EARLIER this year, an immigrant in Spain was not feeling well and went to hospital with symptoms of tuberculosis (TB). He was refused tests and sent home. Not much later he felt so bad that he rushed to the emergency room where again he was turned away. Then he died.
Like many illegal immigrants, the man lived in a small space with ten others. As TB is a contagious disease, all ten are now also at risk. They are unlikely to get any help in Spain: following austerity measures and a legislative change last year, the government will not provide any of the estimated 873.000 non-registered immigrants with non-emergency health care. This could create a vast public health crisis in the very near future, warn researchers at the London School of Hygiene and Tropical Medicine (LSHTM).
A paper published in The Lancet, a medical journal, on December 14th, sounded an alarm bell on the state of Spanish health care. So far European media attention has focused on the impact of austerity on health care in Greece, with reports of dramatic increases in HIV, mental illness, TB and the return of malaria. Greece made cuts two years earlier than Spain did, so their impact became evident sooner. But the situation in Spain is just as worrying, warns Helena Legido-Quigley of the LSHTM, who fears that if the government doesn’t change course soon, similar outbreaks could very well happen in Spain.
As the crisis hit, the Spanish government cut spending on an already relatively lean health care system. (Public health care expenditure is 7% of GDP compared with an average of 7.6% across the European Union, 8.4% in Germany and 9.5% in Denmark.) Expenditure was reduced by 13.7% in 2012 and by 16.2% in 2013 (including social services). Some regions imposed additional cuts as high as 10%. As a result a significant part of the Spanish population is excluded from basic health care, which could in turn lead to public health problems for the entire population.
Elena Urdaneta, from Doctors of The World, a non-profit organisation, says the policy is not only unfair but also extremely dangerous for public health. “You can exclude people, but you cannot exclude diseases.” Not vaccinating children of migrants, for example, is economically inefficient as it is much cheaper than dealing with an outbreak of a contagious disease and yet this is starting to happen in several regions.
Even for those still entitled to health care more treatments, including for Hepatitis C and some cancers, now require the patient to pay for part of the medication. This has led to more people not taking the medication they need as they cannot afford it.
As the impact of such policies on health tends to lag a few years, the real public health crisis will only become evident when it is too late, warns Ms. Legido-Quigley. Health care professionals fear that if nothing is done to reverse these policies, Spain is going down a very slippery slope.
The price tag of $1.2 billion for controlling a TB outbreak in New York City in the 1990s showed the importance of prevention, which would have cost an estimated one-tenth of that. Spain's recent health care cuts reduce prevention. They risk dismantling a system that until very recently was one of the best in terms of value for money in Europe.
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