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Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006–2017)
International Journal for Equity in Health ( IF 4.5 ) Pub Date : 2019-11-29 , DOI: 10.1186/s12939-019-1092-1
Jaime Pinilla , Miguel A. Negrín , Ignacio Abásolo

The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.

中文翻译:

西班牙移民状况获得公共医疗服务的横向不平等趋势(2006-2017年)

这项研究的目的是分析整个2006-2017年期间西班牙移民状况导致的获得公共卫生服务的水平不平等趋势。我们关注“经济移民”,因为他们可能是移民中最脆弱的群体。根据2006-07年度(N = 29,478),2011-12年度(N = 20,884)和2016-17年度(N = 22,903)的国家卫生调查,估计西班牙自治社区中具有随机效应的分层逻辑回归可以解释这种可能性根据移民状况使用公共资助的医疗保健服务,通过医疗保健需求以及其他社会经济和人口统计学变量进行控制的方法。我们的结果表明,尽管在整个研究的十年中它们发生了变化,但仍然存在几个水平不平等现象。关于初级保健服务,这一时期开始(2006-07年)时,尚无全球性的横向准入不平等证据(尽管按大陆进行的分析显示,这种不平等对东欧人和亚洲人不利),而让位于经济移民(尤其是拉丁美洲人和非洲人)的不平等现象所取代。 2011-12和2016-17。专科护理的情况相反,随着这一时期的开始(2006-07年),有证据表明不平等现象不利于经济移民(尤其是来自非洲北部的移民),但这种不平等现象在经济危机之后和之后都消失了(唯一的情况是2011-12年东欧人除外,他们看望专家的可能性比本地人低)。关于急救 我们的证据表明,准入期间的横向不平等现象有利于整个时期仍然存在的经济移民(尤其是拉丁美洲人和北非人)。一般而言,除了2011-12年度之外,住院方面没有任何不平等现象,那里发生了有利于经济移民(尤其是来自拉丁美洲的移民)的不平等现象。即使在执行《皇家法令RD 16/2012》之后,这里获得的结果可能首先可以防止对经济移民在获得公共卫生服务时受到负面歧视的警觉。相反,我们的结果表明,在2006-07年间损害了经济移民的水平,在获得专科护理方面的不平等现象在2011-12年全球范围内消失了,在2016-17年按原产地也消失了。一般而言,除了2011-12年度之外,住院方面没有任何不平等现象,那里发生了有利于经济移民(尤其是来自拉丁美洲的移民)的不平等现象。即使在执行《皇家法令RD 16/2012》之后,这里获得的结果可能首先可以防止对经济移民在获得公共卫生服务时受到负面歧视的警觉。相反,我们的结果表明,在2006-07年间损害了经济移民的专科护理获得的水平不平等,在2011-12年全球范围内消失了,在2016-17年按原产地消失了。一般而言,除了2011-12年度之外,住院方面没有任何不平等现象,那里发生了有利于经济移民(尤其是来自拉丁美洲的移民)的不平等现象。首先,即使在执行《皇家法令RD 16/2012》之后,这里获得的结果也可以首先防止对经济移民在获得公共卫生服务时受到负面歧视的警觉。相反,我们的结果表明,在2006-07年间损害了经济移民的水平,在获得专科护理方面的不平等现象在2011-12年全球范围内消失了,在2016-17年按原产地也消失了。即使在执行《皇家法令RD 16/2012》之后,这里获得的结果可能首先可以防止对经济移民在获得公共卫生服务时受到负面歧视的警觉。相反,我们的结果表明,在2006-07年间损害了经济移民的水平,在获得专科护理方面的不平等现象在2011-12年全球范围内消失了,在2016-17年按原产地也消失了。即使在执行《皇家法令RD 16/2012》之后,这里获得的结果可能首先可以防止对经济移民在获得公共卫生服务时受到负面歧视的警觉。相反,我们的结果表明,在2006-07年间损害了经济移民的专科护理获得的水平不平等,在2011-12年全球范围内消失了,在2016-17年按原产地消失了。
更新日期:2019-11-29
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