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some authors have criticized regional differences in financial compensation because of the inequality this may generate in the geographic distribution of dermatologists&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">13</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Private health are in Spain is growing&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> Part of this growth is a result of cutbacks in public spending &#40;and the subsequent transformation of the health care system&#41;&#44; diversification of supply&#44; and changes in patterns of demand&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">15</span></a> Another factor that explains this growth in our specialty is the growing trend of esthetic procedures&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">After reviewing the literature&#44; we found no scientific publications to date that show the variations in fees per intervention and payment-collection habits among dermatologists providing private care in the different autonomous communities in Spain&#46; Spanish studies examine general aspects of private care<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> or pay conditions of doctors in all specialties&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We consider the description of the characteristics and fees of specialists in medical and surgical dermatology and venereology who provide private care in Spain in 2018 to be important from a scientific&#44; sociological&#44; and historical perspective&#46; This snapshot of the current economic situation in dermatology makes it possible to determine the current state of private care in this specialty&#44; how it is developing&#44; and which areas require criticism or improvement&#59; it is also an historical testament to the social and economic environment&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The primary goal of this study was to describe the characteristics of private dermatology practice and the fees for the most common medical and esthetic procedures&#46; The secondary goal was to analyze these fees by region&#44; age&#44; and sex&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">We carried out an online survey &#40;Appendix B&#59; questions are shown in Supplementary <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; which was open for responses from 17 May to 5 June&#44; 2018&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Requests for responses were sent through the following professional forums with access controlled by dermatologists&#58; Foroderma 2&#46;0 &#40;Facebook group with 668 members at the date of closure of the survey&#41;&#44; Dermachat &#40;chat forum with 340 members on the closure date&#41;&#44; and Dermus &#40;dermatologists who attended the 11th Meeting of Private Dermatology and New Technologies &#91;<span class="elsevierStyleSmallCaps">XI</span> Reuni&#243;n de Dermatolog&#237;a Privada y Nuevas Tecnolog&#237;as&#93;&#44; held in Madrid from May 31 to June 2&#44; 2018&#41;&#46; This meant that all respondents were medical specialists in medical and surgical dermatology and venereology&#46; Although these groups consist of mostly Spanish members&#44; the introduction to the survey and the initial questions excluded any specialist not working in Spain&#46; Responses were only accepted from professionals carrying out private practice &#40;ensured by an exclusion question at the start of the survey&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Data were analyzed using the &#967;<span class="elsevierStyleSup">2</span> test&#44; comparing region&#44; sex&#44; and age&#46; Questions regarding fees were asked in terms of categories to make the survey more acceptable&#46; In order to analyze these data&#44; each category was recoded as its mean value &#40;assuming that fees are distributed uniformly in each category&#41; and the mean fees of the extreme categories were estimated &#40;Appendix B&#44; Supplementary <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; The fees were compared using analysis of variance &#40;ANOVA&#41; and linear regression after verifying that these techniques were applicable&#46; To evaluate the factors that affect fees by sex&#44; we performed successive linear regression models&#44; including the variables sex&#44; age&#44; autonomous community&#44; type of center&#44; and a variable for interaction between sex and age&#46; The SPSS &#40;version 20&#46;0&#41; and Stata &#40;version 15&#41; statistical software packages were used for the statistical analysis&#46; Results of the tests were assumed to be significant for values of p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Demographic Data and Type of Private Activity</span><p id="par0045" class="elsevierStylePara elsevierViewall">A total of 234 specialists in medical and surgical dermatology and venereology who carry out private care in Spain &#40;117 men &#91;50&#37;&#93; and 117 women &#91;50&#37;&#93;&#41; responded to the survey&#46; The demographic and professional-affiliation data of the survey respondents are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">All age groups were represented &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Although fewer women over the age of 60 years responded &#40;11&#37; compared to 19&#37;&#41;&#44; the difference was not significant&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Responses were received from all the regional sections of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41; and the distribution in the sample was similar to that of AEDV dermatologists &#40;compared with the updated numbers by section