@article{gea-sanchez_undocumented_2017,
title = {Undocumented Immigrant Women in Spain: A Scoping Review on Access to and Utilization of Health and Social Services},
author = {Gea-Sánchez, Montserrat and Alconada-Romero, Álvaro and Briones-Vozmediano, Erica and Pastells, Roland and Gastaldo, Denise and Molina, Fidel},
url = {https://link.springer.com/article/10.1007/s10903-016-0356-8},
doi = {10.1007/s10903-016-0356-8},
issn = {1557-1912},
year = {2017},
date = {2017-01-01},
journal = {Journal of Immigrant and Minority Health},
volume = {19},
number = {1},
pages = {194--204},
abstract = {This scoping review summarizes and analyzes relevant studies related to the evidence published on undocumented immigrant women’s access to and utilization of health and social services in Spain. Scientific literature was identified by entering search terms in seven electronic databases which combined retrieved health sciences peer-reviewed articles (Pubmed, Embase, CINAHL Plus and Scopus) and grey literature databases (Europa OpenGrey, DART-Europe and Google Scholar) published between 2004 and 2014 and written in Spanish or in English presenting data about Spain. Those that fulfill the inclusion criteria were selected after a blind peer reviewed process when pertinence and quality was debated. A total of 16 publications were included, the main topics being socio-cultural differences in the access and utilization of social and health services and barriers faced by immigrant women. None of the studies focused exclusively on undocumented women, hence further research is needed in this area.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{cimas_healthcare_2016,
title = {Healthcare coverage for undocumented migrants in Spain: Regional differences after Royal Decree Law 16/2012},
author = {Cimas, Marta and Gullon, Pedro and Aguilera, Eva and Meyer, Stefan and Freire, José Manuel and Perez-Gomez, Beatriz},
url = {http://linkinghub.elsevier.com/retrieve/pii/S0168851016300239},
doi = {10.1016/j.healthpol.2016.02.005},
issn = {01688510},
year = {2016},
date = {2016-01-01},
journal = {Health Policy},
volume = {120},
number = {4},
pages = {384--395},
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.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{suphanchaimat_challenges_2015,
title = {Challenges in the provision of healthcare services for migrants: a systematic review through providers' lens},
author = {Suphanchaimat, Rapeepong and Kantamaturapoj, Kanang and Putthasri, Weerasak and Prakongsai, Phusit},
url = {http://www.biomedcentral.com/1472-6963/15/390},
doi = {10.1186/s12913-015-1065-z},
year = {2015},
date = {2015-01-01},
journal = {BMC Health Services Research},
volume = {15},
number = {1},
pages = {390},
abstract = {Background
In recent years, cross-border migration has gained significant attention in high-level policy dialogues in numerous countries. While there exists some literature describing the health status of migrants, and exploring migrants’ perceptions of service utilisation in receiving countries, there is still little evidence that examines the issue of health services for migrants through the lens of providers. This study therefore aims to systematically review the latest literature, which investigated perceptions and attitudes of healthcare providers in managing care for migrants, as well as examining the challenges and barriers faced in their practices.

Methods
A systematic review was performed by gathering evidence from three main online databases: Medline, Embase and Scopus, plus a purposive search from the World Health Organization’s website and grey literature sources. The articles, published in English since 2000, were reviewed according to the following topics: (1) how healthcare providers interacted with individual migrant patients, (2) how workplace factors shaped services for migrants, and (3) how the external environment, specifically laws and professional norms influenced their practices. Key message of the articles were analysed by thematic analysis.

Results
Thirty seven articles were recruited for the final review. Key findings of the selected articles were synthesised and presented in the data extraction form. Quality of retrieved articles varied substantially. Almost all the selected articles had congruent findings regarding language andcultural challenges, and a lack of knowledge of a host country's health system amongst migrant patients. Most respondents expressed concerns over in-house constraints resulting from heavy workloads and the inadequacy of human resources. Professional norms strongly influenced the behaviours and attitudes of healthcare providers despite conflicting with laws that limited right to health services access for illegal migrants.

Discussion
The perceptions, attitudes and practices of practitioners in the provision of healthcare services for migrants were mainly influenced by: (1) diverse cultural beliefs and language differences, (2) limited institutional capacity, in terms of time and/or resource constraints, (3) the contradiction between professional ethics and laws that limited migrants’ right to health care. Nevertheless, healthcare providers addressedsuch problems by partially ignoring the immigrants’precarious legal status, and using numerous tactics, including seeking help from civil society groups, to support their clinical practice.

