title: Changes in access to health services of the immigrant and native-born population in Spain in the context of economic crisis.
abstract: OBJECTIVE
  To analyze changes in access to health care and its determinants in the immigrant and native-born populations in Spain, before and during the economic crisis.
  
  
  METHODS
  Comparative analysis of two iterations of the Spanish National Health Survey (2006 and 2012). Outcome variables were: unmet need and use of different healthcare levels; explanatory variables: need, predisposing and enabling factors. Multivariate models were performed (1) to compare outcome variables in each group between years, (2) to compare outcome variables between both groups within each year, and (3) to determine the factors associated with health service use for each group and year.
  
  
  RESULTS
  unmet healthcare needs decreased in 2012 compared to 2006; the use of health services remained constant, with some changes worth highlighting, such as the decline in general practitioner visits among autochthons and a narrowed gap in specialist visits between the two populations. The factors associated with health service use in 2006 remained constant in 2012.
  
  
  CONCLUSIONS
  Access to healthcare did not worsen, possibly due to the fact that, until 2012, the national health system may have cushioned the deterioration of social determinants as a consequence of the financial crisis. Further studies are necessary to evaluate the effects of health policy responses to the crisis after 2012.
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain. igarcia@consorci.org.
authors.forename: Irene
authors.initials: I
authors.lastname: Garcia-Subirats
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain. ivargas@consorci.org.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas
authors.affiliation: National School of Public Health, Instituto de Salud Carlos III, Avda Monforte de Lemos 5, Pabellón 7, Madrid 28029, Spain. bsanz@isciii.es.
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz
authors.affiliation: Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain. dmalmusi@aspb.cat.
authors.forename: Davide
authors.initials: D
authors.lastname: Malmusi
authors.affiliation: Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain. elena.ronda@ua.es.
authors.forename: Elena
authors.initials: E
authors.lastname: Ronda
authors.affiliation: Sub-Program on Immigration and Health of the CIBERESP, Melchor Fernández Almagro, 3-5, Madrid 28029, Spain. monica.ballesta@carm.es.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ballesta
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consorci de Salut i Social de Catalunya, Avenida Tibidabo, 21, Barcelona 08022, Spain. mlvazquez@consorci.org.
authors.forename: María
authors.initials: M
authors.lastname: Luisa Vázquez
authors.affiliation: .
authors.forename: Meisi
authors.initials: M
authors.lastname: I
mesh_terms: D000293:Adolescent; D000328:Adult; D057172:Economic Recession; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data* / Q000639:trends; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000208:ethnology; D013038:Specialization / Q000706:statistics & numerical data*