available from the AEDV&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;23&#41;&#46; Statistically significant differences were found with respect to the age of the dermatologists who responded to the survey in the different sections &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;007&#41;&#58; more responses were received from the youngest age group in the Center &#40;34&#46;4&#37; of all those under 40 years of age&#41;&#44; Andalusia &#40;21&#46;9&#37;&#41;&#44; and Galicia &#40;14&#46;1&#37;&#41; sections&#44; and from the oldest age group in the Center &#40;25&#46;7&#37; of all those over 60 years of age&#41;&#44; Valencia &#40;22&#46;9&#37;&#41;&#44; and Galicia &#40;17&#46;1&#37;&#41; sections&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The activity or type of professional practice of the surveyed dermatologists &#40;with three response options&#58; exclusively private practice&#44; mostly public practice with some private practice&#44; or mostly private practice with some public practice&#41; presented statistically significant differences in terms of age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#44; with predominantly private care among the older age groups &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Most of the surveyed dermatologists &#40;50&#46;4&#37;&#41; work in their own clinics or in clinics of up to 4 doctors&#46; In the sample&#44; the most common types of private clinic are distributed unequally between the sections &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; &#40;dermatologist&#39;s own clinic with a small team&#44; dermatologist&#39;s own clinic with a large team&#47;polyclinics&#44; and large hospitals&#47;clinics&#41;&#46; Thus&#44; for example responses were received from dermatologists with their own clinics and a large team only in the Center&#44; Catalonia&#44; Valencia and Galicia sections&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the different types of practice by age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Habits and Methods of Payment Collection&#44; Promotion and Price Changes</p><p id="par0075" class="elsevierStylePara elsevierViewall">The results regarding habits and methods of payment collection&#44; promotions and price changes&#44; and the presence or absence of significant differences in terms of regional section&#44; sex&#44; and age&#44; are summarized in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">In terms of who collects payment&#44; the most common response is that dermatologists delegate this responsibility to their secretaries&#44; receptionists or personnel of the medical center itself &#40;81&#46;6&#37;&#41;&#46; Fifteen percent of those surveyed delegate this task to nursing staff&#46; Only 9&#37; of dermatologists collect payment before performing some techniques &#40;this is more frequently an exceptional practice&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Most specialists accept payment in cash &#40;96&#46;2&#37;&#41; and bank card &#40;75&#46;2&#37;&#41;&#46; The percentage of specialists who accept bank cards differed by regional section &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41;&#58; 100&#37; in the Canary Islands section and lower percentages in the Galicia &#40;54&#46;3&#37;&#41; and Murcia &#40;42&#46;9&#37;&#41; sections&#46; The percentage also differed according to age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;037&#41;&#59; accepting payment by bank card was more common among younger dermatologists &#40;85&#46;9&#37; of those below 40 years of age accept card payment&#41; and less common among older dermatologists &#40;62&#46;9&#37; of those over 60 years of age accept card payment&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Other means of paying fees&#44; such as online banking&#44; also show a high percentage of acceptance &#40;67&#46;1&#37;&#41;&#46; Other more novel systems&#44; however&#44; such as payment via cryptocurrency&#44; are still poorly accepted&#58; only one dermatologist accepted this form of payment&#44; although 8&#46;1&#37; of all respondents were considering including it&#46; Payment by barter is rare&#44; though more common among men &#40;13&#46;7&#37; stated that they occasionally accepted barter&#41; than among women &#40;6&#37;&#41;&#44; with statistically significant differences &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;048&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Three pieces of data stood out in terms of financing and promotions&#46; First&#44; most specialists &#40;81&#46;3&#37;&#41; do not provide financing for treatments &#40;6&#46;4&#37; were considering providing it&#41;&#46; Second&#44; fewer than half of dermatologists provide vouchers for techniques or treatments &#40;42&#46;1&#37;&#41; and this practice is more commonly used for just a few treatments &#40;64&#46;1&#37; of those provided&#41; and by younger dermatologists &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; Third&#44; it is common for discounts to be applied occasionally to family groups &#40;81&#46;1&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Finally&#44; the rate at which fees are changed showed significant differences by both sex and age&#46; Male dermatologists tend to revise their consultation fees over shorter and more defined periods of time &#40;65&#37; have an established time period for adjusting fees&#41;&#44; whereas female dermatologists more frequently change their fees when they deem it appropriate or over longer periods &#40;66&#46;7&#37; do so in periods of more than 5 years or only when they deem it appropriate&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#46; Dermatologists