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スペインの医療費削減で、不法滞在者の健康保険制度からの排除は、不法移民の結核感染などの伝染病患者を病院で治療せずに帰宅させる?
A casa con la tuberculosis
El decreto puede dejar sin tratamiento a personas con enfermedades contagiosas
En urgencias es difícil manejar los casos
house with tuberculosis
The decree may render treatment to people with contagious diseases
In emergency cases it is difficult to handle
Emilio de Benito / Alejandra Madrid Acute 24 ABR 2012 - 21:09 CET
The decree may render treatment to people with contagious diseases
In emergency cases it is difficult to handle
Emilio de Benito / Alejandra Madrid Acute 24 ABR 2012 - 21:09 CET
A person has a cough and fever. Go to the emergency department of a hospital. There, he diagnosed a possible tuberculosis. What is the next step? If it is a person with health cards, doctors will send you to a specialist. You can even admit you and it takes to isolate. What if it's an illegal immigrant?
The decree published on Tuesday BOE looks sharp. A person in that situation will have restricted health care to the "urgency of serious illness or accident, to the discharge." Also attend the "Assistance to pregnancy, childbirth and postpartum," and "foreigners under 18 years" that "will receive health care under the same conditions as the Spanish." The deadline to regularize their papers is 31 August.
Then, in the case of man with TB, would have doctors who let him go and take the metro, which can infect dozens of people? Is it logical to go home with the difficulties that will have to follow the treatment? Is there a hole to avoid what may be a public health problem?
more informationThe more resistant tuberculosis in EuropeThe move threatens disease control and emergency saturateHealth card will leave immigrants to 150,000 within two years
The answer is not unanimous. The president of the Spanish Society of Emergency Medicine (Shemesh), Thomas Toranzo, said the decree "is so poorly regulated that needs clarification." Although ED is "difficult to confirm the diagnosis of tuberculosis, we must ensure treatment." Tuberculosis has different phases, said the expert, and the individual is a highly infectious, and must "enter it and isolate it," and sometimes not. With the present decree, "we can not enter them," said Toranzo. But in the other case the situation is no better. "If you are not going to enter, you have to refer you to a pulmonologist." "In emergencies we have to do if you have insurance or not." What is clear is that "if a public health problem, someone has to do," he concludes.
A ministry spokesman said that "the system has mechanisms to attend to him," although these are not specified in the decree. Again, the fact that the person can transmit the disease would act in their favor. "And, of course, if you are uninsured, you are not going to charge." This is the line that advocates immigration expert and public health Belen Sanz. "Importantly, the population receiving medical care in the emergency room for severe disease should receive medical care until discharge," as stated in the decree, "not to discharge." And this difference "is very important." Indeed, Sanz says this "is complex in certain diseases such as tuberculosis." "This disease is mainly diagnosed in the hospital level, the reviews are done in the hospital, but monitoring and medication, with exceptions, is handled in primary care. Lack of access to primary care may hinder compliance with treatment of tuberculosis. This can have serious implications for public health. "
Health states thatbe a solutioncases for public health
This case is not just a theoretical exercise. In Spain, some 8,000 cases are diagnosed annually, and of these, half occur in immigrants. Some, especially in Eastern Europe, the bring.
Others acquire here, a phenomenon that is increased by the lives of many, with overcrowded and unsanitary. Lack of health insurance card (and the corresponding access to primary care) "may impede adherence to tuberculosis treatment," affects Sanz.
This has an added risk. Tuberculosis and other diseases, have a high potential contagious. It is time to treat them extend their risk. And hence, increase the cost to the healthcare system. Just the opposite of what you want to achieve.
The decree published on Tuesday BOE looks sharp. A person in that situation will have restricted health care to the "urgency of serious illness or accident, to the discharge." Also attend the "Assistance to pregnancy, childbirth and postpartum," and "foreigners under 18 years" that "will receive health care under the same conditions as the Spanish." The deadline to regularize their papers is 31 August.
Then, in the case of man with TB, would have doctors who let him go and take the metro, which can infect dozens of people? Is it logical to go home with the difficulties that will have to follow the treatment? Is there a hole to avoid what may be a public health problem?
more informationThe more resistant tuberculosis in EuropeThe move threatens disease control and emergency saturateHealth card will leave immigrants to 150,000 within two years
The answer is not unanimous. The president of the Spanish Society of Emergency Medicine (Shemesh), Thomas Toranzo, said the decree "is so poorly regulated that needs clarification." Although ED is "difficult to confirm the diagnosis of tuberculosis, we must ensure treatment." Tuberculosis has different phases, said the expert, and the individual is a highly infectious, and must "enter it and isolate it," and sometimes not. With the present decree, "we can not enter them," said Toranzo. But in the other case the situation is no better. "If you are not going to enter, you have to refer you to a pulmonologist." "In emergencies we have to do if you have insurance or not." What is clear is that "if a public health problem, someone has to do," he concludes.
A ministry spokesman said that "the system has mechanisms to attend to him," although these are not specified in the decree. Again, the fact that the person can transmit the disease would act in their favor. "And, of course, if you are uninsured, you are not going to charge." This is the line that advocates immigration expert and public health Belen Sanz. "Importantly, the population receiving medical care in the emergency room for severe disease should receive medical care until discharge," as stated in the decree, "not to discharge." And this difference "is very important." Indeed, Sanz says this "is complex in certain diseases such as tuberculosis." "This disease is mainly diagnosed in the hospital level, the reviews are done in the hospital, but monitoring and medication, with exceptions, is handled in primary care. Lack of access to primary care may hinder compliance with treatment of tuberculosis. This can have serious implications for public health. "
Health states thatbe a solutioncases for public health
This case is not just a theoretical exercise. In Spain, some 8,000 cases are diagnosed annually, and of these, half occur in immigrants. Some, especially in Eastern Europe, the bring.
Others acquire here, a phenomenon that is increased by the lives of many, with overcrowded and unsanitary. Lack of health insurance card (and the corresponding access to primary care) "may impede adherence to tuberculosis treatment," affects Sanz.
This has an added risk. Tuberculosis and other diseases, have a high potential contagious. It is time to treat them extend their risk. And hence, increase the cost to the healthcare system. Just the opposite of what you want to achieve.
スペインの医療費削減で、不法滞在者の健康保険制度からの排除は、不法移民の結核感染などの伝染病患者を病院で治療せずに帰宅させる?
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