Cimas Marta, Gullon Pedro, Aguilera Eva, Meyer Stefan, Freire José Manuel, Perez-Gomez Beatriz
Preventive & Public Health Medicine Teaching Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
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.
Health Policy. 2016 Apr;120(4):384-95. doi: 10.1016/j.healthpol.2016.02.005. Epub 2016 Feb 17.
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.
经济危机引发了关于如何在公共资助的医疗体系中规范无证移民医保覆盖范围的讨论。西班牙作为欧洲受影响最严重的国家之一，可被视为一个特别值得关注的案例。2012年，西班牙政府颁布了一项皇家法令（第16/2012号皇家法令），该法令撤销了无证移民此前享有的全面公共医保覆盖权，如今仅在某些例外情况下适用。然而，西班牙国家卫生系统高度分散，中央政府的这项法令必须由各地区卫生当局来执行。我们的目标是通过详尽审查第16/2012号皇家法令颁布后各自治区发布的地区卫生政策法规，比较2012年第16/2012号皇家法令颁布后17个自治区关于无证移民医保资格的地区政策。我们的分析表明，许多地区采取了法律、立法和行政行动来消除或限制该法令的影响，而其他地区则按其本意执行，这导致西班牙各地区在为非法移民提供医保覆盖方面存在巨大差异。这项法律的不平等实施构成了分散化卫生系统中全国范围内对有争议关键问题进行监管复杂性的一个典型例子。此外，我们的研究结果凸显出，在医疗体系分散化的情况下，国内在医疗服务获取和/或资格方面的差异可能与国家间的差异同样显著。
