Spain: Cruel austerity measures leave patients suffering

Harsh austerity measures implemented by the Spanish government have had a devastating impact on some of the most economically vulnerable and marginalized people in society, resulting in unbearably long waiting lists and forcing patients to ration their medication to save costs, Amnesty International said today.

The Spanish government’s eagerness to cut costs has made life a misery for patients and health workers alike
Sanhita Ambast, Amnesty International's Researcher on Health

In a new report, Wrong Prescription: The Impact of Austerity Measures on the Right to Health in Spain, the organization sets out the human rights risks associated with austerity. It finds that the Spanish government implemented austerity measures in a way that was inconsistent with their human rights obligations. 

“The most vulnerable people are paying the price for austerity measures which have made quality healthcare less accessible and more expensive. The Spanish government’s eagerness to cut costs has made life a misery for patients and health workers alike,” said Sanhita Ambast, Amnesty International’s Researcher on Health.

“Spain’s austerity measures are in direct conflict with the government’s obligation to fulfil the right to health. We spoke to cancer patients who can’t afford the medicine they need to alleviate chemotherapy’s side effects and people with mental health conditions whose support had been suddenly severed. These cuts are not just regressive, they are cruel.” 

The Spanish government began to cut spending on healthcare in 2009 in the wake of the global financial crisis. Austerity measures - notably through the Royal Decree Law 16/2012 (RDL 16/2012) - included shifting the costs of certain products onto individuals, limiting the healthcare available to irregular migrants, and cutting spending on health workers, equipment and infrastructure.

Amnesty International spoke to 243 people in Andalucía and Galicia, including users of the Spanish National Health System (SNS), health workers, and public health experts. In the report, the organization highlights how austerity measures in Spain’s public health system have had a disproportionate impact on people with lower incomes, notably those with chronic health conditions, people with disabilities, and people accessing mental health care.

One doctor told Amnesty International that through the austerity measures “healthcare was impacted for those most vulnerable, and for those at heightened risk. This is an almost unbearable cruelty.”

Increased financial burdens

Amnesty International’s research shows that since austerity measures were introduced, many people with chronic health conditions have struggled to pay for medicines that were previously free. Although the sums involved may not seem high, for people with low incomes they can be devastating.

Either I take my medicines, or I kill myself because of the pain … so if I have to starve myself, I do it, because I must buy medicines

Amnesty International spoke to more than 100 users of the SNS and their families and carers. People described how they now relied on relatives to pay for their healthcare, and others said they had been forced to make choices about which medicine they needed most.

C, a 65-year-old woman who has had a range of health problems including breast cancer, lung metastases, two knee replacements and two hip replacements, described how she sometimes rations the pills she has bought for the month so that she can afford the special bras she needs for her breast prostheses.

V, a man living with a physical disability, described how he sometimes chooses to buy medicine instead of food: “I cannot live with the pain, I need to take my medicines. Either I take my medicines, or I kill myself [because of the pain] … so if I have to starve myself, I do it, because I must buy medicines”.

Health workers stretched

Spending on health workers has decreased since the start of the financial crisis, resulting in lower salaries, poor working conditions and insecure contracts. This has contributed to fewer staff being employed by the health service – according to official data, the number of workers in the SNS decreased by almost 28,500 between 2012 and 2014.

Health workers feel powerless, exploited and disillusioned with the system
Sanhita Ambast

One nurse told Amnesty International: “We know of many cases where nurses have quit their jobs because of the stress. Many nurses attend to 33 complex cases a day. They’ve had to quit because it was impossible for them”.

Several health workers also said that they were under increasing pressure to comply with economic incentives that limit, for example, the amount they should spend on each patient. One patient said his doctor had told him: “I need to prescribe an expensive medicine for you, but I’m going to be lectured about it.”

“All the health workers we spoke to were anxious about not being able to do more for their patients. Exhaustion, economic incentives and an unsustainable workload are all hampering health workers’ ability to provide the best possible care. They feel powerless, exploited and disillusioned with the system,” said Sanhita Ambast.

Waiting lists

The increase in the length of waiting lists to access health care emerged as a key issue in all interviews including with experts, health workers and people using the health system. In 2010, the average waiting time for elective surgery was 65 days; in 2016 this had almost doubled to 115 days.

M, a 49-year-old woman who suffers from a degenerative bone disease, went to the doctor with leg pain in August 2017. The first available appointment with a specialist is in June 2018, leaving M reliant on painkillers and increasingly anxious about her condition.

Mental health services have also been hit hard by austerity, at a time when unemployment and evictions, associated with a risk to mental health, have risen sharply. People seeking mental health services through the SNS explained to Amnesty International how their symptoms and problems went unaddressed for long periods of time due to the long waiting lists, often adding to their distress.

Deteriorating quality of health care

Several health workers and health system users also complained that the quality of medical equipment had deteriorated since the crisis. For example, nurses said that lower quality needles for diabetes tests was making testing more painful for patients. Amnesty International also interviewed wheelchair users and health workers who said that the quality of wheelchairs had got worse after the crisis.

One woman, B, said she often got ulcers because her wheelchair cushion was worn out and could not be replaced, and a doctor expressed concern about the effectiveness of the breaks on wheelchairs currently being provided.

Almost all the health workers who Amnesty International spoke to confirmed that the consultation time they spent with each patient had decreased. A man receiving mental health care and counselling for many years said, “Earlier I had more time with [my psychologist]. Now it’s just 5 minutes. I left the last appointment feeling exactly how I did when I came in”.

Given the human rights risks associated with austerity, international human rights bodies have developed guidelines to ensure that austerity measures are consistent with states’ human rights obligations.

Amnesty International found that the Spanish government has failed to comply with these international guidelines for a number of reasons, including:

  • No human rights impact assessments were conducted before the austerity measures were implemented, and the levels of participation and consultation in how they were developed and implemented were inadequate.
  • Austerity measures are having a disproportionate effect on marginalized groups
  • All alternatives were not exhausted
  • Many of the changes introduced to the health system, notably RDL 16/2012, remain in force years later, despite guidelines stating that austerity measures should be temporary

Amnesty International is calling on the Spanish government to take immediate steps to reform the RDL 16/2012 and ensure that good quality healthcare is accessible for everybody. This should include putting in place safeguards to ensure that vulnerable groups are not disadvantaged, and improving working conditions for health workers.

“The government should also urgently conduct a comprehensive human rights impact assessment to assess how austerity measures have impacted the right to health. A recession does not justify trampling on people’s rights.”

Background

Earlier this month, a UN expert body also found that Spain’s austerity measures had a regressive effect on the enjoyment of the right to health, and that some austerity measures continue to disproportionately affect the most disadvantaged and marginalized groups and persons in the country.

Amnesty International notes that EU institutions continued to make recommendations to Spain to reduce its budget deficit, knowing that this was being accomplished through cuts in public health expenditure. In some instances, specific recommendations called for making public health spending more “cost effective”.

EU institutions have either steered the Spanish government towards policies that were incompatible with Spain’s obligations to fulfil the right to health, or not done enough to mitigate potential human rights impact. In light of this Amnesty International is also calling on EU institutions to conduct human rights impact assessments of all economic reform and financial assistance programmes in Spain.