Department of Medicine, University of Barcelona, Spain.
Department of Medicine, University of Barcelona, Spain.
Health Policy. 2018 Nov;122(11):1155-1160. doi: 10.1016/j.healthpol.2018.08.011. Epub 2018 Aug 30.
In 2012 the Spanish government passed Royal Decree-Law 16/2012 (RDL) aimed at containing public expenditure in response to the economic crisis. This RDL redefined just who would be entitled to public health care. As a result, a large proportion of undocumented immigrants in Spain were excluded from basic publicly financed health care with access only being granted under particular circumstances (emergency care, maternal care, children under 18, asylum seekers and victims of human trafficking).
The aims of this paper are to identify the specific traits of this policy, review its impact on health and health care access, and to evaluate its economic impact.
Most political parties and health professional groups opposed the RDL, and a large number of Spanish regions either declined to apply it or opted to apply it partially. To date, the RDL has had a considerable impact on the access of undocumented immigrants to public health care, with evidence suggesting that approximately 870,000 people have been excluded. A slight increase in infectious diseases has been reported, albeit not as high as originally predicted, and recent evidence points to an increase in mortality among this population subgroup.
Regional legislation favouring the coverage of undocumented immigrants might have acted as a counterweight and thus contained the negative health effects in this population subgroup. But the Constitutional Court invalidated all regional arrangements obliging regions to comply with the RDL.
2012 年，西班牙政府颁布了第 16/2012 号皇家法令（RDL），旨在应对经济危机，控制公共支出。该 RDL 重新定义了谁有资格获得公共医疗保健。结果，西班牙的大量无证移民被排除在基本公共资助的医疗保健之外，只有在特定情况下才能获得（紧急护理、孕产妇保健、18 岁以下儿童、寻求庇护者和人口贩运受害者）。
本文旨在确定该政策的具体特点，审查其对健康和医疗保健机会的影响，并评估其经济影响。
大多数政党和卫生专业团体反对 RDL，许多西班牙地区要么拒绝实施，要么选择部分实施。迄今为止，RDL 对无证移民获得公共医疗保健的机会产生了相当大的影响，有证据表明，约有 87 万人被排除在外。据报道，传染病略有增加，但并未达到最初预测的那么高，最近的证据表明，这一人群亚组的死亡率有所上升。
有利于覆盖无证移民的区域立法可能起到了制衡作用，从而遏制了这一人群亚组的负面健康影响。但是，宪法法院使所有要求地区遵守 RDL 的地区安排都无效。
