Gestor bibliográfico Crisis y Salud

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 After 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. With 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.