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      La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía Translated title: The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)

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          Abstract

          RESUMEN Objetivo Conocer la valoración de personas migrantes sobre su acceso al sistema sanitario tras la entrada en vigor del Real Decreto-Ley16/2012 y sobre el efecto que han podido producir los recortes económicos en dicho acceso. Método Estudio cualitativo fenomenológico con entrevistas semiestructuradas, realizado en Andalucía, en dos fases (2009-2010 y 2012-2013), con 36 participantes. Se segmentó la muestra por tiempo de estancia, nacionalidad y ámbito de residencia. Las nacionalidades de las personas migrantes son Bolivia, Marruecos y Rumanía. Resultados Como elementos facilitadores del acceso en ambas fases se identifican la situación administrativa regular, la posesión de tarjeta sanitaria individual, el conocimiento del idioma, las redes sociales y la información. Los resultados muestran diferencias en el acceso a la atención sanitaria de las personas migrantes antes y después de la aplicación del RDL 16/2012, en el marco de las políticas de austeridad. En la segunda fase se agravan algunas barreras de acceso, como los tiempos de espera y la incompatibilidad de horarios, y empeoran las condiciones socioeconómicas y administrativas de las personas participantes. Conclusiones El diseño de políticas económicas y de regulación de la atención sanitaria debería tener en cuenta las barreras y los facilitadores de acceso como ejes fundamentales de la protección de la salud de las personas migrantes y, por ende, de la población general.

          Translated abstract

          ABSTRACT Objective To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. Method Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. Results Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. Conclusions The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

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          Most cited references 26

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          Review: immigrants and health care access, quality, and cost.

          Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.
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            Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis.

            The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures.
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              Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain

              Background The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona. Methods The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR) of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression. Results The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%). The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63), traumatology (0.47, 95% CI: 0.38; 0.59), medicine (0.48, 95% CI: 0.38; 0.59) and psychiatry (0.42, 95% CI: 0.18; 0.97). No differences were found in utilisation of gynaecology and minor emergency services. Conclusion The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed, especially among immigrants.
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                Author and article information

                Journal
                gs
                Gaceta Sanitaria
                Gac Sanit
                Ediciones Doyma, S.L. (Barcelona, Barcelona, Spain )
                0213-9111
                June 2020
                : 34
                : 3
                : 261-267
                Affiliations
                orgnameCIBER de Epidemiología y Salud Pública (CIBERESP) España
                Granada orgnameInstituto de Investigación Biosanitaria de Granada España
                Sevilla Andalucía orgnameUniversidad de Sevilla orgdiv1Departamento de Enfermería Spain
                Barcelona orgnameConsultoría Independiente en Investigación Social España
                Granada orgnameEscuela Andaluza de Salud Pública España
                Article
                S0213-91112020000300009 S0213-9111(20)03400300009
                10.1016/j.gaceta.2018.09.006

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 37, Pages: 7
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