Partial access: Undermining universality and its consequences in Spanish health care

Every textbook in print about Spanish health care says two things: it is universal and it is predominantly organized by regional governments. Every textbook in print about Spanish health care became inaccurate on 1 September 2012, when a Decree-Law came into effect confined health care access to those enrolled in social security, re-establishing a link that was broken years earlier. The law ended universal health care access by once again limiting non-emergency health care to people who were either paying taxes, or in other defined populations (pensioners, students, prisoners). It also assaulted regional autonomy, since the expansion of health care access (in the form of the Individual Health Card, TSI) had been led by regions in their role as the organizers of the health care system and the governments most directly obliged to cope with the health issues of immigrants, the long term unemployed, and the black economy. Neither the legal instrument nor the constitutional basis was obviously solid, and they are being challenged by some regions.

This paper presents the often misunderstood policy and its justifications and the n its consequences in three areas: territorial politics, where it is a disruption to intergovernmental relations and finance; health care access; and territorial politics. It draws on a mixture of new literature reviews and research into health care access in Barcelona during 2012 and 2012.