Summary of level of barriers to accessing free healthcare services and/or HIV care for undocumented immigrants in seven ACs of Spain
| Governmental document(s) issued after 2012 health reform on undocumented immigrants’ access to free care by each AC (N) | Granted access to free healthcare coverage to all undocumented immigrants (% of study time frame) | Required identification (yes/no) | Required proof of residence (% of study time frame) | Required proof of residence (months) | Full coverage provided or separate instructions on infectious diseases such as HIV (% of study time frame) | Level of access | |
| Andalucía | 1 | 100 | No | No (100) | 0 | Full coverage (100) | High |
| Aragón | 4 | 64 | Yes | Yes (64) | 0–3 | Full coverage (64); separate instruction (69) | Medium |
| Castilla-La Mancha | 2 | 50 | Yes | Yes (100) | 0* | Full coverage (50) | Medium-low |
| Euskadi | 5 | 81 | Yes | Yes (76–90)† | 0–3 | Full coverage (81) | Medium-high |
| Galicia | 4 | 6‡ | Yes | Yes | N/A | Separate instruction (92) | Low§ |
| Madrid | 2 | 63 | Yes | Yes (100) | 0 | Full coverage (100)¶ | Medium |
| Valencia | 4 | 51 | Yes | Yes (51) | 3 | Full coverage (51) | Medium |
*Castilla-La Mancha required proof of residence in the AC but without a minimum time requirement during 100% of the study time frame. However, all undocumented immigrants (without categorisation) were granted access to general healthcare services only during 50% of the study time frame; thus, the AC was considered medium-low access.
†Euskadi in the start required 1 year proof of residence in the AC (68% of the time study time frame), however free care could still be received through emergency room. The requirement was changed to ‘proof of residence in the AC but without a minimum time requirement’ during 11% of the study time frame.
‡Referred to the period between the enactment of 2012 RDL (20 April 2012) and the first instruction issued by the AC (31 August 2012). No instruction issued afterwards had granted access to all undocumented immigrants (without categorisation), which explains 'N/A' in the proof of residence requirement column.
§Galicia created separate instructions on infectious diseases, granting healthcare access to everyone in such cases, but if only the following requirements were met: if patients provided proof of residency, any type of identification and proof of not being covered by any other insurance. Compared with other ACs, the time and level of free general healthcare services granted to undocumented immigrants were different than those granted for HIV care. Specifically, in Galicia, access level for free general care was considered low whereas access level for HIV care was considered medium-high, according to the model in figure 1. As the instruction required presentation of proof of residency and any type of identification, access to HIV care was not considered high even though the calculated percentage of time coverage was 92%.
¶Madrid had a separate section on infectious diseases in its first instruction issued August 2012 stating that everyone should be provided access to HIV care. However, the same instruction did not grant access to free general healthcare services to all undocumented immigrants (eg, those not HIV-positive); thus, the level of access to free general healthcare was not in the same category as access to HIV care. For simple visual presentation, details on the level of HIV care in Madrid were provided in the same section of table 2 and online supplemental table.
AC, autonomous community.