Conclusion
It was evident that healthcare providers faced several challenges in managing care for migrants, which included not only language and cultural barriers, but also resource constraints within their workplaces, and disharmony between the law and their professional norms. Further studies, which explore health care management for migrants in countries with different health insurance models, are recommended.},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{gil-gonzalez_is_2015,
title = {Is health a right for all? An umbrella review of the barriers to health care access faced by migrants.},
author = {Gil-González, Diana and Carrasco-Portiño, Mercedes and Vives-Cases, Carmen and Agudelo-Suárez, Andrés A. and Castejón Bolea, Ramón and Ronda-Pérez, Elena},
url = {http://www.tandfonline.com/doi/full/10.1080/13557858.2014.946473 http://www.ncbi.nlm.nih.gov/pubmed/25117877},
doi = {10.1080/13557858.2014.946473},
issn = {1465-3419},
year = {2015},
date = {2015-01-01},
journal = {Ethnicity & health},
volume = {20},
number = {5},
pages = {523--41},
abstract = {OBJECTIVE To synthesise the scientific evidence concerning barriers to health care access faced by migrants. We sought to critically analyse this evidence with a view to guiding policies. DESIGN A systematic review methodology was used to identify systematic and scoping reviews which quantitatively or qualitatively analysed data from primary studies. The main variables analysed were structural and contextual barriers (health system organisation) as well as individual (patients and providers). The quality of evidence from the systematic reviews was critically appraised. From 2674 reviews, 79 were retained for further scrutiny, and finally 9 met the inclusion criteria. RESULTS The structural barriers identified were the lack of health insurance and the high cost of drugs (non-universal health system) and organisational aspects of health system (social insurance system and national health system). The individual barriers were linguistic and cultural. None of the reviews provided a quality appraisal of the studies. CONCLUSIONS Barriers to health care for migrants range from entitlement in non-universal health systems to accessibility in universal ones, and determinants of access to the respective health services should be analysed within the corresponding national context. Generate social and institutional changes that eliminate barriers to access to health services is essential to ensure health for all.},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{vazquez_was_2015,
title = {Was access to health care easy for immigrants in Spain? The perspectives of health personnel in Catalonia and Andalusia},
author = {Vázquez, María Luisa and Vargas, Ingrid and Jaramillo, Daniel López and Porthé, Victoria and López-Fernández, Luis Andrés and Vargas, Hernán and Bosch, Lola and S-Hernández, Silvia and Azarola, Ainhoa Ruiz},
url = {http://www.sciencedirect.com/science/article/pii/S0168851016000257?via%3Dihub},
doi = {10.1016/j.healthpol.2016.01.011},
isbn = {0168-8510},
year = {2015},
date = {2015-01-01},
abstract = {Until April 2012, all Spanish citizens were entitled to health care and policies had been developed at national and regional level to remove potential barriers of access, however, evidence suggested problems of access for immigrants. In order to identify factors affecting immigrants' access to health care, we conducted a qualitative study based on individual interviews with healthcare managers (n = 27) and professionals (n = 65) in Catalonia and Andalusia, before the policy change that restricted access for some groups. A thematic analysis was carried out. Health professionals considered access to health care "easy" for immigrants and similar to access for autochthons in both regions. Clear barriers were identified to enter the health system (in obtaining the health card) and in using services, indicating a mismatch between the characteristics of services and those of immigrants. Results did not differ among regions, except for in Catalonia, where access to care was considered harder for users without a health card, due to the fees charged, and in general, because of the distance to primary health care in rural areas. In conclusion, despite the universal coverage granted by the Spanish healthcare system and developed health policies, a number of barriers in access emerged that would require implementing the existing policies. However, the measures taken in the context of the economic crisis are pointing in the opposite direction, towards maintaining or increasing barriers.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{llop-girones_acceso_2014,
title = {Acceso a los servicios de salud de la población inmigrante en España},
author = {Llop-Gironés, Alba and Vargas Lorenzo, Ingrid and Garcia-Subirats, Irene and Aller, Marta-Beatriz and Vázquez Navarrete, María Luisa},
url = {http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272014000600005&lng=en&nrm=iso&tlng=en},
doi = {10.4321/S1135-57272014000600005},
year = {2014},
date = {2014-01-01},
journal = {Revista Española de Salud Pública},
volume = {88},
number = {6},
pages = {715--734},
abstract = {Fundamentos: Una importante proporción de población en España es inmigrante y la evidencia internacional señala su acceso inadecuado a los servicios de salud. El objetivo es conocer el acceso a la atención de la población inmigrante en España.
