Erosion of universal health coverage in Spain

Legido‐Quigley, Helena; Urdaneta, Elena; GONZÁLEZ, ÁLVARO HERNANDO CARDONA; Parra, Daniel; Muntaner, Carles; Álvarez-Dardet, Carlos; Martín-Moreno, José M.; McKee, Martin

doi:10.1016/s0140-6736(13)62649-5

Cited by 56 publications

(36 citation statements)

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“…Although some population groups -immigrants aged under 18 years; immigrants during pregnancy, delivery and the post-partum period; and those requiring emergency care after serious illness or injury -continued to have access to public health care, there remain many obstacles in practice [13] and the Autonomous Communities apply the legislation in different ways. Some, in fact, have simply not applied the restricted access to immigrants or have employed subterfuges to maintain access despite the new restrictive regulations.…”

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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“…The Spanish population is suffering increasing levels of impoverishment and inequality (EUROSTAT, 2014;OECD, 2014OECD, , 2015. The Spanish government has confronted the crisis with a severe programme of labour reforms and cuts in social services, including per capita spending on healthcare since 2009 (Legido-Quigley et al, 2013) that is deeply affecting the social determinants of health in Spain . At the same time, some regional governments have imposed additional budget cuts, which have led to an unprecedented increase in territorial disparities on social protection systems (Fundación BBVA, 2015).…”

Section: Introductionmentioning

confidence: 99%

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003–2012)

Varea

Terán

Bernis

et al. 2016

Annals of Human Biology

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Background: There is a growing evidence of the impact of the current European economic crisis on health. In Spain since 2008 there have been increasing levels of impoverishment and inequality, and important cuts in social services, including per capita spending on healthcare. Aim:The objective is to evaluate the impact of the economic crisis on underweight at birth in Spain. Results and conclusions:Results demonstrate a significant increase in the prevalence of underweight at birth as from 2008. All maternal-foetal categories were affected, including those which showed the lowest prevalence before the crisis. In the full adjusted logistic regression, year-on-year GDP per capita remains predictive on underweight at birth risk, in such a way that the fall in GDP between 2007 and 2012 determined an increase of the OR of underweight at birth by 6.63%. Previous trends in maternal socio-demographic profile and a direct impact of the crisis are discussed to explain the trends described.

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“…Experiences in other EU countries introducing similar proposals, such as Spain, indicate that increased bureaucratic barriers to healthcare access resulted in many with rights to healthcare not accessing services. 64 There are also suggestions that although HIV and tuberculosis treatment is still available for non-residents as part of public health provision, many have discontinued or do not access treatment, for fear of being charged or deported. 64,65 The Spanish government announced in 2015 that undocumented migrants will again have free healthcare, after A&E wards became saturated in response to the austerity measure.…”

Section: Nhs Principlesmentioning

confidence: 99%

“…64 There are also suggestions that although HIV and tuberculosis treatment is still available for non-residents as part of public health provision, many have discontinued or do not access treatment, for fear of being charged or deported. 64,65 The Spanish government announced in 2015 that undocumented migrants will again have free healthcare, after A&E wards became saturated in response to the austerity measure. 66 Learning from the Spanish experience, proposed NHS changes are a potential setback for prevention, monitoring, and control of infectious and noninfectious diseases.…”

Section: Nhs Principlesmentioning

confidence: 99%

National Health Service Principles as Experienced by Vulnerable London Migrants in "Austerity Britain": A Qualitative Study of Rights, Entitlements, and Civil-Society Advocacy

Rafighi

Poduval

Legido‐Quigley

et al. 2016

Int J Health Policy Manag

Self Cite

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Background: Recent British National Health Service (NHS) reforms, in response to austerity and alleged 'health tourism, ' could impose additional barriers to healthcare access for non-European Economic Area (EEA) migrants. This study explores policy reform challenges and implications, using excerpts from the perspectives of non-EEA migrants and health advocates in London. Methods: A qualitative study design was selected. Data were collected through document review and 22 indepth interviews with non-EEA migrants and civil-society organisation representatives. Data were analysed thematically using the NHS principles. Results: The experiences of those 'vulnerable migrants' (ie, defined as adult non-EEA asylum-seekers, refugees, undocumented, low-skilled, and trafficked migrants susceptible to marginalised healthcare access) able to access health services were positive, with healthcare professionals generally demonstrating caring attitudes. However, general confusion existed about entitlements due to recent NHS changes, controversy over 'health tourism, ' and challenges registering for health services or accessing secondary facilities. Factors requiring greater clarity or improvement included accessibility, communication, and clarity on general practitioner (GP) responsibilities and migrant entitlements. Conclusion: Legislation to restrict access to healthcare based on immigration status could further compromise the health of vulnerable individuals in Britain. This study highlights current challenges in health services policy and practice and the role of non-governmental organizations (NGOs) in healthcare advocacy (eg, helping the voices of the most vulnerable reach policy-makers). Thus, it contributes to broadening national discussions and enabling more nuanced interpretation of ongoing global debates on immigration and health.

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Erosion of universal health coverage in Spain

Cited by 56 publications

References 1 publication

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

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

Is the economic crisis affecting birth outcome in Spain? Evaluation of temporal trend in underweight at birth (2003–2012)

National Health Service Principles as Experienced by Vulnerable London Migrants in "Austerity Britain": A Qualitative Study of Rights, Entitlements, and Civil-Society Advocacy

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