京都大学 大学院経済学研究科・経済学部

(Title)

"Consequences of Healthcare Access Restriction in Spain"

Abstract:
This presentation brings together evidence from two studies examining the unintended consequences of Spain’s 2012 healthcare reform, which excluded undocumented immigrants from access to public healthcare. Leveraging comprehensive administrative data and difference-in-differences designs, both studies explore how restricting healthcare access affects vulnerable populations, particularly immigrant women.
The first study investigates the reform's impact on fertility behavior and maternal health outcomes. Findings indicate that women from nationalities with higher shares of undocumented immigrants were significantly less likely to terminate pregnancies and more likely to give birth—births that were also more prone to complications and caesarean deliveries. These results point to worsened maternal health outcomes and shifts in fertility decisions likely influenced by healthcare inaccessibility.
The second study explores how the same reform shaped intimate partner violence (IPV) victims’ help-seeking behavior. Analyzing court reports and protection order applications, the study reveals a 12% drop in IPV reporting and legal protection requests among foreign women following the reform—especially in regions with strict enforcement. Crucially, this decline was not driven by reduced IPV incidence but by fewer injury reports from medical professionals, who serve as key intermediaries in the help-seeking process.
Together, these studies underscore the broad and adverse ripple effects of exclusionary healthcare policies—ranging from reproductive choices to safety from violence—raising critical policy questions about access, enforcement, and equity in public health systems.