A recent Spanish law limiting access to healthcare for undocumented migrants is causing a controversy. From 1 September 2012 they will have access only to emergency, maternity, and child care. According to our minister of health, issues such as HIV or oncological treatments will be taken care of by non-governmental organisations (NGOs), something that has not even been discussed with NGOs themselves. Shamefully, it might be time for MSF to launch a Spanish version of their brilliant old campaign about AIDS in Africa.
According to the official census, in January 2012 there were 5.7m resident foreigners, which is 12.1% of the overall inhabitants of Spain (47.2m). Though estimates vary, Luis Andrés Gimeno-Feliu, a family physician who has been studying health and immigration for the past 10 years, says we may have 400 000 undocumented migrants. If you take away the 25% of them who are minors, then around 300 000 of them won’t have full healthcare.
This miserable measure is just a way of finding a scapegoat for the continuous mismanagement of public healthcare, which has been highlighted by an international financial and economic debacle. Though some regions will keep on providing full access, the law will evidently cause a “humanitarian problem.”
Mariano Rajoy’s government is deliberately missing the point when trying to sell this as a tool to fight health tourism. Undocumented migrants are usually job seekers, and it is citizens from Western countries—the documented ones—who may come for a hip replacement, explained Gimeno-Feliu at a recent meeting in Madrid.
He began by talking about perceptions. 50% of Spaniards think that migrants abuse the healthcare system and 81% of family physicians think they visit hospital emergency departments and primary care practices more often than nationals. Worldwide only 3-4% of the global population live in a foreign country (191 million people in 2005), far less than a century ago when mainly Europeans moved abroad.
Spaniards emigrated during the dictatorial Franco regime and they are doing so again now due to 50% youth unemployment. However, immigration to Spain is a recent phenomenom. Since the 1990s us “experts in black economy” have needed a large workforce for maintaining a construction bubble that has now collapsed. Gimeno-Feliu recalled the words of Max Frisch “We wanted workers, and we got people.”
Migrants coming to Spain from poorer countries, are younger and healthier—“the healthy migration effect”—and they use healthcare far less than nationals even when adjusted by age and sex. Their overall mortality adjusted by age is 8% lower than that of nationals, and only those coming from Africa and other EU countries have a higher death rate. “Spaniards are much sicker than migrants, we must learn from them,” Gimeno-Feliu pointed out.
In fact, thanks to migrants’ low use of health services there are more resources for natives. The largest part of budget consumption happens in the last year of life, which currently is used mainly by elderly Spaniards. Beside, the autonomous communities receive funding from central government partly depending on the number of regional healthcare access cards, so having healthy migrants means more money for the region.
Gimeno-Feliu recalled different studies carried out in Aragon (1.3m people, 13% of migrants). Spaniards are admitted far more to hospital than migrants in all age groups, and use primary care far more than them. Among migrants, those from “rich countries” and Latin Americans use primary care the most.
Although in emergency care the data are diverse, a recent large study found migrants came to the primary care emergency room 33% less than nationals.
Regarding emergency hospital care, researchers from Barcelona found that migrants used emergency departments 38% less than nationals, but data from the largest hospital of Aragon show migrants used emergency care 20% more than Spaniards . In any case, as they make up 13% of the population, this extra charge means as little as 3-4% of total visits to emergency departments, which “makes it difficult to say migrants saturate these.”
Pharmaceutical expenditure is also lower among migrants. In Aragon they use 60% fewer medications .
Results are consistently similar in other developed countries. Gimeno-Feliu recalled a study that found that Turkish immigrants in Germany were healthier than Germans, and also healthier than Turkish people living in Turkey.
These disparities may be due to better health, different lifestyles, medicalisation rates, or social, cultural, and accessibility factors, but what seems clear is that healthcare is underused by migrants. Our politicians may be aware of this, but they seem more interested in electioneering. As El Roto, one of most renowned Spanish cartoonists magnificently says, “what a great truth propaganda is.”
1.- Gimeno Feliu LA, Granizo C, Sanz L, Febrel M. Inmigración y Salud. Diagnóstico de la realidad [Immigration and Health. Diagnosis of reality]. In: Gobierno de Aragón, editor. Plan integral para la convivencia intercultural en Aragón 2008/2011. Zaragoza 2009
2.- Gimeno Feliu LA, Armesto FJ, Magallón R Llorente-González JM, Lasheras-Barrio M, Clemente S. Comparative pharmaceutical consumptio study between autóctonos and immigrant population in Spain. 19th Wonca World Conference. Cancun, Mexico. 19-23 de mayo de 2010.
Aser García Rada is a paediatrician at the Hospital Infantil Universitario Niño Jesús in Madrid, Spain, and a freelance journalist.