title: Healthcare coverage for undocumented migrants in Spain: Regional differences after Royal Decree Law 16/2012.
abstract: The economic crisis has prompted the debate on how to regulate health coverage of undocumented migrants in publicly funded healthcare systems. Spain, as one of the most heavily affected countries in Europe, can be considered a case of particular interest. In 2012 the Spanish Government issued a Royal Decree Law (RDL 16/2012) which revoked their previous full right to public healthcare coverage, now limited for some exceptions. However, the Spanish National Health System is highly decentralized, and this Central Government decree had to be implemented by the Regional Health Authorities. Our aim is to compare regional policies regarding entitlement to healthcare for undocumented migrants after RDL 16/2012 in the 17 Autonomous Regions by performing an exhaustive review of the regional health policy regulations published after the enactment of RDL 16/2012. Our analysis shows that many Regions adopted legal, legislative and administrative actions to void or limit its effects, while others applied it as intended, resulting in huge differences in healthcare coverage for irregular migrants among Spanish Regions. The unequal implementation of this Law constitutes a paradigmatic example of the complexity of nation-wide regulation of controversial key issues in decentralized health systems. In addition, our results highlight that within-country differences in access and/or entitlement can be as relevant as those reported among-country when there is healthcare decentralization.
authors.affiliation: Preventive & Public Health Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Cimas
authors.affiliation: Preventive & Public Health Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Social and Cardiovascular Research Group, School of Medicine, Universidad de Alcalá, Alcalá de Henares, Spain. Electronic address: pgullon@isciii.es.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gullon
authors.affiliation: Doctors of the World, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Aguilera
authors.affiliation: Doctors of the World, Madrid, Spain.
authors.forename: Stefan
authors.initials: S
authors.lastname: Meyer
authors.affiliation: Preventive & Public Health Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Freire
authors.affiliation: Preventive & Public Health Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain; CIBERESP, Madrid, Spain; Puerta de Hierro Hospital Research Institute, Madrid, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Perez-Gomez
mesh_terms: D006291:Health Policy / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence*; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000331:legislation & jurisprudence*; D011057:Politics; D013030:Spain; D014171:Transients and Migrants / Q000331:legislation & jurisprudence*
keywords: Health inequalities; Health policy; Immigrants; Migrants; Spain