Métodos: Revisión bibliográfica de los artículos originales (1998-2012) sobre acceso y utilización de los servicios de la población inmigrante en España registrados en Medline y MEDES. Se identificaron 319 artículos de los que se seleccionaron 20. Se utilizó el modelo de Aday y Andersen para el análisis.
Resultados: Entre los artículos seleccionados, 13 estudios cuantitativos analizaron diferencias en la utilización de los servicios entre inmigrantes y autóctonos y 7 determinantes del acceso en inmigrantes. En líneas generales estos muestran menor utilización de la atención especializada, mayor de las urgencias y no se observaron diferencias entre grupos en atención primaria. Los 5 estudios cuantitativos sobre determinantes se centraron en las características de la población (sexo, edad, nivel de estudios y posesión de seguro privado) sin observarse un patrón claro. Los 2 estudios cualitativos analizaron factores relacionados con los servicios de salud y encontraron barreras en el acceso, como la provisión de información o los requisitos para obtener la tarjeta sanitaria.
Conclusiones: El acceso a la atención en inmigrantes ha sido limitadamente abordado, con aproximaciones diferentes y los factores relacionados con la oferta, escasamente analizados. No se observa un patrón de utilización, las diferencias dependen de la clasificación de los inmigrante según origen y nivel asistencial. No obstante, en inmigrantes se observa menor utilización de la atención especializada y mayor de las urgencias, así como determinantes del acceso distintos a la necesidad.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{suess_right_2014,
title = {The right of access to health care for undocumented migrants: a revision of comparative analysis in the European context},
author = {Suess, Amets and Ruiz Perez, I. and Ruiz Azarola, A. and March Cerda, J. C.},
url = {https://academic.oup.com/eurpub/article-lookup/doi/10.1093/eurpub/cku036},
doi = {10.1093/eurpub/cku036},
issn = {1101-1262},
year = {2014},
date = {2014-01-01},
journal = {The European Journal of Public Health},
volume = {24},
number = {5},
pages = {712--720},
abstract = {Background: The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states.; Methods: Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context.; Results: The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants' perspective are identified as future research areas.; Conclusions: Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction.; © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{suess_derecho_2014,
title = {El derecho de acceso sanitario en el contexto del Real Decreto-ley 16/2012: la perspectiva de organizaciones de la sociedad civil y asociaciones profesionales},
author = {Suess, Amets and Ruiz Pérez, Isabel and Ruiz Azarola, Ainhoa and March Cerdà, Joan Carles},
url = {http://linkinghub.elsevier.com/retrieve/pii/S0213911114001927},
doi = {10.1016/j.gaceta.2014.06.008},
issn = {02139111},
year = {2014},
date = {2014-01-01},
journal = {Gaceta Sanitaria},
volume = {28},
number = {6},
pages = {461--469},
abstract = {Objective: The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens' perspectives on the modifications introduced by the RDL 16/2012. Methods: Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context. Results: A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs. Conclusions: The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{woodward_health_2014,
title = {Health and access to care for undocumented migrants living in the European Union: a scoping review},
author = {Woodward, Aniek and Howard, Natasha and Wolffers, Ivan},
url = {https://academic.oup.com/heapol/article-lookup/doi/10.1093/heapol/czt061},
doi = {10.1093/heapol/czt061},
issn = {0268-1080},
year = {2014},
date = {2014-01-01},
journal = {Health Policy and Planning},
volume = {29},
number = {7},
pages = {818--830},
abstract = {BACKGROUND: Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990-2012), thus clarifying what is known, key gaps, and potential next steps.$textbackslashbackslash$n$textbackslashbackslash$nMETHODS: Authors used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights.$textbackslashbackslash$n$textbackslashbackslash$nRESULTS: Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005-2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees appeared most vulnerable. While EU policy supports health-care access for undocumented migrants, practices remain haphazard, with studies reporting differing interpretation and implementation of rights at regional, institutional and individual levels.$textbackslashbackslash$n$textbackslashbackslash$nCONCLUSIONS: This scoping review is an initial attempt to describe available primary evidence on health and access to care for undocumented migrants in the European Union. It underlines the need for more and better-quality research, increased co-operation between gatekeepers, providers, researchers and policy makers, and reduced ambiguities in health-care rights and obligations for undocumented migrants.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{legido-quigley_erosion_2013,
