Spain asks citizens to cough, say “ahh” and pull out their wallets for health care
Story by Olivia Sears
SALAMANCA – Over the past two years, Concepción Quill, 85, has seen the cost of her insulin prescription go from nothing to $5.65 a month. Though a small increase, the notion of paying for medications is new to Quill and other low-income Spaniards who are now worried about their access to long-term treatment.
“I have had Type I diabetes my whole life. I need insulin treatments each day, three times,” the Madrid resident said through a translator from her wheelchair on a visit to Salamanca. A retired secretary living off a limited public pension, Quill explained that her family has picked up the bill for her rising medical costs.
Quill is among the 870,000 who have been affected by recent health care cuts passed by the Spanish government.
As a part of the Spanish government’s austerity measures, state health care spending decreased 13 percent in 2012 and another 16 percent in 2013. The cuts are the result of the passage of the “Royal Decree Law 16/2012” which denies health care access to undocumented foreigners unless they are pregnant, under the age of 18 or in need of emergency care. In addition to eliminating universal health care, the law also reduces financing for more than 400 different medications including insulin treatments for people with diabetes.
In the two years since its introduction, the law has forced patients without private insurance to adjust to a new health care system with narrower coverage options and higher out-of-pocket expenses. Individuals requiring prescriptions for chronic illnesses including Hepatitis B and C, multiple sclerosis, some types of cancers and diabetes are particularly affected.
“Chronically ill patients have to pay more for medications,” said Helena Legido-Quigley, a researcher and lecturer in global health at the London School of Hygiene & Tropical Medicine. “It’s hard for people during the crisis. This is another obstacle.”
Legido-Quigley, 37, studies European health care legislation and its impact on the economy, public health and chronic conditions. Since many chronically ill patients are older and living off pensions, Legido-Quigley explained that RDL 16/2012 in effect targets them – as well as all low-income populations – limiting their access to health care.
The Royal Decree Law forces citizens to pay a portion of the cost of their prescription medications, in some cases up to 60 percent, depending on their income level. It also requires senior citizens to pay up to 10 percent of medication costs, something previously unheard of in Spain. Legido-Quigley said the law hurts pensioners, and fears that some won’t be able to complete treatment because of the costs.
“It’s their life. They sometimes don’t take medications because taking care of families is more important. They have other priorities,” she said.
Legido-Quigley said similar cuts in Greece have led to people not seeking the care they need, prompting an increase in communicable diseases such as HIV, TB and malaria. She predicts similar consequences could happen in Spain. She also said that research has shown austerity measures taken by Spain and other countries have yet to fix their struggling economies. Meanwhile, “if you decide to exclude people from the health care system, public health will deteriorate,” she added.
Leire Ochoa, 32, an obstetrician and gynecologist from the privately-run Hospital de la Santísima Trinidad, finds the law unconscionable.
“How can I do this when my obligation is to help wherever there is need?” she asked. “ If someone needs attention I am not going to say no.”
Ochoa has been practicing medicine for six years and feels as though the law is a violation of her physician’s pledge. In the past two years, refusal of care to undocumented immigrants and rising prescription costs have left many without access to primary care or the medications they need, she said.
“I don’t know why they are doing this,” said Ochoa – and she is not the only one in the medical community asking this question.
In response to the reform, Doctors of the World Spain launched two campaigns. In 2012, the “Derecho a Curar” (Right to Care) campaign was formed to mobilize medical professionals against the law. In 2013, the “Nadie Desechado” (No Disposal) campaign kicked off to raise global awareness of the discriminatory health cuts.
Dr. Alvaro González, president of Doctors of the World Spain, said through a translator “We are working to fix how the economic crisis has affected medicine – on a local and international scale. . . we work for human rights.” Alongside other world health leaders, González presented a report in Madrid earlier this month to the World Health Organization. It focused on access to health care by vulnerable populations in Europe.
As part of his activism, González and his organization demanded that the right to access good health care be restored and protected.
Other medical professionals in Spain are also standing by their beliefs. In January, 2,000 health care workers associated with Doctors of the World Spain risked their careers by announcing they will not follow the law. Together the two campaigns – Right to Care and No Disposal – have recruited more than 19,000 doctors and citizens to join the cause, and presented their support in a letter to the Spanish minister of health, Ana Mato.
With the 2014 European elections just weeks away, Doctors of the World leads the fight against RDL 16/2012. González explained, “At this moment, we are trying to convince the population and public administration that health is a right that all of us have, a right independent of origin and economic state.”
The European Social Charter, a Council of Europe treaty, guarantees economic and social human rights. It includes 47 member states, one of which is Spain. In Article 11 the charter ensures universal access to health care – meaning the health system must be accessible without discrimination of any form.
The Charter has approached the Spanish government several times about how RDL 16/2012 fails to meet that obligation. Its message: If the law is not changed, Spain will ultimately be kicked out of the European Social Charter.
When asked about Article 11, Senator Alberto Gutiérrez Alberca of Spain’s ruling Popular Party said he had no knowledge of the Social Charter’s repeated inquiries to the Spanish government, and therefore refused to comment on the matter. The senator represents the province of Castile-León – which covers Salamanca and is one of 50 provinces in the country – in the upper house of Spain’s Parliament.
He did say, through a translator, “The way we have regulated the expenses for medicines has really benefited the government.” Conversely, he did not believe the new law at all negatively impacted the people.
Advocates such as González are frustrated with the disconnect between Spanish representatives and their electorate. He does not expect the government to change the legislation and revert back to universal health care under the leadership of the Popular Party. He is hopeful, though, that a future ruling party would repeal the law.
Without change, Quill and other pensioners are left to handle the rising cost of their medications on their own. She can rely on her family for financial support, but she’s still resolute in her opposition to the Royal Decree Law 16/2012.
“They [the citizens of Spain] are humans too,” she said, “and we can’t leave people without care.”
Posted on May 15, 2014, in Reporting from Salamanca and tagged austerity, cancer, chronic illness, diabetes, Doctors of the World Spain, Health care, medication, No Disposal, prescription, Right to Care, Royal Decree Law 16/2012, Spain. Bookmark the permalink. 1 Comment.