More than 28,700 people have encountered barriers in the last 32 months that have prevented or made it difficult for them to access the healthcare systemobstacles that are mostly discriminatory in nature and that mainly affect those who are in a situation of greater social vulnerability, such as undocumented migrants.
This is shown by the III Report on access barriers to the National Health System (SNS)which publishes every year Doctors of the Worldin which it has documented between January 1, 2022 and August 31, up to 69,650 cases of obstacles to receiving medical care or accessing essential treatments in the 28,744 people it treated in that period.
The majority of people assisted by Médicos del Mundo are women (61.4%) and, by age, almost half were between 18 and 34 years old; At the extremes, 8.69% of the people served were minors, and 4.75% were over 65 years of age.
Almost all of those affected are foreigners
In relation to origin, practically all of them are foreigners (only 2.78% have Spanish nationality), the vast majority coming from Latin America (Colombia, Peru and Venezuela), followed by North Africa (with a clear preponderance of Moroccofollowed at a great distance by Algeria) and to a lesser extent Europe (especially Romania) and sub-Saharan Africa (Senegal and Mali).
Most of the documented barriers are of a discriminatory nature, which constitute 40.84% and are the “direct consequence of the existence of a legal framework in which much of the logic imposed by the health exclusion of 2012 still persists. “.
In this sense, “the confusing, if not directly contradictory, wording” of Royal Decree-Law 7/2018 that regulates the conditions for the recognition of the right to health care from public funds, “has given rise to the foreign persons (particularly those in an irregular administrative situation) are required to meet a series of requirements that are difficult to comply with to access the health system.
The requirement to reside for more than three months in Spain
Registration as a means of proof that the person resides in Spaintogether with the requirement to prove that said residence is longer than three months, are the main obstacles (16,508 cases). For many migrants it may be impossible to register, either because they do not have a valid identification document, because they live in informal rentals, substandard housing areas or because they are homeless.
The residence requirement of more than three months takes on a “particularly dramatic” character in cases of situations of special vulnerability such as minors (885) and pregnant women (363 cases), which is the result of the fact that current legislation does not guarantee care for these people in all cases.
The collapse of social services and social work, as well as the impossibility in many communities of requesting an appointment with social work if the person is not registered, “turns this safeguard into a true dead end (707 cases).” Meanwhile, the situation of older people reunited in Spain by their daughters and sons continues to be “one of the most unfair and pressing” with 305 cases, the report laments.
Finally, there are the 1,375 cases of applicants for international protection who, once they manage to complete this procedure, “are still sometimes required to provide other types of documentation,” such as registration or proof of residence longer than three months.
Next are the information barriers, which represent the main obstacle in 25% of cases: a total of 5,293 people do not know what their right to access the system is or how to carry out the procedures to be able to exercise it, situations that are in turn consequence of the lack of adequate information from the SNS itself (3,375 cases).
The elderly specifically suffer from this lack of information; In the case of regrouped people, it is due to the lack of an understandable explanation from health personnel and those of Spanish nationality add the role of new technologies, which make it difficult for them to access care (1,231 cases).
Meanwhile, the economic barriers they represent 14.33%; Among them, there is the difficulty in accessing necessary medications (1,849) or emergency billings, which constitute a barrier that predominantly affects migrants who cannot see their right to health care recognized (898).
9.38% of the barriers are physical: the most numerous (3,847) are those related to difficulties in transport to the reference health center, with distances that can reach 10 kilometers.
Also relevant is the time factor of some health centers, which makes it difficult for many people to access the service. healthcare (2,465).
Finally, cultural barriers represent 10.5% of the total documented barriers, with a total of 4,350 cases in which their cultural frameworks have not been duly taken into account.
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