Immigration and the Demand for Health in Spain

In Spain, the recent immigration wave (without any precedent in recent decades in OECD countries) has had important consequences in the provision of key public services. The huge population shock has caused the perception of delays or even shortages in the provision of health services, thereby increasing the perceived quality gap between the public and the private sectors. We examine the effect of the population shock on the demand for private health insurance in two samples: those covered by the Spanish Social Security (SS) system and the sample of civil servants (CS), who periodically decide the provider of care (public or private). We found that the demand for private health insurance increases due to this fact. We quantify the marginal effect at about 0.05 in the SS sample and 0.20 in the CS sample. We ¯nd evidence of direct effects even controlling for their indirect influence through the purchase of private insurance. The population shock changes the preferences for GP services of medium-high income individuals. It has not any effect on the demand for SPs since it is the gatekeeper but not the individual who decides SP visits.