Cost-cutting measures have made it more difficult for foreigners living in Spain to access the country's medical system. Photo: Pedro Armestre/AFP
A recent spate of stories about foreigners being refused medical treatment in Spain has drawn attention to the ways in which Spain's health-care system is being squeezed by austerity measures.
In mid-May, a visit to a medical centre turned into a headache for the British parents of a Spanish-born baby.
The couple, both registered Spanish residents, went to the Aragonese town of Caspe to seek medical attention for their eight-month old baby.
Their child, who had a temperature of 41C, was refused treatment because she only had a provisional national health service card, despite having been born in the Spanish city of Denia.
Both of the child's parents had valid health cards but this was deemed insufficient and they were asked to pay €132 before a doctor would attend to the baby.
Then, in late May, Alpha Pam, a young Senegalese man, died of tuberculosis after repeatedly being denied treatment for the serious but treatable condition.
After going to an outpatient’s clinic on seven occasions, Pam was finally sent to Comarca de Inca hospital to receive treatment.
Pam was then made to sign a guarantee of payment slip and finally given a general check-up. However, on May 22nd he passed away.
Pam's death may have been the first official case linked to new rules introduced last year which prevent undocumented immigrants from having a health card and only allow for their treatment in an emergency room, regardless of whether they have registered at their local town hall.
Spain's undocumented immigrants are able to register as living in an area, but this no longer guarantees them access to the country's health system.
Spain's government subsequently denied that racial discrimination played any role in Pam's death. "Unfortunately, mistakes are sometimes made but that has nothing to do with the health service," Health Minister Ana Mato said in Parliament.
The Balearic Islands’ Health Minister Martí Sansaloni then agreed to sack the director of Comarca de Inca Hospital.
Pam's death, however, shows how fraught life has become for Spain's health-care system, and for the foreigners who use it.
The situation has become particularly difficult since the Spanish government introduced Royal Decree (RD) 16/2012 in August last year.
The law, a series of "emergency measures", imposes severe cuts on the Spanish National Health System and states unregistered foreigners should be refused medical assistance except in emergency situations including serious illness and accidents.
Children under the age of 18 are the other exception: they are entitled to "same conditions of care as Spanish people".
A total of 873,000 people are potentially affected by the move, although not all of Spain's 17 autonomous regions have implemented the changes.
The new rules are part of a drive by Prime Minister Mariano Rajoy's government to slash Spain's health spending by €7 billion ($9.1 billion) and squeeze €150 billion out of the crisis-racked country's budget by 2014.
However, Spanish non-government organization Médicos del Mundo said Pam's death was the "price of austerity".
In a statement on the case, the group said they had been alerted to an outbreak of tuberculous affecting eight people at an immigrant hostel on Majorca. Diagnoses had been made in all cases, but no treatment had been received. Pam had been among that group.
Médicos del Mundo stated that Pam´s death "could have been avoided".
In the case of European Union (EU) residents of Spain and tourists to the country from the EU, the case is slightly different.
UK tourists in Spain can receive treatment using their European Health Insurance Card (EHIC).
However, there have been recent reports of tourists having problems when trying to use their EHIC cards.
Last month, Spain´s The Olive Press newspaper reported on the case of a woman who tried to receive emergency treatment for her 15-year-old son who punctured a testicle.
Despite having an EHIC card, she was told she would have to pay €500 ($640) up front.
"Both the Foreign Office and UK Department of Health are aware of issues faced by British holidaymakers in Spain when attempting to use their EHIC cards," Simon Montague, Director of Communications for the British Embassy Madrid told The Local.
“Visitors to Spain are encouraged to report any incidents involving EHICs to the Department of Health representatives based at the British Consulates in Alicante and Madrid," Montague said in an email.
"The Department of Health submits an annual report to the EU Commission reporting EHIC use and any misuse, and this includes any examples highlighted by the British public. Case studies will also be taken up with the central government in Spain."
According to the Healthcare in Spain website — a joint initiative of the UK government and the regional government of Valencia — "any treatment (using the EHIC card) is provided on the same terms as an insured national of the country you are visiting".
This means "if a Spanish national is required to pay a fee towards their treatment in Spain, customers would also have to pay the same fee. In Spain, customers are obliged to pay between 10 percent and 60 percent towards prescriptions".
Foreign residents for tax purposes in Spain, or people receiving pensions from European member states that have an agreement with Spain, should not be using their EHIC card to obtain medical treatment, as this is reserved for temporary visits to the country.
To find out more about the complex issue of obtaining healthcare in Spain, visit the Healthcare in Spain website
. The questionnaire on the home page will help determine if you are entitled to healthcare in Spain, and how you can go about applying.