Health-care access for migrants in Europe: The case of Spain

摘要

The Spanish Government recently approved (April 20,2012) the transition from a National Healthcare System (NHS) to an insurance model through a Royal Decree-Law, bypassing the need for parliamentary discussion. Universal health-care access, a right guaranteed by laws supported by a large social and political consensus, was abolished overnight. The consequence was that hundreds of thousands of non-citizen residents lost their right to health care, except for emergency services and maternal health. The reform might be in conflict with the Spanish Constitution and the statutes of autonomy of some Spanish regions, with the Constitutional Tribunal having granted leave to appeal to them. The reform was based on a report from the Court of Auditors stating that the NHS was bearing the health-care cost of European citizens (so-called health tourism) due to its inability to secure reimbursement. While the real problem resides in European countries becoming Spain's main healthcare debtors for their insured citizens, the reform de facto excludes the undocumented immigrants, a highly vulnerable population, from preventive and primary care services. This, in turn, might increase the use of costlier services and put the general population at increased risk of infectious diseases. In addition, the reform has raised a conscientious objection movement after creating a serious ethical conflict for health professionals by violating principles of due loyalty and non-abandonment. Public and political opposition are joining health-care professionals in their rejection of the reform. Until now, the NHS has enjoyed high levels of public satisfaction.