over 50 years of age more frequently have a defined period for changing prices &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Habits in Terms of Price-Setting and Provision of Services</span><p id="par0105" class="elsevierStylePara elsevierViewall">The summary of the results regarding habits in terms of establishing fees and the presence or absence of significant differences in terms of regional section&#44; sex&#44; and age&#44; are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Eighty-five percent of respondents establish their fees in multiples of 10&#46; The majority of respondents do not charge for reviewing test results &#40;81&#46;2&#37;&#41;&#59; the same is true for postoperative dressings&#44; which are either not charged for or charged for only rarely &#40;92&#46;7&#37;&#41;&#46; Out-of-hours consultations are performed by 59&#46;9&#37; of dermatologists&#44; of whom 17 &#40;8&#46;3 of all respondents&#41; charge a higher fee for these consultations&#44; with significant differences by age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;002&#41;&#46; A total of 31&#46;6&#37; of male dermatologists and 16&#46;2&#37; of female dermatologists &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; carry out domiciliary visits&#44; for which they frequently charge a higher fee than for visits at the clinic &#40;16&#46;7&#37; vs 7&#46;3&#37;&#41;&#46; These visits are more frequently carried out by older dermatologists&#58; 37&#46;1&#37; of those over 60 years of age stated that they carried out domiciliary visits compared to 11&#46;5&#37; of those under 40 years of age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;037&#41;&#46; Only 9&#37; of the dermatologists surveyed provide teledermatology consultations &#8211; mostly for the same price or lower than for an in situ visit&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Fees</span><p id="par0115" class="elsevierStylePara elsevierViewall">The fees for the different items surveyed are shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46; Below&#44; we discuss differences in price by regional section and age&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The mean fee for a first appointment as a private patient in Spain at the time of the survey was &#8364;88&#46;60&#46; This was the only one of the fees surveyed that showed statistically significant differences between regional sections &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;044&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The only one of the fees investigated that showed statistically significant differences by age was the fee for surgery of medium complexity &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;019&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Differences in fees by sex of the dermatologists surveyed are a different matter&#46; The survey found that female dermatologists charge lower fees than male dermatologists for all items surveyed except one&#46; Fees for first appointments&#44; check-ups&#44; low-complexity surgery&#44; medium-complexity surgery&#44; high-complexity surgery&#44; and administration of botulinum toxin in a small area were all charged at a lower price by female dermatologists&#59; the only item with no significant differences was administration of hyaluronic acid &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46; Application of successive multiple linear regression models&#44; adding the variables age&#44; community&#44; type of center&#44; and a variable for interaction between age and sex showed no major changes in differences between fees&#44; thus ruling out these factors as an explanation of the differences&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">In this study&#44; we describe the characteristics and fees in private care provided by specialists in dermatology working in Spain&#46; Some differences were found based on the sex&#44; age&#44; and geographic location of the dermatologists&#44; notably including greater presence of older dermatologists in private practice&#44; different acceptance rates for credit cards by regional section&#44; and differences in fee changes by age and sex&#46; In terms of fees&#44; differences were observed in the price of first appointments by regional section&#44; and in practically all fee items by sex&#44; where the fees set by female dermatologists were significantly lower than those set by male dermatologists&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">We have been unable to identify similar publications in the literature&#46; Unlike the analyses of the consequences of certain types of payment in the English-speaking world&#44;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">6&#8211;12</span></a> Spanish studies focus on general aspects of private care<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> or pay conditions of doctors in all specialties&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> The survey sample included equal numbers of male and female respondents and was proportional with respect to the number of academic belonging to each regional section of the AEDV&#46; Furthermore&#44; measures were taken to prevent social desirability bias &#40;consisting of giving answers in the survey that are closer to what is socially more acceptable&#41;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">17</span></a>&#59; this was achieved essentially by means of anonymous data collection and processing&#41; and to facilitate participation &#40;such as category-based questions&#41;&#46; The study may&#44; however&#44; have some limitations&#44; such as the relatively small sample size &#40;although it represents more