Issues in the Justiciability of the Right to Health

Juan Antonio Maldonado Molina, Valentina Colcelli, Barbara Pavlikova, Roberto Cippitani, Rodolfo Gutiérrez Silva, Rodolfo Gutiérrez Silva

• Publisher: Fondo Editorial – Ediciones Universidad Cooperativa
• Year: 2019
• ISBN:
  9789587601817
• Topic: Law
• Subtopic: Medical Law
• Index: Law

The judicialization of health care is increasing dramatically in the last decade worldwide. Although this judicial activism has undoubtedly contributed to guaranteeing the protection of this right, many challenges remain despite this progress. The objective of this book is to evaluate the different challenges and opportunities that States have in the protection of the Right to Health while maintaining a balanced level of judicial activism. More specifically, it looks to identify in what contexts judicial activism is justified in order to protect the right to health by analysing the dynamics of litigation as well as its consequences. The book starts by presenting a case in Spain. Juan Antonio Maldonado shows how conflicts between different institutions might arise as a result of disagreements about the protection of the right to health in contexts of economic crisis. As a result of that, the Court had to make difficult decisions about how to solve such conflicts. It then presents an experience in Slovakia, Central Europe. Barbara Pavlíkova examines the Health system in Slovakia describing how the health system has evolved in this country after the fall of communism and how the health system is currently being affected by many factors. In a similar vein, Cippitani and Colcelli focus on the topic of Social Rights and how they are recognized in the Italian context, and finally, Rodolfo Gutiérrez examines the case of Colombia, scrutinizing how the system, despite expanding its level of coverage, is currently generating a high level of judicialization of health. The concluding chapter carries out a comparative analysis of the cases studied in order to generate some recommendations.La judicialización de la atención médica ha aumentado dramáticamente en la última década en todo el mundo. Si bien este activismo judicial ha contribuido indudablemente a garantizar la protección de este derecho, subsisten muchos obstáculos a pesar de los avances en el tema. El objetivo de este libro es evaluar los diferentes desafíos y oportunidades que tienen los estados para proteger el derecho a la salud, al tiempo que mantiene un nivel equilibrado de activismo judicial. Más específicamente, buscadentificar en qué contextos se justifica el activismo judicial para proteger el derecho a la salud mediante el análisis de la dinámica de los litigios y sus consecuencias. El libro comienza presentando un caso en España: Juan Antonio Maldonado muestra cómo pueden surgir conflictos entre diferentes instituciones como resultado de desacuerdos sobre la protección del derecho a la salud en contextos de crisis económica. En consecuencia, la Corte tuvo que tomar decisiones difíciles sobre la manera en que se deben resolver estos conflictos. Posteriormente, se presenta una experiencia en Eslovaquia, Europa Central. Barbara Pavlíkova examina el sistema de salud eslovaco que describe su desarrollo después de la caída del comunismo y cómo muchos factores lo están afectando actualmente. En una línea similar, Cippitani y Colcelli se centran en el tema de los derechos sociales y en cómo se reconocen en el contexto italiano. Y finalmente, Rodolfo Gutiérrez examina el caso de Colombia, analizando cómo el sistema, a pesar de ampliar su nivel de cobertura, está generando actualmente un alto nivel de judicialización de la salud. El capítulo final lleva a cabo un análisis comparativo de los casos estudiados para hacer algunas recomendaciones.

The Exclusion of Foreigners in an Irregular Situation from the Right to Health Care in Spain

Juan Antonio Maldonado Molina

Professor of Labour Law and Social Security

University of Granada, Spain

Abstract

The economic crisis has had a strong impact on the Spanish Social Protection System, including the Health Care System. Until 2012, the principle of universality had no exceptions, with the entire population being covered, including foreigners in an irregular situation. However, the reform approved that year omitted this group. Faced with this, the regional governments within their legislative powers decided not to assume this limitation, extending protection to everyone again. However, the TC has declared that the Autonomous Communities do not have the power to do so, admitting that the right to effective protection of health may be subject to general interests, those that the state legislator deems convenient at the time. Finally, after RDL 7/2018, of July 27th, both foreigners who are legally residing in Spain, as well as those who are not registered or authorised as residents in Spain, have the right to health protection and health care in Spain; the same conditions as for people with Spanish nationality, provided that said persons meet certain requirements.

Keywords: Irregular Immigration, Health Care, Universality.

Resumen

La crisis económica ha tenido un fuerte impacto en el Sistema español de Protección Social, incluyendo el Sistema de Salud. Hasta 2012, el principio de universalidad no tenía excepciones, estando cubierta toda la población, incluyendo los extranjeros en situación irregular. Sin embargo, la reforma aprobada ese año dejó fuera a este colectivo. Frente a ello, los gobiernos regionales decidieron no asumir esa limitación, extendiendo la protección nuevamente a todos, dentro de sus competencias legislativas. Sin embargo, el Tribunal Constitucional declaró que las Comunidades Autónomas no tienen competencia para ello, admitiendo que el derecho a efectiva protección de la salud puede quedar supeditado a los intereses generales, que los que el legislador estatal estima convenientes en cada momento. Finalmente, tras el RDL 7/2018, de 27 de julio, tanto los extranjeros que se encuentren residiendo legalmente en España, como los que no estén registrados ni autorizados como residentes en España tienen derecho a la protección de la salud y a la atención sanitaria en las mismas condiciones que las personas con nacionalidad española, siempre que dichas personas cumplan determinados requisitos.

