Summing up the Health Situation

Due to attacks on so called “health tourists” perpetrated by EU-citizens coming to Spain as tourists with an EHIC (European Health Insurance Card) or taking out residency and a Spanish EHIC, many foreigners in Spain are feeling insecure when it comes to the health services which they can expect to receive here.

Leading politicians, including the President of the Extremadura Region, maintain that some tourists have been throwing themselves on the Spanish health organisation, pretending they have developed illnesses during their tourist stay, producing their foreign EHIC and demanding to be given treatment. They also accuse certain “short term” EU residents of having become residents only to receive free treatment or surgery in Spanish National Health hospitals which they been refused in their home countries, or where they are on long waiting lists.

The politicians, and some hospital Administrators and doctors in the public health sector, are saying that the number of EU-citizens asking for treatment is creating a work overload and increased expenses for Spain.

What is the truth?

We do not deny there are some foreigners with an EHIC (Spanish or foreign) who come to Spain as tourists or become “short term” residents, with the intention of obtaining treatment in the Spanish health system, which they have been refused or are having to wait long periods for in their home countries.  However, as long as the Spanish politicians can not present researched and documented numbers, their harangues must be classified as intended to mask the real problems in the financing of the regional health system.

Of course, if you visit the health centres in certain tourist areas, you can see that a large number of the patients waiting in line to see a doctor, are typical non-Spanish.  This in itself does not imply any cheating, since in many municipalities foreigners represent a substantial percentage of the population; in some even the majority.

One must also understand that more than 90% of the foreigners living in Spain are elderly, retired people who are more prone to illnesses. (It was the same Spanish politicians, who are now complaining about too many foreigners using the public health system, who approved the many, and the large, urbanisation plans which were intended to be sold to foreigners).

Moreover, it is the responsibility of the doctors and the administrations of the local hospitals to refuse treatments to people, such as tourists, who are obviously abusing the health system in Spain.   For the “short term” residents asking for a replacement hip one week after getting their residence permit, I would recommend them to ask the health authorities in the home country if they appear on the waiting list in that country for such an operation. If there is are large number of such “health cheaters” this would be the appropriate action, instead of making unsubstantiated proclamations in the press.

The real background

The real reasons behind the attacks on foreigners living or visiting Spain can be found in the administration of the public health in this country.  Many years ago the public health was transferred from the State to the Regions, giving them an opportunity to expand their budgets and to employ an army of bureaucrats. We no longer have a Spanish National Health System, but instead a Valencia one, an Andalusi, Balearic, Canarian, Catalan and so on.

Each of the regional health services are financed by transfers from the national government, appropriate to the number of inhabitants, but tourists, both nationals and foreign, are concentrated in certain regions.  When a tourist becomes ill they approach the health service where they are staying.

This is how it is:­-  Any country or region which attract tourists, have substantial gains but must also expect to have certain additional costs, including more people using the medical services, clearing rubbish on the beaches left by the tourists, a greater demand for public parking areas, more wear and tear on the roads, etc.

Spain does not have to meet the cost for medical treatment of foreigners who have an EHIC. The health centres and hospitals all over the country send the bills to the health authorities in the home countries of the foreign patients over the national administration, who then reimburse Spain.   The problem is, this money does not go to the regional offices but to the Kingdom of Spain.  Hence the struggle between the State and the Regions.

The economies of the Regional Governments are experiencing grave difficulties, as too are the finances of National Government and town halls. In a recent report by the European Commission, Spain is listed among the countries which are “high risk” when it comes to public finances. The State “solves” this problem by lending money on the international financial markets and by increasing taxes. The Regions obtain their income, or part of it, from certain taxes, but now with substantially reduced income from construction activity and the sale of properties. This, coupled with an inflated administration leaves the Regions in a difficult position and is why some regional politicians are “hitting the yoke instead of the horses.”   They attack the foreigners in an attempt to force the National Government to increase the amount transferred to the Regions, albeit that they are running the risk that foreigners living in Spain will leave due to insecurity of the health services created by populist politicians and because they do not like to be included in a group of suspected health cheaters.

A very short sighted manoeuvre by certain politicians.