than 10&#37; of academics and&#44; therefore&#44; of dermatologists in Spain<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">18</span></a>&#41;&#44; its selection&#44; and the restrictions on representativeness that may result from the differences in age&#44; geographic area&#44; and type of private clinic&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The ages shown in the survey correspond to the current demographics of health care professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> It can be stated that the older Spanish dermatologists are&#44; the more frequently they work in private practice&#46; While there are approximately 3000 private medical centers in Spain and the majority of the turnover &#40;&#8364;3&#44;96 million in 2015&#41; comes from 9 main actors &#40;large hospital groups and insurers&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">14</span></a> dermatologists usually work in small clinics &#40;their own clinics&#44; with up to 4 doctors on the team&#41;&#46; Clinics owned by dermatologists and with more than 4 doctors on the team are the exception and are restricted to a few geographic areas&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">At present&#44; teledermatology consultations are rare&#46; Domiciliary visits by dermatologists are rare and&#44; in general&#44; more common among male dermatologists&#46; In terms of payment-collection habits&#44; we can conclude that most dermatologists tend to delegate this responsibility to administrative personnel&#44; payment is rarely collected in advance&#44; and financing of treatments or the provision of vouchers is also rare&#46; Notable discrepancies were observed in terms of acceptance of payment by bank card&#44; with 100&#37; acceptance in the Canary Islands &#40;possibly owing to the tax-deductible nature of medical expenses included in the Canary Islands 2018 budget with effects retroactive to 2017&#44; which requires submission of proof of payment by bank card&#44; transfer or check<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">19</span></a>&#41; and lower rates of acceptance in other sections &#40;probably linked to tax-related differences between autonomous communities&#41;&#46; It is also of note that most dermatologists set their fees in multiples of 10 and do not adjust them in accordance with the consumer price index&#46; The fact that fees are rounded is probably due to convenience when collecting payment in cash and providing change&#59; a similar reason may explain why prices are updated in increments of 10&#46; The fact that older dermatologists usually have a more established system of setting fees may indicate that experience provides them with greater financial education&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">With regard to fees&#44; the differences in the price of a first appointment are linked to the presence of extreme values in certain geographic areas&#46; Nevertheless&#44; the values are relatively uniform between regional sections&#46; While no differences were observed in nearly any of the fees by age of the dermatologist&#44; medium-complexity surgery &#40;performed privately by most of the specialists surveyed&#41; show a tendency to be charged at a higher rate by older dermatologists&#46; Highly complex surgery is performed by a smaller proportion of dermatologists and by an even smaller proportion of older dermatologists&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The most surprising finding in our survey is that female dermatologists charge lower fees than male dermatologists&#46; We do not know the reasons for this&#46; These findings are in line with a recent publication that observed mean differences of &#8364;12&#44;000 in annual salaries &#40;to the detriment of female doctors&#41; in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">1</span></a> but in our study&#44; it is noteworthy that the differences are not in overall salary but in fee per medical intervention and probably self-imposed&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusions</span><p id="par0165" class="elsevierStylePara elsevierViewall">We believe that this study may serve as a frame of reference for understanding the habits of Spanish dermatologists providing private care&#46; The fact that the fees of female dermatologists are lower requires more detailed study &#8212;probably using qualitative research techniques&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of Interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Per-visit fees and the characteristics of private practice in dermatology have been studied very little&#44; at least in Spain&#46; This study aims to describe how dermatologists in private practice in Spain provide services&#44; collect payment&#44; promote their services&#44; and establish fees&#46; We also analyze differences by region&#44; age&#44; and sex&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We performed a descriptive&#44; cross-sectional study based on an online questionnaire with a total of 31 questions aimed exclusively at dermatologists in private practice in Spain&#46; The questionnaire was open for responses from May 17 to June 5&#44; 2018&#46; The data were analyzed by comparing region&#44; sex&#44; and age&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 234 questionnaires were returned&#44; with equal numbers of male and female respondents and proportional numbers in terms of the regional sections of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41;&#46; Some differences were found for region&#44; age&#44; and sex&#46; The fees of female dermatologists were consistently lower&#44; even after adjusting for confounding factors by means of regression models&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We have described the characteristics of private dermatology practice in Spain&#46; Charging of lower fees by female dermatologists requires more detailed study&#44; probably using qualitative research techniques&#46;</p></span>"
