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Doctors rebel against rules forbidding public healthcare workers from treating illegal immigrants.
BARCELONA, Spain — Kimberly Farias was diagnosed with HIV in Madrid after emigrating from Argentina in 2009. Although she’s here illegally, the thirty year-old has received free medical care and antiretroviral medicines.
That's because Spain's public healthcare system, one of the world’s most progressive, has granted access to anyone here, even those staying temporarily.
That’s just changed.
Farias’s healthcare card was de-activated this month. Now she can’t visit her doctor or get the medications she needs because she can’t pay for her $1,075 monthly treatment.
The Spanish government is trying to stave off economic collapse by saving every possible cent as a second recession hits the country in just four years. Tens of thousands of illegal immigrants like her have also been excluded from the healthcare system under a new law that allows free medical treatment only in emergency cases and for children and pregnant women.
“I’m really worried because it’s a matter of life or death for me,” Faraias says.
The government expected little reaction from average Spanish voters. But a rebellion by thousands of doctors has caught it by surprise.
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Salvador Tranches, vice-president of the Spanish Society of Primary Care and Community Medicine, semFYC, says doctors' ethical code prevents them from going along with the new law.
“It dictates that we can’t leave a patient defenseless once we’ve started a medical relationship with him,” he says. “It’s human beings getting sick, not healthcare cards.”
Tranches has joined the nearly 2,000 doctors who have declared themselves to be conscientious objectors.
Pressured by the European Union to cut its deficit from 8.9 percent of GDP in 2011 to 6.3 this year, the conservative Spanish government has raised taxes and enacted the biggest budget cuts in Spanish history, most of them in healthcare, education and other public services. It’s part of an effort to cut the budget deficit by $82 billion by 2014.
But semFYC and other organizations dispute the government’s claim the healthcare cuts will save $630 million a year, saying they will actually increase costs.
Although Tranches admits the measures will save money in the short to mid-term, he says it won’t last over time. “It will be like a boomerang.”
Many doctors argue it’s cheaper for the government to fund preventive care for mild conditions than treatment for patients whose conditions have deteriorated.
They also argue hospitals will be brought to a standstill because immigrants will now be seen only in emergency rooms.
Those who require follow-ups must pay for them themselves. Critics say that’s not simply unjust, but also dangerous for public health.
They say people diagnosed with psychoses can become threats to society without proper supervision. Infectious diseases such as tuberculosis — rare in Spain but not necessarily in countries from which immigrants travel — may also spread without control.
Immigrant groups and humanitarian organizations say more than that, the new system is discriminatory and encourages xenophobia and racism.
“It puts illegal immigrants into a ghetto and creates a kind of apartheid,” Tranches says.
Gilberto Torres, spokesperson for the National Federation of Immigrant and Refugees Associations, says the new rules reinforce the views of those who blame immigrants for high unemployment and taxing the welfare system without contributing to it.
“It turns immigrants into scapegoats for everything going on in Spain,” he says.
Statistics show immigrants actually use the public healthcare system far less than Spaniards. A semFYC study from 2008 showed that Spanish citizens saw a doctor an average of 8.3 times a year, compared to immigrants at 4.7 times.
Others point to the fact that the Spanish healthcare system isn’t sustained by social security contributions from legal workers' salaries but by sales, income and other taxes.
“Illegal immigrants contribute to the healthcare by living, shopping and spending here,” said a general practitioner named Manuel Ferran.
He works in one of Barcelona’s most multicultural neighborhoods, where he treats people from more than 75 countries among his 1,500 patients.
Although Ferran is a conscientious objector to the new rules, he won’t need to break the law because he practices in the semiautonomous region of Catalonia, which is among the half of Spain’s 17 semiautonomous regions that have declared they won’t observe the new regulations.
Conscientious objectors in other regions say they’ll see patients without registering their visits or during extra hours.
That’s what a psychiatrist in Madrid named Ricardo Angora says he intends to do. He scheduled follow-up visits for patients before Sept. 1 and instructed them to go directly to his office without passing his clinic’s registration desk.
“It doesn't make sense for me to volunteer in Third World countries and leave my patients here unattended,” said Angora, a member of the NGO Medicos del Mundo (Doctors of the World).
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The government has defended itself by saying the new measure isn’t directed against poor illegal immigrants but “healthcare tourism.”
Critics say many Europeans travel to Spain for medical procedures, including retired British and Germans who visit holiday resorts for hip replacements and return home without paying a cent.
Bilateral agreements with other countries stipulate patients’ home countries must pay their bills, but the process is rarely followed.
The government says foreign state health services and private insurers owe it $1.5 billion.
Contentious objectors to the new law say the government should crack down on health tourism instead of poor illegal immigrants.
Tranches says until then, thousands of physicians — who worry about more cuts to Spain's healthcare system if they don't stand firm — will continue to see their patients regardless of their legal status.