|Implemented in this survey?|
The extension of the TSI (Individual Sanitary Health Card) to all foreign migrants in 2001 was the first step to improve their access to the public health system. After that, in 2007 the Catalan Government launched the Directive Immigration Health Plan as a brand new health policy that also aims to improve their health status. This plan establishes the main objectives to follow and fullfil the main goal. At the same time, it incorporates an educational training for all health professionals.
In 2001, the extension of the TSI to all foreign migrants that registered at the council of their city village was the first step to improve their access to Public Health in Catalonia and in Spain (also see JOSEP M. JANSÀ. "Improving access of migrants to Public Health". HealthPolicyMonitor, 29/10/2004. www.hpm.org/survey/es/b4/2) . This measure was accompanied by specific strategies for maginalized populations in order to get better knowledge of their needs and consecuently to offer them better medical attention.
Following this original idea, in 2004 the Catalonian Health Plan was launched . This plan is the main tool that gives the Catalan regional government the competences to set up priorities in health care for the whole population of Catalonia. One of these goals is immigration so in 2007, the Directive Immigration Plan for Health was developed. This plan aims to define premises and values as well as strategic objectives to improve between 2007 and 2010 the health status of the immigrant population and their access to public health services .
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
This policy is completely new in Catalonia and in Spain. In fact, several regional governments all over the country have developed their own Immigration Plan in order to offer better access to Publich Health services to immigrants. Although brand new, this policy is strongly dependent on the public health policy and services of each country.
|Implemented in this survey?|
The Health Department of the Catalan Government has taken the leadership in the Directive Immigration Plan for Health in Catalonia that was launched in 2007. Different associations of health professionals, migrants and NGO's strongly supported this idea from the beginning and are part of the Advisory Council. This council has the main responsibility for giving advise to the Monitorig Commission and develop, revise and assess this plan.
|Health Department of Catalan Goverment||very supportive||strongly opposed|
|Welfare and Family Department||very supportive||strongly opposed|
|Locals Goverrments||very supportive||strongly opposed|
|Trade Unions||very supportive||strongly opposed|
|NGO's||very supportive||strongly opposed|
|Migrants Associations||very supportive||strongly opposed|
|Scientific Socities||very supportive||strongly opposed|
|Medical and Nurse Associations||very supportive||strongly opposed|
|Other Health Professionals Associations||very supportive||strongly opposed|
After a process of setting up objetives and priorities from all groups involved in the Advisory Council, the Directive Inmigration Plan draft was evaluated by the Monitorig Comission in order to be aproved by the Catalan Health Department and the Catalan Parliament. This first Immigration Health Plan was approved in 2007 and will be in force until the end of 2010. During this time, the Monitoring Commission will be in charge of revising any change and assessing the new results.
|Health Department of Catalan Goverment||very strong||none|
|Welfare and Family Department||very strong||none|
|Locals Goverrments||very strong||none|
|Trade Unions||very strong||none|
|Migrants Associations||very strong||none|
|Scientific Socities||very strong||none|
|Medical and Nurse Associations||very strong||none|
|Other Health Professionals Associations||very strong||none|
This Immigration Health Plan develops three small plans:
Health professionals (above all from Primary Care Units) and migrant populations are the groups directly affected by this Plan. The implementation of this plan has been and it will be succesful as long as the main obstacles (lack of public health budget and lack of time and interest of health professionals) will not interfere with the main goal.
Since the extension of the TSI among the migrant population is already established and its impact on cost and efficiency has not been directly evaluated in health terms, this new Plan incorporates health indicators for immigrants:
These indicators (most of them shared indicators with the Catalan Health Plan) will periodically shed a light on the health status of migrants, weakness and strong points, as well as improvements. To develop these indicators, the Health Department has made a big effort to establish and expand new information technologies.
Moreover, a wide evaluation use to be made every year, and results are public and discussed among all groups involved in this Plan.
To sum up, they aim to be a real mesure of this policy impact and its cost and efficiency.
In general, this policy will achieve its objectives considering the progresses already made, above all regarding the extension of TSI to the whole population. The main objective is to improve health status and equity for all immigrants and - following the Spanish Constitution - to guarantee public health access to the whole of the Spanish population.
However, underfinancing in the health budget, health professionals' demotivation and abusive use of health resources could be real menaces to take into account.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The impact of this policy will be strongly positive. It will balance oportunities among different population groups (equity) and also help the vulnerable migrant population to achieve the same level of access to public healthcare as available to the rest of Spanish population.