Free clinic utilisation by immigrants after the introduction of a restrictive health policy in the Basque Country (Spain)

• Published in: Public health (London) Vol. 163; pp. 9 - 15
• Main Authors: Pérez-Urdiales, I., San Sebastián, M., Goicolea, I.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2018; Elsevier Science Ltd
• Subjects: Adolescent; Adult; Aged; Ambulatory Care Facilities - economics; Attendance; Basque people; Confounding factors; Data processing; Emigrants and Immigrants - statistics & numerical data; Employment; Facilities and Services Utilization - statistics & numerical data; Female; free clinic; Health care; Health care access; Health care policy; Health Policy; Health services; Health Services Accessibility - legislation & jurisprudence; healthcare access; Humans; Immigrants; Implementation; Interrupted Time Series Analysis; Male; Middle Aged; migrant; Migrants; Noncitizens; Regression analysis; Regression models; Seasonal variations; Sex; Spain; Statistical analysis; Time series; Trends; Undocumented immigrants; Undocumented Immigrants - statistics & numerical data; Unemployment; Welfare; Young Adult; Spain; Basque region Spain; free clinic; health policy; migrant; undocumented immigrants; healthcare access
• ISSN: 0033-3506; 1476-5616; 1476-5616
• DOI: 10.1016/j.puhe.2018.06.006

Policies restricting healthcare access for immigrants were applied in times of reduced public funding for welfare in Spain. This study aimed to assess the impact of the implementation of a more restrictive health policy in the Basque Country region, Decree 114/2012, on the number of consultations attended at a free clinic, where the majority of patients are undocumented immigrants. Interrupted time series. A negative binomial regression model was applied in two phases to the number of healthcare consultations during the period 2007–2017 (n = 9272) to estimate the level and trend changes associated with the implementation of the policy. Data were analysed separately by sex and adjusted for consultations' seasonality and unemployment rate and the sex-specific percentage of migrant population in Biscay province as confounding factors. Different trends of attendance between men and women were observed during the whole period, constituting 76.94% and 23.06% of all consultations, respectively. After the implementation of the decree, the number of consultations for women per trimester decreased and increased for men by 1%, although it was not statistically significant in either of the trends. No clear relationship between the implementation of the Basque Decree 114/2012 and an increase in the attendance of immigrants in a free clinic during the studied period was found. •New restrictive health law for immigrants and their use of free clinics are not related.•Men attended the free clinic in a greater proportion than women during whole period.•Free clinics are important actors in ensuring the right to health for immigrants.