Palabras clave: inmigración irregular, asistencia sanitaria, universalidad

How to cite this chapter? ¿Cómo citar este capítulo? Maldonado Molina, J. A. (2019). The Exclution of Foreigners in an Irregular situation from the Right to Health Care in Spain. In R. Gutiérrez Silva (Ed.), Issues in the Justiciability of the Right to Health (pp. 28-53). Bogotá, Colombia: Ediciones UCC. doi: https://dx.doi.org/10.16925/9789587601350

Introduction

The Spanish Constitution of 1978 recognises, under Article 43, the right to health care. However, this recognition is not considered a “fundamental right” as its appearance within the constitutional text is deemed nothing more than an inspiring principle. Indeed, it is formally accepted in Chapter III of Title I of the Constitution, among the “Principles governing social and economic policy”, limiting its efficiency such that “it (they) is (are) only exercisable from the moment and in the terms in which it is established under an ordinary law” (Borrajo Dacruz, 1991, p. 1486). Therefore, they do not go beyond being programmatic precepts, “whose fulfilment can only be demanded, in principle, by the narrow channel of constitutional control, and not by way of jurisdictional protection of fundamental rights” (Martín Valverde, 1988, p. 66)1.

However, it should be clarified that “the programmatic nature does not imply that the principle is not legally binding” (Monereo Pérez, 1996, pp. 90-93), but rather that this precept —as well as the others that make up this block— must be interpreted in connection to the clause contained in Article 10.2 of the Constitution, according to which, “the norms, related to fundamental rights and freedoms that the Constitution recognises, will be interpreted in accordance with the Universal Declaration of Human Rights and international treaties and agreements as ratified by Spain”2. In this regard, under the constitutional law of the European Union, access to social security is considered a fundamental right.

In any case, the Spanish Constitution of 1978 recognises the right to health care, but subsequently adds a mandate to the legislator that the public authorities are authorised to organise and protect public health through the use of preventive measures and provision of necessary services and welfare. Therefore, it is the law that establishes the rights and duties of everyone in this regard and we must analyse the legal development of this right in the Spanish legal system.

1 The Right to Health Care for Foreigners in Spain

It is commonplace in studies related to health care in Spain to begin by underlining its universal character, an issue derived from an explicit statement with regards to the Law, that since 1986, Article 1.2 of the General Health Law states “all Spaniards and foreign citizens who have established their residence in the national territory are holders of the right to health protection and health care”. Therefore, it would seem that one need solely reside (legally) in Spain for this to apply. Regarding Spaniards, Article 3.2 of the said Law is even more categorical: “Public health care will be extended to the entire Spanish population”.

Regarding foreigners, although the Law of 1986 is conditioned towards residency, Law 4/2000 of January 11th,on the rights and freedoms of foreigners in Spain and their social integration —the so-called “Immigration Law”—, extended the right to foreigners in an irregular situation, albeit not in a homogeneous and undifferentiated way, given that its extension to the aforementioned very much depends on subjective —administrative situation of the subject, age, stage of pregnancy— or objective —that the required health care is urgent— circumstance.3

Of the cases expressly admitted, the most relevant was that of any foreigner who was registered in the municipal registry —which is different from having legal residence—. The other cases were already “included in the current system of sources of our legal system” (Molina Navarrete, 2001, pp. 233-234). But there were others whose recognition was imposed —and continues to be recognised— by international standards in the matter. For example:

• Foreigners under the age of 18 in Spain receive privileged treatment, as the Law recognises the right for this category of foreigner to merely stay in Spain, regardless of circumstance and without the requirement to comply with formalities such as registration. The regulation of foreign minors is not only a tributary of international provisions referring to foreigners, but also of those contemplated for Spanish minors. This can be traced back to the “Constitución Española” —hereinafter, CE— or Spanish Constitution itself where, under Article 39.4, it is indicated that “children will enjoy the same protection as that outlined under international agreements”. Article 24 of the Convention on the Rights of Children, even goes as far as to recognise the right to the enjoyment of the highest level of health and services for the treatment of diseases, as well as their rehabilitation, assuring therefore that the States Parties will deprive no child of their right to health care4.
• In the case of emergency health care, the administrative situation of the foreigner is irrelevant, and neither legal residency nor municipal census is required: Merely being in Spain is the only requirement and this also applies to foreigners in an irregular situation. This case is applicable in the case of accidents o...

Table of contents

• List of Contributors
• The Exclusion of Foreigners in an Irregular Situation from the Right to Health Care in Spain
• Justiciability of the Right to Health and the Heath System in Slovakia
• Public and Private Enforcement of Social Rights
• The Justiciability of the Right to Health in Colombia