On March 10, the Council of Ministers approved a royal decree which regulates the procedure for the recognition of the right to health protection and healthcare charged to public funds for foreign persons who are in Spain without legal residence. Its purpose is, fundamentally, to recover the universal nature of the National Health System to guarantee healthcare to all people living in Spain, also reducing bureaucracy and simplifying procedures. A month later, the norm has fueled a debate: Does it open the door to health tourism or is a disinformation narrative being fed? What is the legal reality?
What the decree changes and what it implies
Driven by the Ministry of Health, the royal decree closes the gap opened in 2012, when the Government of Mariano Rajoy broke the universality of the SNS by expelling irregular immigrants. In 2018, the coalition Government presided over by Pedro Sánchez reversed the situation with a royal decree-law that, however, did not completely knock down the access barrier because its application depended on the Autonomous Communities. Now, the royal decree eliminates those administrative obstacles that generated situations of exclusion.
The rule shields healthcare for all people living in Spain, regardless of their situation. To be attended, a responsible declaration is enough, that is, a mechanism that allows the applicant to simply declare that they meet the requirements: residing in Spain.
To prove habitual residence a certificate or registration form must be provided or, failing that, a certificate of enrollment in an educational center, of schooling, a travel letter issued by the consulate or utility bills for electricity, gas, water or telephone or internet, reports from social centers or consular documentation.
Healthcare can be received from the moment the application is submitted -which can be done at the healthcare center itself-, which, according to Health, “avoids eternal waits to be able to access a doctor and guarantees that no person is left unprotected while the administrative procedure is resolved”.
Here is the point that fuels the debate: the responsible declaration and the resolution of the administrative procedure. The system first provides the attention, and then, checks if the requirements are met; and if it is not resolved in three months, the administrative silence will be understood as positive in favor of the applicant.
Spain, attractive destination?
The so-called health tourism refers to the displacement of people to another country with the objective of receiving medical attention, either for reasons of cost or quality, waiting times or access to certain treatments. It arises from the differences between healthcare systems and rides on the back of greater international mobility.
A perfect example would be United States, where healthcare has a very high cost and largely depends on private insurance. In that context, certain treatments -especially those of high complexity or long duration- can mean unaffordable bills for part of the population. This gap has historically favored some American patients traveling abroad in search of more affordable alternatives.
Spain stands as an attractive destination for its universality and quality. The question is: is it true that the Government promotes health tourism with the recently approved royal decree?
Matter of narrative
The Ministry of Health regrets that the narrative is misleading. They rule out that the alleged “health tourism” is promoted or use of public health services by non-residents or non-contributors.
In this regard, they argue that the decree is aimed “at people who live and reside in Spain”, except for Spanish women residing abroad and their relatives.
Health denies that health tourism is promoted because the royal decree is aimed at “to people who live and reside in Spain”
They assure that with the royal decree Spain will not be the “hospital of the world” and a call effect is not being generated since “the decree requires accrediting habitual residence in Spain”. “It seeks to attend to those who live and coexist here, not health tourism,” they emphasize from Mónica García’s portfolio.