Spain’s open-door policy towards immigrants and a few too many unhealthy British tourists have provoked the first big political crisis for José Luis Rodríguez Zapatero’s Socialist government as the country struggles to provide free healthcare and education for the new arrivals.
More than 4m immigrants have entered Spain in the past five years, increasing the total population by 10 per cent to 44m. No other country in Europe has had to cope with such a large influx in such a short space of time, placing public services under severe strain.
The healthcare financial crunch is compounded by the number of tourists – some 55m – visiting Spain each year. If they fall ill, they are also entitled to free medical care, and some visitors take advantage of this.
“You’d be surprised to know how many elderly British tourists have taken to slipping off the gangway as soon as they get off the ferry in Bilbao, just to get hip-replacement surgery in Spain,” says a former British consular official in the Basque country. Basque doctors have taken to calling them “medical tourists”.
Valencia, the Balearic and Canary Islands, and Andalucia, which receive the majority of visitors, are demanding extra funds to cover the cost of treating non-residents.
The funding crisis is creating tensions between the central government, which funds the €45bn ($55bn) Spanish healthcare service, and regional administrations, which are responsible for the provision of services.
It has also created a rift between rich regions with little immigration, such as the Basque country and its well-funded healthcare service, and poor regions such as Andalucia and Extremadura, which are running big deficits.
In addition, the tension has affected relations between Mr Zapatero’s government and his regional allies, particularly in Catalonia, which is demanding a new tax-sharing regime with the central government to increase the region’s fiscal autonomy.
“The devolution of healthcare services to the regions was badly planned,” says Antonio Díaz Morales, a healthcare specialist at the Instituto de Empresa business school in Madrid. “The regions took the money but there was no common strategy and no central guidelines on how the money was to be spent. As a result, there has been a big rise in healthcare spending but very little co-ordination.”
Tensions are running high in Madrid, where 1m new arrivals in recent years have stretched the healthcare service to breaking point.
At the Gregorio Marañon teaching hospital in Madrid, the emergency services are coping with a 30 per cent increase in casualties and a 40 per cent increase in medical consultations.
On a recent weekday evening, the waiting rooms in the emergency ward were overflowing. There was a shortage of wheelchairs, and elderly patients with bruises and fractures waited hours for an X-ray. Latin American mothers nursed ailing babies. Two Romanian construction workers were rushed in with head wounds.
Madrid’s regional government, led by Esperanza Aguirre, a conservative politician, says it needs an extra €1.7bn for healthcare to cut hospital waiting lists and attend its immigrant community. Madrid is also short of 50,000 school places as a result of the unexpected growth of its population.
Last week, Mr Zapatero offered regional leaders €1.7bn to cover about one-third of the €5bn shortfall in healthcare funding. In exchange, Mr Zapatero expects the regions to curb costs and raise local taxes to fund €1.8bn in extra spending. But regional leaders said they would not raise local taxes, and the opposition Popular party rejected the deal outright.
Pedro Solbes, finance minister, accused the Popular party of adopting a cynical stance. “They will take the money and run,” he said in parliament this week.