Speaking at a press conference, the health minister, Ana Mato, announced that the government will address a change in the Immigration Act to prevent relatives of legal foreign residents coming to Spain “exclusively” to benefit in health care.
In this sense, the government will clarify procedures for the registration process that will take into account, “people who really live in Spain”, justifying the move, saying, “there were people from other countries living in Spain to incorporate their health card to everyone in the family that live in our country, who only came to Spain for health care.”
“It is absolute nonsense and we want to stop this illegal use of our health services and abuse that are assumed in this field”, as well as then stating that the government would look at historic expenditures, amending the Act, to also review agreements with some countries who “do not return the money owed for health care.”
Taking into account the report of the Court of Auditors, corresponding to 2009 data, they estimated that over 700,000 people were using health services inappropriately, which cost some 917 million euro in that year alone.
Article 12 of the Law on Rights and Freedoms of Foreigners in Spain, as amended in 2009, recognizes that “foreigners registered in the municipality where they have their habitual residence” are entitled to health care “in the same conditions as Spanish.”
However, those who are not registered as residents are entitled to “emergency health care for serious illness or accident, whatever its cause and continuity of this care until discharge.” As well as recognizing the right of foreigners to receive assistance during pregnancy, childbirth and postpartum, and those under the age of eighteen who are also entitled to the same care as those of Spanish nationality.
Tax increases and subsidy cuts have already become the “bitter pill” that the Spanish government are feeding the country to try to heal what they call is years of damage from the ignorance of the previous administration, but there austerity plans seem to target the most vulnerable and needy, including education and health.
Closing medical centres for part of the day may seem like an immediate saving opportunity, but this move has been met with a massive barrage of complaints from those already suffering to get access to medical treatment.
There is a huge amount of waste in medication, with millions being flushed away in drugs that are neither necessary nor taken and there is also a somewhat lackadaisical approach to drug distribution, with many people who are entitled to free medication obtaining drugs on behalf of family members who would otherwise have to pay and a seemingly serious lack of control over prescriptions in terms of drugs being given to the person they are intended. So long as the pharmacists and drug companies get paid, many don´t appreciate the fat that somebody somewhere still has to foot the bill.
The problem of health may well run deeper than is apparent however. Plans to cut prescription costs to those who pay for medicines which were implemented by the previous government already hit the pharmaceutical industries hard, although enforcing the law that meant “white label” drugs, rather than big brand medication meant savings for the “man in the street”, it did threaten to reduce the profits of the larger companies.
In September last year, you might remember that Pfizer alone had announced a threat to cut 220 support jobs in Spain, as a direct response to chemists being forced to sell the cheaper, unbranded alternative to their own brands. But this move alone was to save 2.5 billion euro.
Regional governments have run up huge amounts of debts with pharmaceutical companies and not paid the bills for some time, resulting in chemist shops closing their doors in industrial action, this prompting a payment plan to be implemented, but governments are still finding it difficult to reach those payments on times, with pharmaceutical heads not ruling out further industrial action in the coming months.
Spain on the whole is reportedly shouldering a 12 billion euro debt with these companies. Sagrario Pérez Castellanos, the director general of Basic Services and Pharmacy at the Health Ministry, told reporters that she couldn’t confirm the figure, saying that the government didn’t have data for hospitals’ full costs because regional governments, who are responsible for budgeting their health services, can’t – or won’t – provide accurate figures.
The Spanish national newspaper El País however report that Farmaindustria, the body that represents Spain’s pharmaceutical companies, has a clearer picture of the problem: it says that of the 12 billion euro, “6.4 billion covers medicines, and the rest covers items such as disposable gloves, bandages, syringes, etc.” It adds that regional health authorities take between 18 and 26 months to pay their suppliers.
Now, in the latest move to cut spending wherever possible, the elderly have become the targets. For the first time in history, pensioners who receive state benefits will be asked to pay for their prescription medication. It is also looking likely that workers who pay into the health care system will see a 20% rise on the fees they have to pay, but pensioners are looking at being charged 10% of the total cost of their bill.
The Minister for health, Ana Mato, presented the proposals to the regional governments this week, explaining that patients with contributory pensions would have to pay 10% of the cost, drugs with a monthly cap of 8 euro for those with incomes below 18,000 euro and 18 euro per month cap for those who earn more than that. For others who are subsidised, such as active workers, so far paying 40%, there will be different categories and payment scales. Those who earn less than 18,000 euro per year and with large families will continue to pay 40% of the drug, while those with a salary above that figure the fee will rise to 50% of the price.
The third group, those who earn more than 100,000 euro per year, would see an increase which would see them paying 60% of the total cost. During the presentation, Ana Mato said the move would provide, “a few hundred million euro”, or between 1% and 1.5% of pharmaceutical expenditure. However, later in the week, those figures were quoted as more likely to be in the region of just 160 million euro.
Many concerned citizens are now starting to accuse the President of committing a political u-turn. In the election manifesto of the PP and whilst campaigning for votes, he repeatedly stated that “I will not enter copay in Health” and “I will not raise taxes, no”. On 30 December the government approved the second largest tax increase in the recent history of Spain and have fast tracked the concept of copay for health. Even in his latest quote on the subject, on 17th March, facing questions at a press conference, Mariano Rajoy said, “If you ask me personally I am not in favour of co-payment in health care,”
In response, the President of the Colegio de Farmacéuticos de Alicante, Jaime Carbonell, said that the moves will be difficult to apply in practice. But the president of the Organización Médica Colegial, Juan José Rodríguez Sendín, has wholeheartedly supported the move, as it makes “economic sense” to try to cut down on the amount of economic waste in the drug industry.
Representative of those who look at protecting the health system are not looking on these moves favourably. The Federación de Asociaciones para la Defensa de la Sanidad Pública believe that these announcements on health cuts and charges are simply a “trial balloon” to test public reaction, and for the tip of an iceberg of further cuts once these have successfully been implemented. They are looking to organise a nationwide protest on 29th April, asking for the proposals to be reversed.
The previously announced centralisation of hospital food distribution is ready to start, resulting in a planned annual saving of 6 million euro per year on the 40,000 meals served daily in hospitals across the country. The centralisation of drug distribution is already being progressed, with which the ministry hope to save 1,000 million per year, and has begun with the acquisition of the flu vaccine ready for next winter to be distributed through this model.