The Spain Government owes 23.1 million for assistance in Primary Care, 798.9 for Specialized Care, 99.6 for pending settlements and 101.3 for assistance to people from other countries
The Consell attributes the situation to the ineffectiveness of the Assistance Guarantee Fund and to the methodology used by the Ministry of Health to make the calculations
The Consell has authorised the Ministry of Health to claim from the Government of Spain the 1,022.9 million euros that it owes due to the lack of compensation from the Assistance Guarantee Fund and the Health Cohesion Fund, mechanisms with which the central Administration should remunerate the health care provided in the Valencian Community to patients from other autonomous regions and to foreigners.
Specifically, the state Executive owes the Community, through the Assistance Guarantee Fund, 23.1 million euros for assistance in Primary Care to visitors from other communities between July 2012 and December 2013, as well as 798.9 million euros more for assistance to displaced persons in Specialized Care between July 2012 and up to the present.
In addition, the central government is also awaiting payment, through the Health Cohesion Fund, of more than 99.6 million euros for the settlements of the years between 2013 and 2023; as well as another 101.3 million euros for the settlement of the billing generated in the Valencian Community for health care provided to foreigners.
Now the Consell is demanding the payment of the funds not received due to the ineffectiveness of the implementation of the Assistance Guarantee Fund as provided for in Royal Decree Law 16/2012, of April 20, on Urgent Measures to guarantee the sustainability of the National Health System.
Pursuant to the decree, and within the framework of the Healthcare Guarantee Fund, financial compensation for healthcare for people displaced between autonomous communities should also have been implemented, but at present this mechanism has had a very limited scope and is creating significant financial damage to the Generalitat.
Thus, retroactive compensation for assistance provided from July 2012 (date of entry into force of Royal Decree Law 16/2012) to December 2013 in Primary Care to visitors from other communities has remained pending.
More than 199,000 visits per year
In the field of specialised care, the confusing wording of section 5 of article 3 of Royal Decree Law 16/2012 makes it necessary to develop it in regulations for the effective implementation of compensation. Thus, in the information systems of the Ministry of Health, more than 199,000 Specialised Care services provided annually to displaced persons from other autonomous communities are being identified and recorded individually, which represent an expenditure of 77.6 million euros per year that has not been remunerated.
Furthermore, since the entry into force of Law 17/2012, of December 27, on the General State Budget, the Health Cohesion Fund acquired an extra-budgetary character, so that the autonomous communities that, like the Valencian Community, present positive balances in the joint liquidation of the Assistance Guarantee Fund and the Health Cohesion Fund must be compensated by the Ministry of Finance.
Likewise, all healthcare provided to foreign citizens with a European Health Card or from countries with a reciprocal healthcare agreement is billable, but the methodology for calculating the settlement of this billing used by the National Institute of Social Security (INSS) and the Ministry of Health does not respect the rights to payment legitimately acquired by the communities and generates significant losses for tourist autonomous regions such as the Comunitat, with perverse effects and unjust enrichment of some at the expense of others.
