Spanish doctors and the Spanish public health system have come under fire from the European Commission after claims that hospitals in Spain have been breaking the rules of the European Health Insurance Card agreement (EHIC). EU law states that public health services in the participating countries must treat needy European travellers to free (or reduced cost) health care. However, there have been several recent reports from tourists complaining that when they have visited Spain for travels or business trips, Spanish hospitals have refused to acknowledge the cards. The Commission is now in the process of taking legal action against Spain in order to resolve the matter.
The EHIC facilitates a very straightforward process for people from (and going to) any of the 31 participating European Economic Area countries (plus switzerland): those carrying the EHIC are entitled to health care and emergency medical treatment resulting from illness or accidents while out travelling like broken bones from falls or food poisoning. In addition, travellers who are temporarily away from home are entitled to health care for long-term conditions or pre existing illnesses such as kidney dialysis, which require regular hospital check ups for blood tests, medication or injections. Lastly, the EHIC covers routine maternity care in any of the 31 countries. In all of the above cases, the agreement is that the tourist presents the card and receives free healthcare which is later paid for by the NHS.
Spain has been participating in this EHIC scheme since 2005 and, previous to that, the E111 scheme which it replaced (which required travellers to carry a signed document instead of a card, but entitled them to the same level of public health care if they needed it). Travellers are encouraged to carry the EHIC card with them whenever they travel within Europe because it helps to protect against the costs of unexpected medical problems. On the other hand, it is not advised to travel without an additional private health insurance which offers much more extensive cover for things like dental work, transportation back to the UK or emergency accommodation if travel plans are delayed due to ill health.
There are well known instances when the EHIC card is not valid, notably for people who specifically travel overseas just to receive medical treatment (like giving birth or any other non emergency procedures). Nevertheless, neither was the case when Ray Burton from the UK recently arrived at a Spanish hospital with symptoms of severe dehydration. Instead of being able to use the EHIC to access the same standard of care as other Spanish citizens, the hospital failed to acknowledge the card, and insisted that Burton provide his credit card instead. Another Brit who was holidaying with friends returned from a trip to in Mallorca to find a bill totaling 3,000 GBP for an overnight hospital stay when the EHIC card was refused.
Tourists from UK and other European destinations have returned home from holidaying in Spain with numerous reports of the EHIC being dismissed or refused. As a result of these cases, and many others, Spain is being investigated for a breach of EU law for demanding foreign patients to pay for their medical treatment upfront and instructing them to file an insurance claim to get the money refunded later on.
In other cases, they have been accused of tricking tourists into signing insurance paperwork when treatment should have been covered. For one British traveller, a month spent in a Spanish hospital resulted in a bill totalling £54,000 which was issued through a Spanish debt collector. Again, the hospital tried to convince the patient that the bill was the travel insurance company's responsibility, despite the fact that the treatment was legally covered under the EHIC scheme. There are many other reports of people visiting Spanish clinics or hospitals being diverted to expensive private hospitals where the EHIC card is not recognised, so that those in need of emergency health care have little choice but to hand over cash, credit cards or private health insurance policies.Spain's economic situation is never far from the headlines, so it has been claimed by some that this recent boycotting of the the ECHI is a money saving scheme to prevent local hospitals from paying for large medical expenses; others have suggested it's a money making scheme for private hospitals. Whatever the reason, Spain is not alone in these accusations: other EEA countries which are also struggling with large national debt and government spending cuts like Portugal and Greece, have also been accused of breaching EU law over the ECHI cards.
The Commission is preparing to investigate a number of cases, and if Spain is found guilty of failing to acknowledge the EHIC card, it could face a large fine. In the meantime, tourists planning to visit Spain on holiday this summer are being reminded that the EHIC card is never a substitute for travel insurance with medical cover- and in light of these reports, holidaymakers are being encouraged to take out an insurance policy in case of unexpected medical emergencies. For those who do find themselves in a Spanish clinic or hospital, the advice is not to sign anything they are not sure about, and to keep a copy of any receipts or documents they are given.