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 A no-deal Brexit could leave many patients with HIV or other chronic
conditions in the lurch after 2020, authors Jean McHale from the
University of Birmingham in the UK and Miguel Ramiro Avilés of the
University of Alcalá in Spain wrote in AIDS, online September 26.
"We're not scare-mongering. We're indicating to patients that there
are concerns (and) that it's really important that there's clarity,"
McHale said in a phone interview.
At present, European Union law guarantees healthcare to British
citizens residing in any other member state. Spain is home to nearly
one-third of British nationals living in other EU countries. The UK
government reimburses Spain for any health care costs, and Spain
pays the costs for its nationals in the UK.
Under the withdrawal agreement negotiated between the UK and EU but
rejected by the UK Parliament, that reciprocity would have
continued. In a no-deal Brexit scenario, British nationals who
obtain a residence visa to continue living in Spain will temporarily
receive protection from Royal Decree-Law 5/2019, passed by the
Spanish government earlier this year. But this guarantees healthcare
coverage only for 21 months - through December 2020 - and will
require reciprocity from Britain for Spanish nationals in the UK.
Without a long-term bilateral agreement, HIV patients could still
lose access to treatment, the authors warn.
"The UK and Spain have each taken steps to ensure that people living
in each country can continue to access healthcare as they do now
until at least 31 December 2020," a spokesperson of Britain's
Department of Health and Social Care told Reuters Health by email.
"Our priority is to secure the continuation of reciprocal healthcare
arrangements so UK and EU nationals have access to medical treatment
in the same way they do now... Public health law in Spain protects
the right to treatment for any HIV patient and this will be
unaffected by the outcome of Brexit."
The spokesperson also cited the National Health Service (NHS) page
for Spain: http://bit.ly/2qvRUGh.
However, Aviles says that the spirit of Spanish law is to protect
nationals of low-income countries who will be covered because their
home countries do not reimburse their medical costs. He noted that
in 2016, UK nationals living in Spain spent GBP 222 million ($288.05
million) on healthcare, while Spanish nationals living in the UK
spent GBP 4 million ($5.19 million).
Without reciprocity and reimbursement, the Spanish NHS cannot afford
this cost, he said.
For years, the Spanish National Health System has provided free
access to drugs that reduce the AIDS virus to undetectable levels,
which also prevents transmission to others.
If treatment becomes inaccessible, Brexit poses "not simply a
serious problem for the individual patient," the authors write, but
a public health risk.
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The UK is scheduled to leave the European Union at the end of
October. The possibility of a no-deal Brexit remains high, as
Britain's politicians argue over whether to leave with a deal, exit
without a deal or hold another referendum.
Tamara Hervey of the University of Sheffield, UK, who leads a
research project on post-Brexit health governance, says this would
be the "worst outcome" for patients and public health.
"Unraveling over 40 years of integration needs to be done carefully,
with attention to all its facets," said Hervey, who was not involved
in the paper.
"Because 'health' is not regarded by the UK government as part of
'trade' or 'security', which is where the Brexit negotiations are
being conceptualized, it is very difficult for the health messages
to reach the appropriate governmental levels, or for government to
act on them."
Joaquin Cayon-De las Cuevas, an associate professor of health law at
the University of Cantabria in Spain, agrees.
"The public agenda has been mostly focused on political, territorial
and commercial issues," he said.
"As far as I know, there are no particular public health insurance
programs that can facilitate treatment access. I am afraid the
subscription of a private health insurance will end up being the
only absolutely safe guarantee."
After Brexit, patients will need to buy expensive private insurance
or subscribe to the Spanish national health service, but this would
not cover medicines administered outside of hospitals, the authors
note.
They estimate the average annual cost in Spain to treat HIV is 7,923
euros ($8,680).
The UK government's "get ready for Brexit" information campaign
simply advises travelers to make sure their health needs are covered
by insurance, without details on whether such insurance will be
accessible, Hervey said.
Outlining a possibility not considered in the paper, she added,
"Spain could ... unilaterally declare that ... it recognizes the
provision the UK has made for Spanish nationals in the UK to access
treatment as sufficient reciprocation."
Cayon-De las Cuevas is hopeful that an agreement will be reached.
"My fear is that the political reaction might occur too late, when
there has already been damage to patients," he said.
SOURCE: http://bit.ly/2VGEfrr
AIDS 2019
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