Gibraltar Residents Lose Access to Free Spanish Healthcare

International private medical insurance and global healthcare analyst, and report author, Ian Youngman, takes a look at how the UK’s cavalier attitude to international law has a direct impact on cross-border healthcare in Gibraltar, and why this could be good business for international health and travel insurers.

Background

Gibraltar is a British colony famous for its apes.

The 2022 population is a mere 35,000.

10% of those living in Gibraltar are British citizens.

When the UK left the EU in January 2020, so did Gibraltar.

Cross-border travel

Thousands of British and Spanish citizens travel between Gibraltar and Spain daily for work. 13,000 Spanish and 2000 British people working in Gibraltar live nearby in Spain and commute daily.

Expatriates in Gibraltar fall into four categories:

• Gibraltarians and British subjects employed in Her Majesty's Service or in the service of the Government of Gibraltar
• Those married to Gibraltarians
• EU nationals
• Non-EU nationals.

Healthcare

Gibraltar has its own health authority that provides healthcare facilities.

There is a community hospital.

The size of Gibraltar's population means that it is not always practical for medical specialists to be employed full time, so if needed they are flown in from the UK.

The cost of healthcare locally is expensive and with limited facilities most locals go to Spain for treatment.

All citizens must pay health insurance contributions but care is free at the point of care.

The GHA operates a Group Practice Medical Scheme, which is a contributory scheme and enables registered persons to access free medical treatment.

The UK and Gibraltar have a special arrangement, which means that all UK citizens have access to free healthcare facilities in Gibraltar with no obligation to pay insurance contributions.

Brexit

The UK left the European Union on December 31, 2020.

Since then the UK has been in negotiation with Spain over healthcare and visas for Gibraltar residents.

So as the UK seeks to break its own deals with Europe, there are impacts elsewhere that they probably never even thought or care about.

The EU in general and specifically Ireland and Germany have warned the UK that new legislation relating to Northern Ireland breaks the deal that the UK made with the EU and also breaks international law.

There are concerns that the UK has not been serious about finding solutions with Spain as negotiations are sporadic.

UK MPs have set up an enquiry into what has gone wrong with the negotiations.

Spain does not believe that the UK is really interested in what happens to Gibraltar.

Loss of healthcare rights

British nationals who have temporary resident status in Gibraltar are being refused entry into Spain without revealing the reason for their visit, where they will be staying, and the amount of cash they have.

In a major blow to Gibraltar residents they have lost access to free healthcare in Spain.

The Spanish government has announced that residents of Gibraltar will no longer receive free healthcare in Spain.

Residents of Gibraltar lost their free access to the Spanish healthcare system from Friday, July 1.

Spain was very generous in allowing those living on the Rock to continue to receive free healthcare within the country, for 18-months.

In response, Gibraltar has also announced that Spanish citizens will not be able to receive free treatment should they need it when spending time in the British territory. This affects cross-border Spanish workers.

Fabian Picardo, the Chief Minister of Gibraltar, recommended that those travelling across the border ensure they have travel insurance that includes medical cover, every time they go to Spain, even if it is only for a few hours (such as a shopping trip or a meal) or they will have to pay for any medical care received.

Previously, residents of both Spain and Gibraltar were able to have access to free healthcare on either side of the border. Now, however, costly medical bills will be invoiced in the event of an emergency or accident that requires medical treatment.

European citizens who live in Spain but work in Gibraltar will not be affected by the measure.

What triggered the change?

The news comes after the ninth round of negotiations over the future relationship between the EU and the UK continue to stall.

Discussions were due to continue in June, however, there is still no date on when the latest attempts to ratify an agreement will begin.

The timing of the announcement is not a coincidence.

This ties up with the UK government bringing in domestic legislation to override cross-border rules in Ireland based on the deal that the UK government negotiated with the EU. Spain’s attitude is that if the UK wants to break international law by overriding a deal they made, then Spain cannot trust the UK on any new deal between the UK and Spain on Gibraltar.

Gibraltar residents feel abandoned by the UK and the pressure helps Spain with its claim to take back control of Gibraltar.

Effect on Gibraltar residents

Gibraltar residents insured under the Group Practice Medical Scheme will no longer be able to access free emergency health care in Spain during a temporary stay there. This has been the position in all EU member states except Spain since 31 December 2020.

The Gibraltar government says that as a result, the Gibraltar Health Authority will no longer provide free healthcare for visitors who are covered by Spain’s social security system.

Opportunity

There are very few international health insurers in Gibraltar.

IMG and WTW have local offices.

While there are many authorised insurers most of these only do offshore business not domestic.

Travel and health insurers could offer individual annual cover.

Insurers or brokers could try to do a deal with the local government to offer block cover for citizens.