The transformation of Spain into an immigration country has had a considerable social and demographical impact. The welfare state has adapted well to this population change, providing a high degree of protection to the population with immigrant origin settled in Spain. In the current context of economic and fiscal crisis experienced by the countries from the southern periphery of the Euro zone,which strongly affects the economy of Spain, the Spanish health authorities have adopted a series of measures that threaten to undermine the functioning of the National Health System as one of universal character. The exclusion of undocumented immigrants from the coverage of the public health system is one of the most serious of these measures. Since there are no clear arguments of economic or health-related nature that justify the adoption of this measure, it is classified it as an initiative of fundamentally political character, destined to send a message of strictness to the migration phenomenon. The complex articulation of political and financial responsibilities in the health care context, a result of the multilevel governmental structure of the Spanish State, leads to an unequal application of this measure, which is vetoed in some regions, but implemented in others. The result is an extremely confuse situation in which there is moreroom for bureaucratic discretion, as well as for health inequalities within the Spanish society.
Health policy; Immigration; Universality; Decentralization