title: Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia.
abstract: Until April 2012, all Spanish citizens were entitled to health care and policies had been developed at national and regional level to remove potential barriers of access, however, evidence suggested problems of access for immigrants. In order to identify factors affecting immigrants' access to health care, we conducted a qualitative study based on individual interviews with healthcare managers (n=27) and professionals (n=65) in Catalonia and Andalusia, before the policy change that restricted access for some groups. A thematic analysis was carried out. Health professionals considered access to health care "easy" for immigrants and similar to access for autochthons in both regions. Clear barriers were identified to enter the health system (in obtaining the health card) and in using services, indicating a mismatch between the characteristics of services and those of immigrants. Results did not differ among regions, except for in Catalonia, where access to care was considered harder for users without a health card, due to the fees charged, and in general, because of the distance to primary health care in rural areas. In conclusion, despite the universal coverage granted by the Spanish healthcare system and developed health policies, a number of barriers in access emerged that would require implementing the existing policies. However, the measures taken in the context of the economic crisis are pointing in the opposite direction, towards maintaining or increasing barriers.
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo, 21, 08022 Barcelona, Spain. Electronic address: mlvazquez@consorci.org.
authors.forename: María-Luisa
authors.initials: ML
authors.lastname: Vázquez
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo, 21, 08022 Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011 Granada, Spain.
authors.forename: Daniel López
authors.initials: DL
authors.lastname: Jaramillo
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo, 21, 08022 Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Porthé
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011 Granada, Spain.
authors.forename: Luis Andrés
authors.initials: LA
authors.lastname: López-Fernández
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo, 21, 08022 Barcelona, Spain; Agència de Salut Pública de Barcelona, Plaça Lesseps, 1, 08023 Barcelona, Spain.
authors.forename: Hernán
authors.initials: H
authors.lastname: Vargas
authors.affiliation: Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19, 17230 Palamós, Spain.
authors.forename: Lola
authors.initials: L
authors.lastname: Bosch
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011 Granada, Spain.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Hernández
authors.affiliation: Escuela Andaluza de Salud Pública, Campus Universitario de Cartuja, Cuesta del Observatorio, 4, 18011 Granada, Spain.
authors.forename: Ainhoa Ruiz
authors.initials: AR
authors.lastname: Azarola
mesh_terms: D001291:Attitude of Health Personnel; D003144:Communication Barriers; D003695:Delivery of Health Care / Q000458:organization & administration; D054242:Emigrants and Immigrants; D006282:Health Personnel / Q000523:psychology; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D036301:Qualitative Research; D012424:Rural Population; D013030:Spain
keywords: Access to healthcare; Health personnel; Health services accessibility; Immigrants