(Reuters Health) – British citizens with HIV who live in Spain could face serious healthcare challenges post-Brexit, potentially risking public health at large, researchers say.
A no-deal Brexit could leave many patients with HIV or other chronic conditions in the lurch, the researchers write the journal AIDS.
“We’re not scare-mongering. We’re indicating to patients that there are concerns (and) that it’s really important that there’s clarity,” said coauthor Jean McHale from the University of Birmingham, UK, 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 continue. In a no-deal Brexit scenario, however, the protection is lost.
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 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.
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.
The UK is scheduled to leave the European Union at the end of October. The possibility of a no-deal Brexit remains high, as many see little chance of the trading bloc agreeing to substantial changes to the original agreement.
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: bit.ly/2VGEfrr AIDS, online September 26, 2019.