Alfonso Aguarón Turrientes

AEAL, Spanish Group of People Affected by Lymphoma, Myeloma and Leukemia

The outlook of economic crisis in Spain has resulted in the current Government adopting a set of measures and decisions focused on the search of solutions. Many of them are not supported by the vast majority of the population because they seriously affect some social rights.


Historically, the Spanish Public Health & National Health System has been considered one of the most efficient and one with more coverage than anywhere else in the world . The reasons that result in this fact might be shocking for a non-Spanish reader, but they are mainly summarised in two parts: first of all, the Spanish Constitution from 1978 (the supreme rule of the Spanish Law), establishes an interventionist state in some matters such as the protection of public health; secondly, in article 43 of the cited text, the right of universal access to public health services is granted to all citizens living in Spain (that is, if they are included in their town census). So any person, regardless of their income, has the right to receive health assistance by the means included in the Common Services Portfolio of the National Health System. Depending on their income, they will pay more or fewer taxes and the Government will be responsible for granting the viability, sustainability, operation and equity of access in any place inside Spanish territory .

Contrary to what could seem like an untenable system, it’s fair to mention that spending in public health represents 6% of Spanish GDP, below the EU average which is 9,6% and far below its neighbours (France: 11,1%; Germany: 10,6%; Belgium: 10,4%; etc.). The lack of barriers to access to health helps with the prevention and early diagnosis of many diseases which, in turn, leads to savings in the budget. In many cases, this fact avoids the need of diagnostic checks, treatments and long-term inpatient care, something that would increase spending significantly .

When focusing on blood cancers (such as lymphoma, myeloma, leukaemia, MDS, MPN), a patient has free access to diagnosis and treatments through the public health system. Once the European Medicines Agency (EMA) has approved the use of a new drug for a particular condition, the manufacturer of the drug negotiates the pricing in Spain with the Spanish Medicines Agency (AEMPS), an organisation dependent on the Ministry of Health. The process of pricing in haematology in Spain has been relatively quick compared with other countries (from six months to one year), easing access to the newest treatments through the National Health System.

So far, you might be thinking that Spain is like a quasi-utopia health paradise. And, probably in a sense, patients haven’t been worried about the price of a drug or access to a diagnostic check or, in those aspects that shouldn’t be a big deal for a person diagnosed with a blood cancer in a developed country. At least not so far…

Regarding the health system and, more concrete, patients with a blood cancer, there are a set of new measures contained in the Spanish Royal Decree 16/2012 , also known as “Law of urgent measures for granting the sustainability of the National Health System and for improving the quality and security of its services” that are of concern. A quick look at the report, elaborated by the Spanish Group of Cancer Patients (GEPAC), an umbrella organization in which AEAL is one of its founding members, with the collaboration of the health-specialized lawyer firm Faus & Moliner, let us know the worrying implications of this set of rules.

For the first time ever in Spain, a copayment for treatments delivered at hospital pharmacies is set. In the case of oncology, a draft paper with 32 drugs has been proposed. In this list we can find imatinib, nilotinib, dasatinib and hydroxiurea, widely used for the treatment of CML. It’s also established copayment limits depending on the income, equating a person who earns 18.000€ a year to another who earns 99.999€, which leads into an unfair situation.

In the same way, some barriers have been set that will affect the healthcare provided to disadvantaged groups, such as irregular migrants or those who have been unemployed for a long time. Some other complementary services, such as transportation from the patient’s residence to the hospital or orthopaedics, which a patient could request for free it was needed, will now have to first be approved by the hospital.

But maybe the most serious implications for those who are already diagnosed with a serious disease like a blood cancer (and also for those who will be diagnosed in the coming years) are related to the new process of approval and re-evaluation of new drugs. Every region in Spain now has the possibility to re-evaluate or deny the use of a treatment which has already been approved by the EMA and the Ministry of Health, based only on financial reasons. This illegal (goes against the Spanish Constitution and the EU regulatory laws) nonsense measure may delay the access to more efficient treatments and also will lead to inequities between the different regions of Spain.


All these rules offend the equity and universality criteria of the National Health System. A short-term consequence is that the income or the residence of a patient may seriously affect the patient’s journey during the course of their disease. In the future, we might see a trending-to-private health system at the sacrifice of care, prevention and early diagnosis. In essence: a more expensive health system which offers less and worse support for the patients.

At the time of writing this article, it’s hard to estimate the number of patients affected by this situation, and our current commitment is to support those who are looking for support and advice. However, our main goal, as patient advocates, is to provide real data that show that these measures are not justified even in the current financial crisis. And, in any case, as we’ve been doing since 2002, defend and advocate for the rights and the state-of-the-art support for oncohaematological patients.
AEAL, Spanish Group of People Affected by Lymphoma, Myeloma and Leukemia

A Canadian Perspective on the situation in Spain…

“Well it [Spain] certainly appears to be leaning more towards a Canadian model. Federal approval and regional funding by the sounds of things. This is so backwards and against what many countries are trying to aim for, no inequity no matter where you live,” said Sue Robson, Executive Director, Lymphoma Foundation Canada.


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