title = {Erosion of universal health coverage in Spain},
author = {Legido-Quigley, Helena and Urdaneta, Elena and Gonzalez, Alvaro and La Parra, Daniel and Muntaner, Carles and Alvarez-Dardet, Carlos and Martin-Moreno, Jose M and McKee, Martin},
url = {http://linkinghub.elsevier.com/retrieve/pii/S0140673613626495},
doi = {10.1016/S0140-6736(13)62649-5},
issn = {01406736},
year = {2013},
date = {2013-12-01},
journal = {The Lancet},
volume = {382},
number = {9909},
pages = {1977},
abstract = {Whereas the recent UN resolution urges governments to accelerate progress towards universal access to affordable and quality health-care services, the Spanish Government, bypassing the parliamentary procedure, enacted a Royal Decree to limit access to free services at the point of delivery for all—undermining the principle of universal coverage. Spanish health and social service budgets have been subjected to large cuts (13·7% in 2012 and 16·2% in 2013) with some regions imposing additional budget cuts.1$textbackslashbackslash$nAfter the Royal Decree implementation in September, 2012, about 873 000 non-residents (probably including migrants no longer living in Spain) have lost entitlement to comprehensive care.2 The government justifies the policy on austerity grounds, even though public expenditure on health care in Spain was already among the lowest in Europe before the recent changes.$textbackslashbackslash$nWith the new law, individuals losing entitlement to comprehensive care retain protection if they are younger than 18 years; during pregnancy, delivery, and post-partum period; and for emergency care after serious illness or injury. However, there are many obstacles. Medicos del Mundo have documented 1192 cases when people were unable to obtain care because of a lack of appropriate documentation, conflicting interpretations of the Decree, and in some cases discrimination and racism.3 Such changes could have serious consequences for population health, especially with regard to tuberculosis and HIV infections,4 and could threaten access to mental health, addiction, and chronic care services for vulnerable populations, such as the homeless.$textbackslashbackslash$nWhile the UN resolution calls upon governments to avoid substantial direct payments at the point of delivery, the Spanish Government has also introduced copayments for drugs. Pensioners will have to pay an increasing part of the cost of medicines. From October, 2013, patients with hepatitis C, HIV, rheumatoid arthritis, and some cancers will also have to pay 10% of their treatment costs in hospital pharmacies up to €4·20 per prescription.5 Even small out-of-pocket expenses are a barrier to effective treatment. The Federation of Associations Defending Public Health reports that 17% of pensioners could not complete the course of their treatment because of their high and increasing costs.6$textbackslashbackslash$nAt the European level, several reports are worth mentioning. According to Eurostat's At risk of poverty or social exclusion in the EU27, austerity measures could affect children in particular—they are disproportionately affected by the financial crisis with nearly 30% being at risk of poverty or social exclusion. The Council of Europe has raised concerns regarding the difficulties some children (ie, undocumented migrants) are facing in accessing health care.7 In its recent recommendations, the European Council has clearly emphasised the need for an assessment of the effects of austerity measures on vulnerable groups in Spain.$textbackslashbackslash$nAusterity measures adopted by Spain and other European countries have failed to heal their economies, and there is growing evidence that these measures threathen the health of their citizens.1, 4$textbackslashbackslash$nThere is still time to save the Spanish health system and reverse the restrictions limiting universal protection. It is possible to re-establish universal access to quality health-care services, free at the point of delivery, in line with the UN resolution.$textbackslashbackslash$nWe declare that we have no conflicts of interest.},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{odonnell_health-care_2013,
title = {Health-care access for migrants in Europe.},
author = {O'Donnell, Catherine and Burns, Nicola and Dowrick, Christopher and Lionis, Christos and MacFarlane, Anne},
url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84881161947&partnerID=tZOtx3y1 http://dx.doi.org/10.1016/S0140-6736(13)61666-9},
doi = {10.1016/S0140-6736(13)61666-9},
issn = {0140-6736},
year = {2013},
date = {2013-01-01},
journal = {The Lancet},
volume = {382},
number = {9890},
pages = {393},
