloor K, Mateus C, Yazbeck AM, Munck J, Bremner J; ECHO Consortium. ECHO: health care performance assessment in several European health systems. Eur J Public Health. 2015 Feb; 25 Suppl 1:3-7.

Thygesen LC, Baixauli-Pérez C, Librero-López J, Martínez-Lizaga N, Ridao-López M, Bernal-Delgado E; ECHO Consortium. Comparing variation across European countries: building geographical areas to provide sounder estimates. Eur J Public Health. 2015 Feb; 25 Suppl 1:8-14.

Cookson R, Gutacker N, Garcia-Armesto S, Angulo-Pueyo E, Christiansen T, Bloor K, Bernal-Delgado E. Socioeconomic inequality in hip replacement in four European countries from 2002 to 2009-area-level analysis of hospital data. Eur J Public Health. 2015 Feb;25 Suppl 1:21-7.

Gutacker N, Bloor K, Cookson R, Garcia-Armesto S, Bernal-Delgado E. Comparing hospital performance within and across countries: an illustrative study of coronary artery bypass graft surgery in England and Spain. Eur J Public Health. 2015 Feb; 25 Suppl 1:28-34

Thygesen LC, Christiansen T, Garcia-Armesto S, Angulo-Pueyo E, Martínez-Lizaga N, Bernal-Delgado E; ECHO Consortium. Potentially avoidable hospitalizations in five European countries in 2009 and time trends from 2002 to 2009 based on administrative data. Eur J Public Health. 2015 Feb; 25 Suppl 1:35-43

García-Armesto S, Angulo-Pueyo E, Martínez-Lizaga N, Mateus C, Joaquim I, Bernal-Delgado E; ECHO Consortium. Potential of geographical variation analysis for realigning providers to value-based care. ECHO case study on lower-value indications of C-section in five European countries. Eur J Public Health. 2015 Feb; 25 Suppl 1:44-51.

Salinas M, Lopez-Garrigos M, Flores E, Uris J, Leiva-Salinas C. Larger differences in utilization of rarely requested tests in primary care in Spain. Biochemia medica 2015;25:410-5.

Miravitlles M, Huerta A, Valle M, et al. Clinical variables impacting on the estimation of utilities in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease 2015;10:367.


Bernal-Delgado E, Garcia-Armesto S, Peiro S, Atlas VPMG. Atlas of Variations in Medical Practice in Spain: the Spanish National Health Service under scrutiny. Health Policy 2014;114:15-30.

Ibañez-Beroiz B, Librero J, Bernal-Delgado E, García-Armesto S, Villanueva-Ferragud S, Peiró S. Joint spatial modeling to identify shared patterns among chronic related potentially preventable hospitalizations. BMC medical research methodology 2014;14:74.


Alonso-Babarro A, Astray-Mochales J, Dominguez-Berjon F, et al. The association between in-patient death, utilization of hospital resources and availability of palliative home care for cancer patients. Palliative Medicine 2013;27:68-75.

Padilla-Eguiluz NG, García-Rey E, Cordero-Ampuero J, Gómez-Barrena E. Regional variability in the rates of total hip replacement in Spain. Hip international: the journal of clinical and experimental research on hip pathology and therapy 2013;24:81-90.


Aizpuru F, Latorre A, Ibáñez B, et al. Variability in the detection and monitoring of chronic patients in primary care according to what is registered in the electronic health record. Family practice 2012;(6):696-705.


Ibanez-Beroiz B, Librero-Lopez J, Peiro-Moreno S, Bernal-Delgado E. Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases. BMC Medical Research Methodology 2011;11:172.

Llorente C, Blasco JA, Quintana JM, et al. Interhospital variation in appropriateness of cataract surgery. Journal of Evaluation in Clinical Practice 2011;17:188-95.

Ridao-Lopez, Manuel. Garcia-Armesto, Sandra. Abadia-Taira, Begona. Peiro-Moreno, Salvador. Bernal-Delgado, Enrique. Income level and regional policies, underlying factors associated with unwarranted variations in conservative breast cancer surgery in Spain. BMC Cancer. 11:145, 2011.


Garrido-Cumbrera M, Borrell C, Palencia L, et al. Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system. International Journal of Health Services 2010;40:525-42.


Ibáñez B, Librero J, Bernal-Delgado E, Peiró S, López-Valcarcel BG, Martínez N, Aizpuru F. Is there much variation in variation? Revisiting statistics of small area variation in health services research. BMC Health Serv Res. 2009; 9:60.


Magan P, Otero A, Alberquilla A, Ribera JM, Magan P, Otero A, et al. Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage. BMC Health Services Research 2008;8:42.

Román R, Comas M, Mar J, Bernal E, Jiménez-Puente A, Gutiérrez-Moreno S, Castells X; IRYSS Network Modelling Group. Geographical variations in the benefit of applying a prioritization system for cataract surgery in different regions of Spain. BMC Health Services Research 2008; 8(1):32


Atlas VPM

Atlas of Variations in Medical Practice in the National Health System (Spanish & English)


Low-value Surgical Procedures

Potentially Avoidable Hospitalizations in Chronic Care


Echo (European Collaboration for Healthcare Optimization)


Atlas on Potentially Avoidable Hospitalizations in Chronic Care (2019)

Atlas on Hospitalizations for Coronary Ischemic Disease and Cardiac Procedure (2019)

Atlas for Monitoring Diabetes Care (2019)

Atlas on Orthopaedic (2017)

Atlas on Lower Value Care (2017)

Atlas on Potentially Avoidable Hospitalizations in Chronic Conditions: 2015 Update, differences between sexes and age groups (2017)

Atlas on Cardiovascular, Lower Value Care, Potencially Avoidable Hospitalizations, Orthopaedic Care in European Countries (Spain, Denmark and Slovenia) (2014)