Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of  Economic Crisis

García-Subirats, Irene; Vargas, Íngrid; Sanz-Barbero, Belén; Malmusi, Davide; Ronda, Elena; Ballesta, M. Teresa Sánchez; Vázquez, María Luisa

doi:10.3390/ijerph111010182

Cited by 32 publications

(46 citation statements)

References 33 publications

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“…Despite the restrictions and cutbacks applied, analysis of the data obtained in national health surveys in 2006 (pre-crisis) and 2011-12 (mid-crisis) reveals no deterioration in immigrants' access to health care or in their health status, compared to persons with Spanish nationality [15]. The 2011 survey was conducted prior to the adoption of RDL 16/2012.…”

Section: Impact On Healthcare Service Access and Uptakementioning

confidence: 99%

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

López-Valcarcel

Pérez

2016

Appl Health Econ Health Policy

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This paper reviews economic and medical research publications to determine the extent to which the measures applied in Spain to control public health spending following the economic and financial crisis that began in 2008 have affected healthcare utilization, health and fairness within the public healthcare system. The majority of the studies examined focus on the most controversial cutbacks that came into force in mid-2012. The conclusions drawn, in general, are inconclusive. The consequences of this new policy of healthcare austerity are apparent in terms of access to the system but no systematic effects on the health of the general population are reported. Studies based on indicators of premature mortality, avoidable mortality or self-perceived health have not found clear negative effects of the crisis on public health. The increased demands for co-payment provoked a short-term cutback in the consumption of medicines, but this effect faded after 12-18 months. No deterioration in the health of immigrants after the onset of the crisis was unambigously detected. The impact of the recession in the general population in diseases associated with mental health is well documented, although the high levels of unemployment are identified as direct causes, and therefore it is social policies rather than measures affecting the healthcare system that would be primarily responsible. In addition, some health problems have a clear social dimension, which seems to have become more acute during the crisis, affecting in particular the most vulnerable population groups and the most disadvantaged social classes, thus widening the inequality gap. 3 Key points for decision makers Some health problems have a clear social dimension, which seems to have become more acute during the crisis  The public health system has borne a disproportionate share of the burden of spending cuts provoked by the crisis, but it has managed to avoid irreversible deterioration. The most tangible consequences of healthcare spending cuts and austerity measures concern problems of access to health care, both for specific population groups (undocumented immigrants) and for patients in general (longer waiting lists). The studies have common limitations: use of cross-sectional data and no consideration of lags between the cause (economic recession) and its effects (mortality, morbidity). In order to better estimate the effects of the crisis on health population, up-to-date data of cohorts from clinical records and registries would be needed. No attempt has been made in Spain so far to reform the health system with a view to achieving its long-term sustainability, in response to the 2008 recession and for preventing future recessions

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Section: Impact On Healthcare Service Access and Uptakementioning

confidence: 99%

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

López-Valcarcel

Pérez

2016

Appl Health Econ Health Policy

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“…As a result of the financial crisis affecting Spain from 2008, various austerity and cost-containment measures were introduced into the health and social welfare system. One change, introduced after our survey was conducted, was the restriction of access to health care among undocumented migrants (and others considered to be uninsured under the universal, residence permit-based system) to emergency and ante- and post-natal care only 29 . The implication is likely to be more severe restrictions than the already significant restrictions we observe in our results.…”

Section: Discussionmentioning

confidence: 70%

Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries

Falla

Veldhuijzen

Ahmad

et al. 2016

Eur J Public Health

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Background: To investigate access to treatment for chronic hepatitis B/C among six vulnerable patient/population groups at-risk of infection: undocumented migrants, asylum seekers, people without health insurance, people with state insurance, people who inject drugs (PWID) and people abusing alcohol. Methods: An online survey among experts in gastroenterology, hepatology and infectious diseases in 2012 in six EU countries: Germany, Hungary, Italy, the Netherlands, Spain and the UK. A four-point ordinal scale measured access to treatment (no, some, significant or complete restriction). Results: From 235 recipients, 64 responses were received (27%). Differences in access between and within countries were reported for all groups except people with state insurance. Most professionals, other than in Spain and Hungary, reported no or few restrictions for PWID. Significant/complete treatment restriction was reported for all groups by the majority in Hungary and Spain, while Italian respondents reported no/few restrictions. Significant/complete restriction was reported for undocumented migrants and people without health insurance in the UK and Spain. Opinion about undocumented migrants in Germany and the Netherlands was divergent. Conclusions: Although effective chronic hepatitis B/C treatment exists, limited access among vulnerable patient populations was seen in all study countries. Discordance of opinion about restrictions within countries is seen, especially for groups for whom the health care system determines treatment access, such as undocumented migrants, asylum seekers and people without health insurance. This suggests low awareness, or lack, of entitlement guidance among clinicians. Expanding treatment access among risk groups will contribute to reducing chronic viral hepatitis-associated avoidable morbidity and mortality.

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“…Several studies analysed public hospital utilisation by foreign residents in Spain, specially focusing on immigrant population [ 33 , 34 , 35 ]. In general, previous studies found lower rates of utilisation, which were attributed to age and better health conditions among the immigrant population [ 11 , 36 , 37 ]. However, given that average utilisation rates by immigrants are not comparable to those by pensioners; more research focussed on specific groups among foreign residents is required.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, in Europe there are not these kinds of analyses in spite of the increasing mobility of patients. With the exception of some specific subjects, e.g., the analysis of healthcare resources required by economic immigrants [ 11 ], the literature related to patients mobile throughout Europe is still in its infancy [ 6 ]. Rosenmöller et al [ 2 ] propose five categories of mobile patients in Europe: (1) citizens on holidays, (2) pensioners or retired long-term residents, (3) cross-border care, (4) medical travellers and (5) people sent abroad by their national healthcare system [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital Costs of Foreign Non-Resident Patients: A Comparative Analysis in Catalonia, Spain

Arroyo-Borrell

Vicens

Sáez

et al. 2017

IJERPH

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Although patient mobility has increased over the world, in Europe there is a lack of empirical studies. The aim of the study was to compare foreign non-resident patients versus domestic patients for the particular Catalan case, focusing on patient characteristics, hospitalisation costs and differences in costs depending on the typology of the hospital they are treated. We used data from the 2012 Minimum Basic Data Set-Acute Care hospitals (CMBD-HA) in Catalonia. We matched two case-control groups: first, foreign non-resident patients versus domestic patients and, second, foreign non-resident patients treated by Regional Public Hospitals versus other type of hospitals. Hospitalisation costs were modelled using a GLM Gamma with a log-link. Our results show that foreign non-resident patients were significantly less costly than domestic patients (12% cheaper). Our findings also suggested differences in the characteristics of foreign non-resident patients using Regional Public Hospitals or other kinds of hospitals although we did not observe significant differences in the healthcare costs. Nevertheless, women, 15–24 and 35–44 years old patients and the days of stay were less costly in Regional Public Hospitals. In general, acute hospitalizations of foreign non-resident patients while they are on holiday cost substantially less than domestic patients. The typology of hospital is not found to be a relevant factor influencing costs.

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Changes in Access to Health Services of the Immigrant and Native-Born Population in Spain in the Context of Economic Crisis

Cited by 32 publications

References 33 publications

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

Economic Crisis, Austerity Policies, Health and Fairness: Lessons Learned in Spain

Limited access to hepatitis B/C treatment among vulnerable risk populations: an expert survey in six European countries

Hospital Costs of Foreign Non-Resident Patients: A Comparative Analysis in Catalonia, Spain

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