El derecho a la asistencia sanitaria en la población inmigrante en situación administrativa irregular tras la aprobación del Real Decreto-Ley 16/2012: una aproximación al caso valenciano

Health exclusion for immigrants in an irregular administrative situation in Spain was established by Royal Decree-Law 16/2012 on urgent measures to ensure sustainability of the Spanish National Health System and to improve quality and safety thereof (hereinafter, RDL 16/2012). This measure has been disputed both for the arguments used for its justification, as well as for the consequences that the lack of access to public health services has for the affected population. Besides, its implementation has been different in each of the autonomous communities. In the Comunitat Valenciana, the Region of Valencia, particularly, there have been specific responses to this measure: on the one hand, the creation of the Valencian Health Protection Program (known in Spanish as PVPS) to attend excluded people and, on the other hand, the reaction of part of the civil society, taking the shape of the Observatory on the Universal Right to Health of the Comunitat Valenciana (known in Spanish as ODUSALUD). This research deals with the consequences of health exclusion and the measures taken in this community, allowing the assessment of the effects of regulatory decisions on health protection, a field of special protection regarding international standards. To this end, a combination of primary and secondary data and methods has been employed. In order to access primary data, a qualitative methodology has been used, allowing a deep study of the perceptions and experiences of the excluded population and the members of social groups. Secondary data have been retrieved from legal and statistical documentary sources, public reports and expert analysis, as well as from news and information appearing in press and social media. Results obtained allowed the identification of the new health protection framework and how its implementation in the Comunitat Valenciana, where 127,420 health cards have been cancelled, has meant a break in the globalization of health care. It has also been found that there has been a proliferation of barriers to public health services that increases the exclusion even in cases where assistance is guaranteed, like an emergency situation, and that explains the meagre results of the PVPS, from which only 2,768 people have benefited. It has also been identified how part of the affected population seeks support from other people and social entities to be able to receive health care in case of illness, while another group exclude itself from public system. This reality has effects on living conditions combined with the special social, economic and personal vulnerability of the immigrant population in an irregular administrative situation. On the other hand, ODUSALUD, that unites 87 social organizations, has developed an action to diagnose and denounce health exclusion and has coordinated advocacy aimed at modifying the causes of this situation and recovering the universal right to health care. It represents a way of articulating active political citizenship that may have had a direct effect on the subsequent changes occurred at regional level. In short, this study shows the distance established between the supposed objectives of RDL 16/2012 and the effects produced on health system and on the excluded population, which mean a break in the globalization of health care and affect the guaranteed right to health care. And at the same time, it points out how the reaction from part of civil society asks for the change of the model that has been eventually implemented in the Comunitat Valenciana.