[Immigration in Spain and the health system: a fiscal policy perspective]

The Spanish population has grown by over 6 million people in the last 10 years and immigrants account for 4.5 million of this increase. Although this influx has largely been motivated by economic reasons, stimulated by the sharp growth of the Spanish economy, sociological factors must also be considered to assess the impact of immigration shock on public expenditure and the social welfare system. On the one hand, the demographic growth caused by immigration temporarily balances the pension system, as immigrants have a lower average age and a higher fertility rate. On the other hand, the demographic and economic features of the immigrant community make additional demands on the social welfare system. Universal access to basic public services such as the education and health systems is a crucial asset in the integration policy aimed at the immigrant collective, and compensates for its possible effect as an incentive to immigrate. In the short term, the huge population growth has led to health services' congestion, especially in primary health care, because of the unequal geographic distribution of immigrants. The health expenditure imputable to immigrants is lower than their share in the total population and is highly concentrated in four autonomous regions.