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            "titulo" => "Background and objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Materials and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las tarifas por acto m&#233;dico y los h&#225;bitos de asistencia privada de los dermat&#243;logos apenas han sido objeto de estudio&#44; al menos en nuestro entorno inmediato&#46; Con el presente trabajo pretendemos describir h&#225;bitos de prestaci&#243;n de servicios&#44; medios de cobro&#44; promoci&#243;n y fijaci&#243;n de tarifas de los dermat&#243;logos que realizan asistencia privada en Espa&#241;a&#46; Secundariamente&#44; buscamos analizar las diferencias por secci&#243;n territorial&#44; edad y sexo&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo transversal a partir de un cuestionario <span class="elsevierStyleItalic">on-line</span> con un total de 31 preguntas dirigido exclusivamente a dermat&#243;logos con asistencia privada en Espa&#241;a&#44; abierto a respuestas del 17 de mayo al 5 de junio de 2018&#46; Los datos fueron analizados comparando por secci&#243;n territorial&#44; sexo y edad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se recibi&#243; un total de 234 respuestas&#44; paritarias en cuanto a sexo y proporcionadas en cuanto a las secciones territoriales de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;AEDV&#41;&#46; Pudieron constatarse algunas diferencias por secci&#243;n territorial&#44; edad y sexo&#46; Destacaban las tarifas sistem&#225;ticamente menores de las dermat&#243;logas&#44; incluso tras ajustar por factores de confusi&#243;n mediante modelos de regresi&#243;n&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Quedan descritas caracter&#237;sticas de la asistencia privada en Dermatolog&#237;a en Espa&#241;a&#46; El hecho de que haya tarifas m&#225;s baratas entre las dermat&#243;logas requiere de un estudio m&#225;s detallado&#44; probablemente mediante t&#233;cnicas de investigaci&#243;n cualitativa&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Antecedentes y objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Materiales y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Martin-Gorgojo A&#44; Garc&#237;a-Doval I&#44; del R&#237;o de la Torre E&#46; Survey on Private Dermatology Practice Characteristics and Fees in Spain in 2018&#46; Actas Dermosifiliogr&#46; 2019&#59;110&#58;137&#8211;145&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0055"
          ]
        ]
      ]
    ]
    "multimedia" => array:12 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1266
            "Ancho" => 1509
            "Tamanyo" => 86737
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ages of respondents by sex&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1680
            "Ancho" => 2084
            "Tamanyo" => 157589
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Usual professional activity or practice by age of surveyed dermatologists&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1648
            "Ancho" => 2085
            "Tamanyo" => 159131
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Type of private clinic in which surveyed dermatologists work&#44; by age&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1493
            "Ancho" => 1507
            "Tamanyo" => 88135
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Provision of treatment vouchers by age&#46;</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr5.jpeg"
            "Alto" => 1211
            "Ancho" => 1500
            "Tamanyo" => 80032
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Periodicity of changes in fees by age&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Sex</td><td class="td" title="table-entry  " align="left" valign="top">Male&#58; 117 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Female&#58; 117 &#40;50&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Age</td><td class="td" title="table-entry  " align="left" valign="top">Under 40 years of age&#58; 64 &#40;27&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">40-50 years of age&#58; 56 &#40;23&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">50-60 years of age&#58; 79 &#40;33&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Over 60 years of age&#58; 35 &#40;15&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="10" align="left" valign="top">Regional section to which you belong</td><td class="td" title="table-entry  " align="left" valign="top">Andalusia&#58; 45 &#40;19&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias&#8211;Cantabria&#8211;Castillia-Leon&#58; 12 &#40;5&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balearic Islands&#58; 5 &#40;2&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Canary Islands&#58; 6 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Catalonia&#58; 14 &#40;6&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Center&#58; 67 &#40;28&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galicia&#58; 35 &#40;15&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murcia&#58; 7 &#40;3&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valencia&#58; 19 &#40;8&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basque Country-Navarre-Aragon-Rioja&#58; 24 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Usual practice activity</td><td class="td" title="table-entry  " align="left" valign="top">Private only&#58; 95 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mostly private with some public&#58; 45 &#40;19&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mostly public with some private&#58; 94 &#40;40&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Type of private clinic</td><td class="td" title="table-entry  " align="left" valign="top">Own&#47;dermatologist-owned clinic with up to 4 doctors on the team&#58; 118 &#40;50&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Own&#47;dermatologist-owned clinic with &#62;<span class="elsevierStyleHsp" style=""></span>4 doctors&#58; 21 &#40;9&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical center&#47;polyclinic with several specializations&#58; 51 &#40;21&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Large hospital&#47;private clinic&#58; 44 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1978880.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic Data and Professional Affiliation&#46;</p>"
        ]
      ]
      6 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Person&#47;s who collect payment for medical interventions in the center</td><td class="td" title="table-entry  " align="left" valign="top">The specialist who performed the intervention&#58; 8 &#40;3&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Auxiliary&#44; clinical&#44; hired nursing personnel&#58; 35 &#40;15&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Secretary&#44; receptionist&#58; 138 &#40;59&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Personnel of the clinic or medical center&#58; 53 &#40;22&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Payment-collection in advance of interventions</td><td class="td" title="table-entry  " align="left" valign="top">Never&#58; 213 &#40;91&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Occasionally&#44; in specific interventions that require expenditure of material or prior preparation &#40;e&#46;g&#46; injectable polylactic acid&#41;&#58; 15 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Often&#58; 6 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Acceptance of payment in cash</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 225 &#40;96&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#58; 9 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Acceptance of payment by bank card</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 60 &#40;25&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#58; 174 &#40;74&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Acceptance of payment via online banking</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 60 &#40;25&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#58; 174 &#40;74&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Acceptance of payment via virtual currency or blockchain</td><td class="td" title="table-entry  " align="left" valign="top">No&#58; 214 &#40;91&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#58; 19 &#40;8&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#44; but I am considering it in the near future&#58; 1 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Acceptance of payment by barter &#40;exchange of services&#41;</td><td class="td" title="table-entry  " align="left" valign="top">Never&#58; 211 &#40;90&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rarely&#58; 23 &#40;9&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Usually&#58; 0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Do you provide treatment vouchers &#40;session packs&#41; for esthetic treatment&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 28 &#40;12&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#44; but only for a few treatments&#47;techniques&#58; 50 &#40;21&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Never&#58; 107 &#40;45&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prefers not to answer&#47;not applicable&#58; 49 &#40;20&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">Do you provide financing options for treatments&#63;</td><td class="td" title="table-entry  " align="left" valign="top">No&#44; and I am not considering it&#58; 133 &#40;56&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#44; but I am considering it&#58; 15 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rarely&#58; 23 &#40;9&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Usually&#58; 11 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prefers not to answer&#47;not applicable&#58; 52 &#40;22&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Do you provide a discount for consultations by several family members in the same visit&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Never&#58; 43 &#40;18&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rarely&#58; 101 &#40;43&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Always&#58; 83 &#40;35&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Prefers not to answer&#47;not applicable&#58; 7 &#40;3&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="5" align="left" valign="top">How often do you change&#47;revise your fees&#63;</td><td class="td" title="table-entry  " align="left" valign="top">Each year&#44; in line with the consumer price index&#58; 15 &#40;6&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Every 2 years&#58; 33 &#40;14&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Every 3-5 years&#58; 45 &#40;19&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In periods of more than 5 years&#58; 46 &#40;19&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Only when I consider it appropriate&#58; 95 &#40;40&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Payment-Collection&#44; Promotion and Price-Change Habits&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Results&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Fees in multiples of 10</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 199 &#40;85&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#58; 35 &#40;15&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">I charge for reviewing results</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#58; 44 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No&#58; 190 &#40;81&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">I charge for postoperative dressings</td><td class="td" title="table-entry  " align="left" valign="top">Never&#58; 146 &#40;62&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rarely&#58; 71 &#40;30&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Often&#58; 6 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Always&#58; 11 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Out of hours&#58; provision of coverage and charging habits</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; I provide coverage and charge a similar fee&#58; 123 &#40;52&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#44; I provide coverage and charge more for out-of-hours consultations&#58; 17 &#40;7&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Does not attend patients out of hours&#47;no response&#58; 94 &#40;40&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="3" align="left" valign="top">Domiciliary visits&#58; provision of visits and charging habits</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; I provide domiciliary visits and charge the usual consultation fee&#58; 17 &#40;7&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#44; I provide domiciliary visits and charge a higher fee&#58; 39 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Does not provide visits&#47;no response&#58; 178 &#40;76&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Teledermatology consultations&#58; provision of service and charging habits</td><td class="td" title="table-entry  " align="left" valign="top">Yes&#44; I provide teledermatology consultations and charge a fee similar to in situ consultation fees&#58; 9 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#44; I provide teledermatology consultations and charge a lower fee&#58; 11 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes&#44; I provide teledermatology consultations and charge a higher fee&#58; 1 &#40;0&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Does not provide service&#47;no response&#58; 213 &#40;91&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Habits in Price-Setting and Provision of Services&#46;</p>"
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          0 => array:3 [
            "identificador" => "at4"
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        "tabla" => array:1 [
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Item and Sections</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;Price in &#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Interquartile Range &#40;Q<span class="elsevierStyleInf">25</span>-Q<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="10" align="left" valign="top">First appointment</td><td class="td" title="table-entry  " align="left" valign="top">Andalusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">86&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias&#8211;Cantabria&#8211;Castillia-Leon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balearic Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Canary Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Catalonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">94&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Center&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murcia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60-80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basque Country-Navarre-Aragon-Rioja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">70-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Item in Overall Regional Sections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean &#40;Price in &#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Interquartile Range &#40;Q<span class="elsevierStyleInf">25</span>-Q<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First Appointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80-105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Check-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40-80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Low-complexity surgery &#40;e&#46;g&#46; shaving a nevus&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75-150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medium-complexity surgery &#40;e&#46;g&#46; removal of a tumor on the torso or a small or medium tumor on the face with direct closure&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">High-complexity surgery &#40;e&#46;g&#46; removal of a large tumor on the torso or a large tumor on the face with complex closure by means of flap or graft&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infiltration of botulinum toxin in a small anatomic area &#40;e&#46;g&#46; between the eyebrows&#41;&#44; including material&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">150-400&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Infiltration of a vial of hyaluronic acid&#44; including material&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">250-350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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