Effects on utilisation, health and user satisfaction when access to health care is limited

Effects on utilisation, health and user satisfaction when access to health care is limited

February 19, 2019

Working Paper

There has been increasing recent debate on whether and to what extent certain sectors of the immigrant population, e.g. undocumented immigrant and mobile EU workers, should get access to welfare benefits and public services. Work package 5’s latest paper explores a reform that was introduced in Spain in 2012 and that imposed restrictions in access to health services for the undocumented immigrant population in order to shed light on this issue. The 2012 law specifically linked entitlement to contribution to the system, thus excluding a large group of undocumented immigrants from receiving health care.

In this paper, the authors focus on the impact of this reform on health care utilisation, satisfaction and self-reported health status. The results highlight important reductions in planned care by undocumented immigrants which do not seem to be fully compensated by higher emergency care use by this population. In addition, the findings reflect a sharp decrease in levels of satisfaction with the emergency services which since the reform constitute the only health resource available to undocumented immigrants. These results suggest that restrictions on access to health care can have major health and well-being effects on those affected by the restrictions. With the reported sharp drop in planned care which includes regular screening tests for early detection of diseases as well as treatment of existing diseases, the incidence of diseases and the associated mortality will most probably increase for this population. Furthermore, there could be spillover effects to other parts of the population, such as the native population, if contagious diseases are also rising due to the lack of adequate treatment.