title: Changes in access to health care for immigrants in Catalonia during the economic crisis: Opinions of health professionals and immigrant users.
abstract: Policy measures introduced in Spain during the economic crisis included a reduction in public health expenditure and in healthcare entitlements (RDL16/2012), which affected the general population as a whole, but especially immigrants. This paper analyzes changes in immigrants' access to health care during the economic crisis from the perspective of health professionals (medical and administrative) and immigrants. A qualitative descriptive-interpretative study was conducted in Catalonia through individual interviews with a theoretical sample of health professionals (n=34) and immigrant users (n=20). Thematic analysis was conducted and data quality was ensured through triangulation. Informants described barriers to enter the health system related to reduced healthcare entitlements and a stricter enforcement of administrative requirements: while medical professionals highlighted restrictions to accessing the healthcare continuum, immigrants accentuated barriers to obtaining the individual health card. With regard to use of services, an increase in waiting times due to cutbacks in human resources dominated the informants' discourse. Health professionals pointed out organizational changes to increase efficiency that may improve access to primary care. Informants related lower health services utilization to a deterioration in immigrants' living and working conditions. According to health professionals, these conditions limited the use of services during working hours and led to delays in seeking care and treatment interruptions. Results show an aggravation of pre-existing barriers to health services utilization and, simultaneously, the appearance of new barriers to enter the system. These changes in the healthcare services contradict the equity principles of the national health system (NHS), thus policy decisions are needed to address this problem.
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Spain. Electronic address: vporthe@consorci.org.
authors.forename: Victoria
authors.initials: V
authors.lastname: Porthé
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Spain. Electronic address: ivargas@consorci.org.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Vargas
authors.affiliation: Escuela Nacional de Sanidad, Instituto de Salud Carlos III, CIBER de Epidemiología y Salud Pública, CIBERESP, Spain. Electronic address: bsanz@isciii.es.
authors.forename: Belén
authors.initials: B
authors.lastname: Sanz-Barbero
authors.affiliation: Evaluation, Information Network and Quality Unit, Catalonian Health Institute, Spain. Electronic address: iplaza.bcn.ics@gencat.cat.
authors.forename: Isabel
authors.initials: I
authors.lastname: Plaza-Espuña
authors.affiliation: Unitat de Atenció al Ciutadà i Comunicació, Serveis de Salut Integrats del Baix Empordà, Spain. Electronic address: dbosch@ssibe.cat.
authors.forename: Lola
authors.initials: L
authors.lastname: Bosch
authors.affiliation: Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Spain. Electronic address: mlvazquez@consorci.org.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Vázquez
mesh_terms: D057172:Economic Recession; D054242:Emigrants and Immigrants / Q000523:psychology*; D006282:Health Personnel / Q000523:psychology*; D006291:Health Policy; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D011320:Primary Health Care; D036301:Qualitative Research; D013030:Spain
keywords: Barriers to access; Economic crisis; Health policy; Healthcare access; Migrants