This week, the Council of Ministers presented a bill aimed at facilitating immediate and free universal access to public health for all citizens, including all immigrants living in Spain, regardless of their administrative status. This is to avoid the dysfunctions found in some communes. So far, the rule has led to an interpretation that has allowed some hospitals to deny them medical care. The PP government reduced this right in 2012 and the PSOE reversed this policy in 2018, but left an ambiguity in the text that made it easier to refuse immigrants if they could not prove that they had been in Spain for more than three months . The new project also guarantees free healthcare for Spaniards living abroad during their visits to the country. The bill on equity, universality and cohesion of the national health system proposes further specific advances to prevent the different health services of the autonomous communities from erecting barriers that hinder access to certain services for vulnerable people. The aim is to ensure a common service portfolio for all citizens. The project eliminates prosthetic co-payments for lower-income pensioners, minors with disabilities, and those at risk of poverty or minimum income recipients, groups for whom the government had already eliminated drug co-payments.
The draft law establishes the primacy of the public health network as a general criterion and limits the possibilities for privatization in the provision of services. To this end, it sets out a set of requirements for outsourcing care and the need to justify the decision to outsource it to private providers. The goal is to limit this possibility to cases where it actually represents a benefit for the system, and thus to avoid a policy of systematic “substitution” of public services by clientelist criteria or parasitism of public resources.
The reaction of some agents involved seems exaggerated, to say the least. The sector’s employers, the Spanish Private Health Alliance (ASPE), accuse the government of making Spain “the only European country to ban private healthcare services from its national healthcare system”. It does not seem very realistic when it is theoretically a question of establishing legally binding criteria that prevent the excesses in the privatization of services that have already been identified in various municipalities. The Interterritorial Health Council, in which the communities are represented, must now set the guidelines and indicators to determine whether or not an autonomy meets the criteria set out in the law and to what extent the provision of a public service by a private company is advisable. If this filter really works, it should become the guarantor that the area of competence of the Autonomous Communities is respected and that conflicts and their solutions are discussed. The political goal of putting an end to the routine and unnecessary privatization of the healthcare system must now find concrete formalization in the parliamentary process that awaits it. The project, presented by the Ministry of Health, has not yet pledged the support of the coalition’s minority partner, United We Can, which is calling for more emphasis on canceling concerts with private sponsors.