Spain has excellent private hospitals and clinics that attract paying medical tourists from the UK and many other European countries. But the government is now attacking health tourism.
Spain’s economy is declining, while the public hospital system faces dramatic budget cuts with a battle between central and regional governments on healthcare cuts. The Spanish have always led the fight against freedom of movement within the EU healthcare system, and are now blaming this for the burden of treating foreigners, by whom they mean anyone not Spanish, even if they are one of the several million expatriates residing there.
In the past, Spanish hospitals and doctors have been very lax about who they treat for free, and it is fair to say that some people have taken advantage of an inefficient and poorly managed system. In 2009, some 700,000 foreigner treatments cost €1 billion, according to government data; although they are very vague when pressed as to how much of this they got paid by other governments, how much is legally due for Spain to pay under EU rules, how much non-payment was due to poor administration, and how does it compare to the income they get from the tourism that props up the Spanish economy?
Spain’s main allegation is that it is finding it hard to get money out of other governments for treating their citizens. But other countries counter that much of the money Spain alleges is owed is not payable as the people are legally living and working in Spain. Spanish politicians have mixed up nationalism and problems in paying for Spanish healthcare, with complex allegations that it is all the fault of a badly worded Spanish law from 2007. Foreign countries have hit back at Spain by saying that the Spanish are keen to take money from millions of tourists and expatriates, but not so keen on spending money on them that is legally due. The real crux of the problem is that the Spanish health service faces a 7 billion € spending cut this year, with hospitals expected to close.
The British Embassy did not help matters by a badly worded webpage that gives advice to British citizens on how to get the most out of the Spanish health system. Minister Cristóbal Montoro complained, “We must avoid the foreigners abusing the health service. There are Europeans who come to Spain to use services which are not available in their own countries”.
The Spanish Government says it will ask the European Commission to ensure the proper use of the free movement of persons between the EU members and the healthcare system in different countries; but few expect the EU to do more than remind Spain that they are in the EU and cannot pick and choose which laws apply to them.
The British Embassy released a statement in Spanish, “The British government does not approve or promote health tourism. The object of the advice we gave is to guarantee that British citizens who are in Spain, residents or tourists, clearly meet the requirements of Spanish and European legislation regarding their rights and obligations.”
The British Embassy also reminded Spanish ministers that more than 13 million British citizens travel to Spain each year, accounting for one in four of all tourists. The contribution of the UK to the Spanish tourist industry is put at 10 billion € a year, or 1% of Spain’s GDP. It also pointed out that it is in the interests of both countries that their citizens know how to use the Spanish health system correctly if they get ill. The Embassy guarantees that the U.K. can reimburse Spain correctly and efficiently in line with the pertinent European legislation.
The British Embassy also points out that in addition to 13 million tourists, there are millions of Britons who are legally living and sometimes working in Spain who have the right to use the Spanish health system is the same way that Spanish citizens living in Britain has the right to use the National Health Service. They also highlight the 500million € that the UK pays Spain for healthcare for British pensioners who have retired to Spain, and that while these pensioners get good service from the Spanish health system they also pay taxes in Spain on pensions from the UK.
Spain may not like the system but EU rules state that you if you are an EU citizen in another EU country you get the same healthcare as a citizen of that country. EU law is clear - you should be entitled to treatment on the same basis as the locals. If you are a visitor you cannot fly in for a replacement hip operation but if you break you hip on holiday you are entitled to hospital treatment.
What the over-reaction of Spanish politicians shows is that it is highly improbable that Spain will enact the EU cross-border healthcare directive in 2013.They already have a track record of delaying EU laws till years after the supposed action date. They will not be the only impoverished EU country to fight tooth and nail against enacting, operating and paying any other country in line with the EU cross-border health directive that means well but may become a toothless tiger.