A government health insurance scheme for undocumented migrants has proved a failure, according to figures seen by EL PAÍS. In August 2012, the Health Ministry announced that foreigners in Spain without residency or work permits would no longer be provided with free healthcare. Instead, they would have to take out government-run health insurance. For under-65s, the cost is €60 euros; for over-65s, the fee rises to €157 a month. In both cases, the policy only provides access to basic state healthcare services. Costs for medicine and health transport services are excluded, and should a policy holder miss a monthly payment, their medical access is suspended for three months. Minors and pregnant women are excluded from the policy system and entitled to free healthcare, although they must pay 40 percent of the cost of prescriptions.
The measures came into effect in September 2013, and the Health Ministry’s own figures show that just 300 people have taken out the insurance policy since then.
The majority of health departments in Spain’s regions say they have not received any requests from people to take out the policies.
Health Minister Ana Mato made excluding non-resident foreigners a major policy objective when the current Popular Party (PP) government took office in December 2011: by September the following year, an estimated 150,000 people were no longer covered by the Social Security system, and were only entitled to emergency care.
“I was afraid of my own son”
Jeanette, a 46-year-old Ecuadorian woman, says she is ashamed to admit that for several months she was unable to pay for the medicine required by her 22-year-old son, who suffers from schizophrenia. She was unemployed, and although she has residency and work permits, her son’s Social Security card had been cancelled by the health authorities in Castilla-La Mancha.
Her son’s treatment cost €1,000 a month: “We knew the dangers of him not taking his medication, but we just couldn’t pay. He went for eight months without taking them. He suffered from mood swings. Sometimes I wondered what would happen if he picked up a knife one day and went out on to the street. I was afraid of my own son,” she says.
Jeanette’s son had always been resident in Spain, and had a European health card. Despite this, he was denied cover for a year, unable to visit a doctor or hospital in Castilla-La Mancha. Finally, Doctors of the World was able to help her cut through the red tape, and she was issued with a health card for her son. “We have a lot of financial problems still, but it is a big difference only paying €17 a month instead of €1,000,” she says.
When the measures were announced, there were protests from regional governments, including in Andalusia, the Basque Country and Asturias, which have opposed the order to bar the doors of surgeries to non-resident immigrants. Under Spain’s devolved healthcare system, it falls to the regions to implement the plan, including checking documents and managing the policy system. Castilla-La Mancha, which is run by María Dolores de Cospedal, the PP’s secretary general, has led the way in applying the health ministry’s new rules. It provides no cover at all to people outside the system. The case of a woman whose case is being investigated by the courts, and whose name cannot be revealed, is just one example of how the new measures are hitting the most vulnerable. Four years ago, after living in Spain since 2004, she brought her 33-year-old mentally disabled daughter to live with her. During the process to regularize her situation, the new law came into effect. Since then she has been caught in a bureaucratic nightmare.
Her daughter was given a Social Security number, but has not been issued with a card, which means that she can only receive medical treatment by attending her local hospital’s emergency room, for which her mother is charged.
Idoia Ugarte Gurrutxaga, the president of the Castilla-La Mancha branch of Doctors of the World, says she knows of at least 17 cases of pregnant women and those of 56 minors who have been denied healthcare, and have not been given a Social Security card.
The majority of vulnerable people denied healthcare are unaware of their rights, and are reluctant to see a doctor out of fear they will be charged. Yo Sí Sanidad Universal, a campaign group set up to advise migrants about the government’s restrictions on healthcare, cites the case of a Bangladeshi man who was taken to a Madrid hospital after suffering a heart attack, and was then sent a bill for €12,000. Yo Sí Sanidad Universal took up the matter, and the hospital rectified, saying the bill had been sent in error.
Agustín Rivera, the director general of the Health Ministry’s Basic Services and Pharmaceuticals department, says the new measures have helped “clarify” who is eligible for healthcare and who is not. “We have ended the €1 billion loss caused by health tourism that the Court of Auditors identified,” he says. The Court of Auditors also pointed out that almost all of the €970 million for which Spain had failed to charge resulted from visitors from the EU, and not from undocumented migrants.
A Bangladeshi man taken to a Madrid hospital after suffering a heart attack was sent a bill for €12,000
The Health Ministry’s insurance policies have done little to help migrants’ problems. In Castilla y León, just 12 of the policies have been taken out. In Valencia the figure is 191. In Murcia, the majority of the 24 people who have taken out policies are from Latin America and Europe. In Madrid, where 43 policies have been issued, the typical profile is a Latin American woman in her 50s.
So far, there are no figures on the savings that the Health Ministry’s measures have provided. The Council of Europe says that excluding people with no residency papers from the healthcare system is illegal, but Ana Mato says Spain provides more healthcare to foreigners than any other EU member state.
Agustín Rivero insists that the reforms have established a healthcare system that is “universal, public, and free for those who reside in Spain, and provides access for vulnerable groups.” He adds that anybody with an infectious disease will also be given free treatment, regardless of their situation.
But many vulnerable people have fallen through the net. Juan Pablo is a Uruguayan who has been diagnosed with paranoid schizophrenia. He has not been able to take his full complement of medicines for the last year. “I can’t afford it,” he says. “Before, I paid €3 or €4; now it costs me around €800 a month.” He has lived in Spain for 10 years, working most of the time. “For nine years I was slowly reducing the amount of medicine I took, and I was getting better. Now I have panic attacks.” He hopes that Doctors of the World will be able to help him return to treatment: “Otherwise, I don’t know what I will do.”