Where to apply for a health care card? Health care and migrants

The right to health is a fundamental human right that all people have, whatever their origin, ethnicity or nationality. Therefore it’s a right that must be universal, and handled as such by public administrations and authorities. It must not be forgotten that in addition to being a matter of justice and human rights, it is also about the effectiveness of an overall health care system, as it improves public health and reduces costs.

Nonetheless, within a political framework of persecution against migrants, this right has been severely attacked. In 2012, the most restrictive measure yet was handed down by Spain’s PP government: migrants with irregular residency status were banished from the health care system. The different measures taken in the Basque Autonomous Community and in Navarre to ameliorate this situation (though the measures were still restrictive) were challenged and annulled from Madrid, in yet another aggression against our capacity to generate our own policies, also regarding a competency that was transferred to the local government years ago.

In 2018, the government published a decree meant to reinstate universal health care, although, as we will see later on, migrants still suffer numerous limitations.

However, if you’re a migrant, we recommend you apply for your health care card as soon as possible, whatever your administrative status. You can apply at any health care center (the out-patient clinic staff will handle all the formalities).

If you have a legal administrative situation:

1. Go to your health care center (call 012 for information on your assigned center).
2. Complete the application sheet that center personnel will provide.
3. You will need the following documents to complete the formalities:

– Photocopy of the TIE (you should also take the original).
– Proof of municipal census registry (request it a minimum of 15 days prior to the visit; when requesting it, let them know you need it for your health care card).
– The document that accredits that you are entitled to health care. Request this document at the Institute of Social Security (INSS offices HERE).
– If you have children: family register (if they are under 14, their identification documents too).

4. Your health care card will arrive by mail.

If you are in an irregular administrative situation:

1. In this case, you should also go to your health care center and complete an application.
2. You will need the following documents to complete the formalities:

– Passport or identity document from your country of origin. In order to be considered a valid document, it must bear a photograph of you.
– Document that accredits that you have lived in Spain for at least 3 months. If you have registered in the municipal census, proof of registration will be sufficient. If you haven’t been able to register in the municipal census, other documents can be presented: proof of your children’s school enrollment, social services documents, etc.
– Certificate of non-exportation of health care. In other words, the health care cannot be exported from your country of origin to Spain. This will be necessary if you are from a country of the European Union or from Chile. This certificate must be issued by the administration of your country of origin. Therefore, you should apply for it in your consulate.
– You must declare that there is no third-party obliged to make payment. In other words, that you do not have a private insurance policy. This is stated on the application itself. Therefore, you don’t need a separate document, although the authorities will check it. As will be explained later, this is the criteria used to deny health care to parents of migrants who have arrived through the family regrouping system.

3. If your application is approved, remember to renew your card every two years.
4. Once you achieve residency status, you will have to go back to the health care center to apply for your health care card for residents.

Regrouped parents, excluded from the public system:

Despite the PSOE government’s claims, it is not true that the universal right to health has been recovered. People with irregular administrative situations face difficulties accessing health care, such as cases in which their consulate does not want to issue a non-exportation certificate. In some cases they are told to return to their home country to apply for it there, which is practically impossible, precisely because they are in an irregular situation.

Nevertheless, the most devastating exclusion is that suffered by the parents of migrants. In order to receive the residency permit for family reunification, they are obliged to take out a private health insurance policy. As they tend to be elderly persons, private insurers do not want them as customers. If they do get private health insurance, the policies do not cover the needs they have. On one hand, to be able to stay in Spain, they are required to take out a private health insurance policy, and on the other, the State denies them access to public health care because they have private insurance policies. It is inhumane that individuals who need even more care due to their age are precisely those who are denied health care service.

Levels of health care service:

Once in the system, you will be assigned to a general practitioner. Any time you have a health problem, they will be the person who sees you and monitors your evolution. You must request an appointment in advance with the health care center, and they will tell you at what time the doctor can see you.

If you need emergency care (for example, if you’ve had an accident) you don’t need to book an appointment. Go to the emergency department of your local hospital, and they will treat you directly. Please remember this only applies to emergencies.

To see a specialist, you must first go to your general practitioner. They will refer you to a specialist.

The specialist will determine whether your illness requires hospitalization or surgery.

To sum up, the first step will always be going to the general practitioner in your town or neighborhood. Though other health care providers may take part in your treatment, you can’t go directly to the specialists and/or surgeons.

Last, the administrations that are responsible for health services management are:

In Araba, Bizkaia and Gipuzkoa: Ministry of Health of Euskadi and Osakidetza
In Navarre: Ministry of Health of Navarre and Osasunbidea