Tehran University of Medical Sciences Iranian Journal of Public Health 2251-6085 51 3 2022 03 10 495 507 EN Raquel Sánchez Recio 1. Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Aragon, Spain 2. Aragon Health Services Research Group (GRISSA), Zaragoza, Aragon, Spain Juan Pablo Alonso Pérez De Ágreda 1. Aragon Health Services Research Group (GRISSA), Zaragoza, Aragon, Spain 2. Public Health Surveillance Service, Government of Aragon, Zaragoza, Aragon, Spain María José Rabanaque 1. Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Aragon, Spain 2. Aragon Health Services Research Group (GRISSA), Zaragoza, Aragon, Spain Isabel Aguilar Palacio 1. Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Aragon, Spain 2. Aragon Health Services Research Group (GRISSA), Zaragoza, Aragon, Spain 2020 12 16 2021 05 04 Background: We aimed to examine the available evidence about the impact of the crisis on the use of healthcare services in Europe. Methods: We developed a systematic review of scientific literature for the period 2008-2017. The researchers searched three databases Medline/PubMed, Scopus and Web of Knowledge. For manual searching, several specialized journals of related scope as well as the finalized articles' reference list were searched. Descriptive and thematic analyses were carried out. PRISMA quality criteria and the recommendations of the Centre for Reviews and Dissemination were followed. Results: Of 3,685 studies, 35 met inclusion criteria. Regarding “Effects of the social structure” healthcare accessibility inequalities increased by socioeconomic levels, especially in unemployed, people with low educational levels and migrants. Regarding “Healthcare effect”, the impact of the recession was observed in unmet needs, pharmaceutical spending containment, reduction of hospital beds, and privatization of services. Conclusion: Austerity policies have contributed to increasing inequalities in the use of health services during the economic downturn. In the current economic climate, new management and health planning strategies such as hospitalisation at home, new models of integrated care and pharmaceutical management are needed to help achieve greater equity and equality in health. https://ijph.tums.ac.ir/index.php/ijph/article/view/23223 https://ijph.tums.ac.ir/index.php/ijph/article/download/23223/7525