The austerity reforms being made by the Spanish government could lead to the effective dismantling of large parts of the country's healthcare system, with potentially detrimental effects on the health of the Spanish people, researchers have warned, writing in the British Medical Journal (BMJ).

National budget cuts of 13.65%, or 365 million euros, and regional budget cuts of up to 10% to health and social care services in 2012 have coincided with increased demands on Spain’s health system, particularly affecting the elderly, disabled people and those with poor mental health, say the authors, led by the London School of Hygiene and Tropical Medicine. They also highlight the increases in depression, alcohol-related disorders and suicides in Spain since the financial crisis hit and unemployment increased.

Spain already has one of the lowest public expenditures on healthcare for its Gross Domestic Product (GDP) in the European Union (EU). Further cuts of 1.10 billion euros are to be made this year to the dependency fund for the elderly and disabled, putting these vulnerable people even more at risk, the authors warn.

Key changes made by the Spanish government include excluding undocumented immigrants from accessing free healthcare services and increasing the co-payments that patients must make for extra treatments such as drugs, prosthetics and some ambulance trips. Authorities with devolved powers in 17 regions across Spain have also been required to make further cuts, and in Madrid and Catalonia this has led to a move towards privatisation of hospitals, increases in waiting times, cutbacks in emergency services and fewer surgical procedures.

"Our analysis is the first to look at the overall impact of austerity measures in Spain on the healthcare system, and the findings are of great concern," said lead author Dr Helena Legido-Quigley, lecturer in global health at the London School of Hygiene and Tropical Medicine, added that many of the measures which are being taken to save money do not have a strong evidence base.

The research finds detrimental effects on the health of the Spanish people and that this could worsen, if no corrective measures are implemented, with the risk of increases in HIV and tuberculosis, as has been seen in Greece, where healthcare services have also had severe cuts. There is also the risk of a rise in drug resistance and spread of disease, Dr Legido-Quigley warns.

As part of their analysis, the researchers conducted interviews with 34 doctors and nurses across Catalonia, many of whom expressed fears that "the cuts are going to kill people." Some also raised concerns around the "clear intention to privatise and…make money on health and social services," and made allegations of corruption and conflicts of interest.

Co-author Martin McKee, professor of European public health at the London School, noted that, for five years, policies to address the financial crisis have focused almost entirely on economic indicators. "Our paper sheds light on the burden of human suffering that has followed from these policies," he said.

And co-author Jose Martin-Moreno, professor of medicine and public health at the University of Valencia, pointed out that the cuts in public health expenditure which are being implemented in response to the general economic crisis are, in fact, coming at a time when health systems need more, not fewer, resources. Among other factors, they need to deal with the adverse health effects associated with unemployment.

"Cuts to essential health services, when insufficiently assessed or supported by evidence, can destabilise the health system, threatening not only equal access to healthcare but also healthcare quality, which can even generate increases in other costs in the long term," Prof Martin-Moreno warns.