Spain's migrant healthcare dilemma
A new law in Spain has revived the debate over whether illegal immigrants should receive free public healthcare.
Simone from Brazil and Prince from Nigeria are both illegal immigrants living in Spain. They both have long-term, potentially life-threatening illnesses. And until recently they both received free public healthcare.
However that could all now change.
As of this month, a new healthcare law means illegal immigrants who are over 18 will only get treated for free within Spain's healthcare system if it is an emergency or a pregnancy or birth.
Prince, 42, was born in Nigeria but has been living in Madrid for the last 15 years.
He has HIV and takes four different types of drug every day to treat the virus.
Crucially he does not have a Spanish health card and so, under the letter of Spain's new health law, he will not get free treatment.
He says he cannot afford the medicines, which he claims would cost hundreds of euros a month, and fears that the new law could send him "direct to the grave".
Simone Belmont, 40 and a mother-of-two, was diagnosed with breast cancer in 2011.
She had a mastectomy and has undergone chemotherapy and radiotherapy. All of that treatment was administered free, courtesy of Spain's public health system.
Now, though, she says she is worried.
"I have appointments with my doctor, and I'm not sure if I'll be seen," she says.'Segregation'
A health organisation, Doctors of the World, is running a campaign against the new law called "Right to treat", in which they are encouraging doctors to defy the new law and continue treating people who do not have the correct legal status.
The group estimates that there are around 150,000 people living in Spain illegally who will be affected.
End Quote Dr Ricardo Angora Doctors of the World
We are not talking about a privilege - basic healthcare is a human right”
Dr Ricardo Angora says that a huge population of immigrants will be "segregated".
He warns that the new law will create a "health apartheid", in which some will be eligible for free treatment and others will not.
"We are not talking about a privilege - basic healthcare is a human right," he says.
In a recent speech, Health Minister Ana Mato argued that the new measures relating to illegal immigrants' access to free public healthcare were "not driven by a desire to save money".
She argued it was a question of Spain complying with European health regulations and ensuring that Spanish people received the same treatment abroad as those from abroad received in Spain.
She also said that provisions would be made to ensure that certain diseases were controlled, including "chronic illnesses for foreign people without legal residency [in Spain]".
However there has been no detail on what those provisions will be and, when we asked Spain's health ministry whether illnesses like HIV and cancer would be treated free on the health system, we were referred back to the minister's speech.
What is more, some doctors and nurses have said they will defy the new law.
On top of all that, Spain's regional governments are the ones that actually implement healthcare policy. Healthcare makes up 40-50% of their budgets.
Five of Spain's autonomous communities, including Catalonia and Andalusia, two of the largest in population terms, have publicly said they will not implement the new law.False economy?
Although the government argues that the new law is not driven by financial considerations, many analysts believe otherwise.
And, in times of economic crisis and austerity, there is no doubt that wider health reforms that the Spanish government is implementing are designed to reduce Spain's overall health bill.
Spain currently spends around 9.5% of GDP on healthcare per year, which is the average amount developed countries in the OECD spend. Britain spends around 12% of its GDP.
However Spain's healthcare bill has been rising faster than other nations.
Professor Nuria Mas from Spain's IESE business school specialises in the economics of healthcare policy.
She says, over the course of the last 10 years, Germany's annual health bill has risen, on average, by around 2%.
In Spain that figure is 5.5%.
Overall, she believes the new law could increase the amount Spain spends on healthcare each year, because some illegal immigrants might avoid preventative or early treatments, which they would have to pay for.
If they then wait until their condition becomes an emergency for which, under the new law, they would be covered, then the Spanish state would pick up the tab.
And emergency treatments are often more expensive.
However she also says Spain's free public health system has contributed to a "pull effect", making it "very attractive for immigrants, especially illegal ones, to come to Spain".
The new law will, she argues, make it "more difficult" for those people and may reduce the "pull effect" now and beyond Spain's financial crisis.