abstract = {The Health in Europe Series highlights two crucial issues: health-care access for migrants1 and the effect of austerity measures on health care.2$textbackslashbackslash$nThe RESTORE study is exploring the implementation of initiatives designed to support multicultural consultations in primary care, in six European countries (Austria, England, Greece, Ireland, Scotland, and the Netherlands).3 We wish to draw attention to the disproportionate effect that austerity measures are having on migrant health care, even in countries that seem less affected by the economic downturn.$textbackslashbackslash$nWe observe that an area particularly affected is the provision of interpretation services for patients who speak a foreign language. In the Netherlands, the government recently stopped paying for medical interpreter services.4 In England, the cost of National Health Service translation services has led to discussion about the provision of face-to-face interpreters. Out-of-pocket expenses and a lack of free health care for migrants are also affecting their ability to access health services. In Greece, migrants struggling to register their asylum claim are deemed to have irregular status and, as such, are unable to access medical care.5$textbackslashbackslash$nIn the Netherlands, all patients now have to make a financial contribution to their mental health care. Because migrants have a greater prevalence of mental health problems and are more likely to be on low incomes, this affects them disproportionately. In Scotland, mental health services for asylum seekers have been cut. In Ireland several agencies that supported migrant rights have had their funding cut. Changes to entitlements in England mean that asylum seekers whose applications have been refused can no longer access non-urgent secondary care services for free.$textbackslashbackslash$nAt times of financial hardship, there is a temptation to cut services targeted at minority populations, but this might affect other parts of the health system. Without translation services, patients who do not speak the first language of the country well are more likely to access health care at the most permeable part of the system—emergency departments. This might be inappropriate and, in the long term, costly. A lack of culturally and language appropriate preventive services might result in patients only accessing health care late. Increased reliance on copayments might further marginalise such groups.$textbackslashbackslash$nEvidence of the effects of the austerity measures is only emerging. We urge policy makers and governments to refrain from cutting services for some of the most vulnerable patients in society. The right to health must be protected, even in times of fiscal austerity.$textbackslashbackslash$nWe declare that we have no conflicts of interest.$textbackslashbackslash$n},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{vazquez_navarrete_are_2013,
title = {Are migrants health policies aimed at improving access to quality healthcare? An analysis of Spanish policies.},
author = {Vázquez Navarrete, María Luisa and Terraza-Núñez, Rebeca and S-Hernández, Silvia and Vargas, Ingrid and Bosch, Lola and González, Andrea and Pequeño, Sandra and Cantos, Raquel and Martínez, Juan Ignacio and López, Luís Andrés},
url = {http://linkinghub.elsevier.com/retrieve/pii/S0168851013001693},
doi = {10.1016/j.healthpol.2013.06.007},
issn = {1872-6054},
year = {2013},
date = {2013-01-01},
journal = {Health policy (Amsterdam, Netherlands)},
volume = {113},
number = {3},
pages = {236--46},
abstract = {Although until April 2012, all Spanish citizens regardless of their origin, residence status and work situation were entitled to health care, available evidence suggested inadequate access for immigrants. Following the Aday and Andersen model, we conducted an analysis of policy elements that affect immigrants' access to health care in Spain, based on documentary analysis of national policies and selected regional policies related to migrant health care. Selected documents were (a) laws and plans in force at the time containing migrant health policies and (b) evaluations. The analysis included policy principles, objectives, strategies and evaluations. Results show that the national and regional policies analyzed are based on the principle that health care is a right granted to immigrants by law. These policies include strategies to facilitate access to health care, reducing barriers for entry to the system, for example simplifying requirements and raising awareness, but mostly they address the necessary qualities for services to be able to attend to a more diverse population, such as the adaptation of resources and programs, or improved communication and training. However, limited planning was identified in terms of their implementation, necessary resources and evaluation. In conclusion, the policies address relevant barriers of access for migrants and signal improvements in the health system's responsiveness, but reinforcement is required in order for them to be effectively implemented.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{sanz-barbero_pattern_2011,
title = {Pattern of health services use by immigrants from different regions of the world residing in Spain.},
author = {Sanz-Barbero, Belén and Regidor, Enrique and Galindo, Silvia and Pascual, Cruz and Lostao, Lourdes and Díaz, José Manuel and Sánchez, Elisabeth},
url = {https://link.springer.com/article/10.1007/s00038-011-0237-9},
doi = {10.1007/s00038-011-0237-9},
year = {2011},
date = {2011-10-01},
journal = {International journal of public health},
