A senior evangelical leader in Spain has cautiously welcomed a government decision to expand access to public health care for migrants without legal residency, while warning that poorly controlled policies could unintentionally encourage health tourism.
Spain’s Ministry of Health announced March 10 that administrative barriers preventing undocumented migrants from accessing the country’s public health system will be removed under a new Royal Decree approved by the Council of Ministers at the Moncloa Palace. The measure takes immediate effect.
The decree updates a 2018 regulation that restored access to health protection and medical care for people without legal residency but left significant administrative hurdles in place.
One such obstacle was the requirement to provide proof of municipal registration — known as a padrón — a document that many undocumented migrants struggle to obtain because landlords often refuse to register tenants without legal status.
According to the government’s official summary of the decision, the reform seeks to create “a uniform and effective procedure throughout the country for recognizing the right to health of unregistered and unauthorized foreign nationals.”
“This regulation aims to guarantee equity and prevent inequalities within this group, enabling better disease control through primary care and a more efficient use of public resources,” the summary said.
Under the updated rules, migrants can now demonstrate residency through alternative documentation such as utility bills or reports from social services. Health care applications will also be automatically approved if authorities do not issue a rejection within three months. Provisional access to care will be granted while paperwork is being processed.
The reform applies across Spain’s 17 autonomous regions.
Dr. Xesús-Manuel Suárez-García, secretary general of the Spanish Evangelical Alliance and a member of the executive committee of GBU España (IFES), told Christian Daily International that the policy raises complex ethical and practical questions.
He said Christian teaching clearly supports equal treatment of foreigners who legally reside in a country, citing Leviticus 24:22: “You are to have the same law for the foreigner and the native-born. I am the Lord your God.”
However, Suárez-García said debates around universal health access for undocumented migrants often fall into two opposing extremes — both of which he believes are problematic.
“I experienced the first one directly in a Latin American country,” he said. “My family helps support a shelter home there, and one day a girl became very ill.”
When caregivers took the child to a nearby hospital, staff told them the girl needed immediate treatment but would not be admitted unless they paid $500.
“Letting a child die, whether a national or a foreigner, because the family cannot pay is inhumane,” he said.
Yet the opposite extreme — offering completely free hospital treatment to anyone who arrives in Spain — can also create difficult consequences, he said, including what he described as “health tourism.”
Suárez-García recounted a case in which a Venezuelan mother traveled to Spain with her daughter, who needed treatment for a serious kidney condition, after neighbors advised her that medical care could be obtained upon arrival.
“I knew about the case myself and spoke to colleagues at one hospital so that the girl was admitted and cured,” he said.
The situation illustrated both the humanitarian impulse to provide care and the broader policy challenges governments face.
Suárez-García said he fully understood the mother’s decision — and even helped facilitate treatment — but acknowledged the political concerns about what he calls the “call effect,” a pull factor that could encourage people to travel to Spain specifically for medical care.
“Hospital treatment certainly has a cost; the only difference is who pays for it,” he said.
“In this case it should not be the Spanish state — the Spanish people through their taxes — but the Venezuelan state, which should ensure that there is a budget to provide proper care for its nationals.”
He suggested that governments could explore mechanisms allowing Spain to recover the costs of treatment from a patient’s home country.
“In a political debate where I presented this case, I said that the girl had to be treated, but the bill should be charged to the Venezuelan government — for example by deducting it from the bill for oil sold to Spain,” he said.
For poorer countries that lack such resources, he said medical costs could potentially be incorporated into development aid budgets.
“But we should never assume that these treatments are free,” he said. “They are not.”
To prevent the “call effect,” Suárez-García argued that policies should avoid relying solely on self-declared residency.
“I believe a mechanism should be put in place to offer hospital care to specific cases in a controlled way,” he said, suggesting bilateral agreements with sending countries and clear treatment protocols.
At the same time, he acknowledged concerns among Spanish citizens about the capacity of the public health system.
“It is true that budgetary resources for health care are not unlimited, and it is also true that public health care in Spain is saturated,” he said.
“That is why this type of collaboration cannot be unlimited, but must be controlled with as much rationality as sensitivity and humanity.”