volume = {56},
number = {5},
pages = {567--576},
abstract = {OBJECTIVE: To determine immigrants' frequency of use of four health services by place of origin and compare it with that of the Spanish population. METHODS: Based on the 2006 National Health Survey in Spain, we estimated the frequency of use of four health services in men and women from: Spain, Western countries, Eastern Europe, Latin America, North Africa, Sub Saharan Africa and Asia/Oceania. These results were compared with the Spanish population by calculating odds ratios adjusted for age, socioeconomic position, health status, and type of health coverage. RESULTS: Immigrant men generally use health services less frequently than Spanish nationals. The main exceptions are Latin American men, who more often use emergency services (OR 1.68, 95% CI 1.41-1.99) and Sub-Saharan men, who use specialists more frequently (OR 2.93, 1.70-5.05). Immigrant women use health services about as frequently as Spanish women. The main exceptions are North African women, who less frequently use specialists (OR 0.39, 0.22-0.71) and Sub-Saharan women who more frequently use GPs (OR 4.06, 2.21-7.44), specialists (OR 2.29, 1.06-4.95) and emergency services (OR 2.92, 1.49-5.72). CONCLUSIONS: Health services use by the immigrant population in Spain differs by gender and place of origin.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@article{regidor_utilizacion_2009,
title = {La utilización de los servicios sanitarios por la población inmigrante en España},
author = {Regidor, Enrique and Sanz-Barbero, Belén and Pascual, Cruz and Lostao, Lourdes and Sánchez, Elisabeth and Díaz Olalla, José Manuel},
url = {file:///Users/Roland/Documents/Mendeley export/Gaceta Sanitaria/Regidor et al. - 2009.pdf},
doi = {10.1016/j.gaceta.2009.01.010},
year = {2009},
date = {2009-01-01},
journal = {Gaceta Sanitaria},
volume = {23},
number = {Supl 1},
pages = {4--11},
abstract = {Objective: To compare health services utilization between the immigrant and indigenous populations in Spain. Methods: We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. Results: In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. Conclusion: The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date. © 2008 SESPAS.},
keywords = {Accés Serveis de Salut, Immigrants, Salut},
pubstate = {published},
tppubtype = {article}
}

@book{huber_quality_2008,
title = {Quality in and equality of access to healthcare services},
author = {Huber, Manfred and Stanciole, Anderson and Wahlbeck, Kristian and Tamsma, Nicoline and Torres, Federico and Jelfs, Elisabeth and Bremner, Jeni},
url = {http://www.euro.centre.org/data/1237457784_41597.pdf},
year = {2008},
date = {2008-01-01},
publisher = {European Commission Directorate-General for Employment, Social Affairs and Equal Opportunities},
address = {Luxembourg},
keywords = {Accés Serveis de Salut, Salut},
pubstate = {published},
tppubtype = {book}
}

@article{perez-rodriguez_demand_2006,
title = {Demand for psychiatric emergency services and immigration. Findings in a Spanish hospital during the year 2003},
author = {Perez-Rodriguez, M Mercedes and Baca-Garcia, Enrique and Quintero-Gutierrez, Francisco J and Gonzalez, Gloria and Saiz-Gonzalez, Dolores and Botillo, Carlota and Basurte-Villamor, Ignacio and Sevilla, Juncal and Gonzalez de Rivera, Jose L},
url = {https://academic.oup.com/eurpub/article-lookup/doi/10.1093/eurpub/ckl021},
doi = {10.1093/eurpub/ckl021},
year = {2006},
date = {2006-01-01},
journal = {The European Journal of Public Health},
volume = {16},
number = {4},
pages = {383--387},
abstract = {BACKGROUND: The aim of this study is to investigate differences among immigrants and natives regarding access and pathways to psychiatric care, psychiatric admission rates, length of stay, continuity of care, and main diagnoses. METHODS: Psychiatric emergency visits (1511) and hospitalizations (410) were registered in a Spanish Hospital with a catchment area of 280 000 people (19.3% immigrants) during the year 2003. Motives for demanding emergency psychiatric care, pathways to care, admission rates, length of stay, continuity of care, and main diagnoses were compared among natives and immigrants. RESULTS: Immigrants accounted for 13.0% of consultations to the psychiatric emergency room (15.9% of patients) and 11.0% of admissions to the psychiatric hospitalization unit (13.5% of patients). The pathways to care were different for immigrants and natives. Immigrants had a lower rate of readmission to the psychiatric emergency room. Motives for consultation and hospitalization were also different among immigrants and natives. Immigrants showed more self-aggressive behaviours and neuroses, and lower rates of affective disorders and psychoses. CONCLUSIONS: Immigrants under-used psychiatric emergency and hospitalization services in comparison with natives. They did not consult because of psychoses or affective disorders, but mainly because of reactive conditions related to the stress of migration.},
keywords = {Accés Serveis de Salut, Salut, Salut Mental},
pubstate = {published},
tppubtype = {article}
}