Spain health service told to pay €82,000 to ‘terminal’ patient who survived after going private

Being told that your illness has reached the point where there is little more doctors can do is devastating enough. For one man in the Basque Country, however, that was not where his story ended. He sought treatment privately, survived and later needed rehabilitation. Now the public health service has been ordered to pay €82,000 towards the costs.

The High Court of Justice of the Basque Country (TSJPV) has ruled that Osakidetza (Basque public health service) must cover the medical expenses incurred by the patient after he turned to private healthcare. The ruling covers costs at another clinic and at a rehabilitation centre, with the total amount set at €82,000. 

Patient turned to private treatment

The case centres on a man who had been considered terminal while receiving care through the Basque public health system. He subsequently sought treatment at a private clinic, where he survived. His care did not end there, with further treatment at a rehabilitation centre also generating expenses. The costs were then taken to court, with the patient seeking reimbursement from Osakidetza for the treatment he had paid for privately.

The TSJPV has now ruled in his favour and ordered the Basque health service to pay €82,000. The decision concerns the expenses included in the case rather than creating a general right for patients in the Basque Country to choose private healthcare and later have the bill covered by Osakidetza.

€82,000 awarded for private care

The amount awarded includes expenses incurred both at the private clinic and at the rehabilitation centre. That means the case goes beyond the cost of the treatment that followed the patient’s original prognosis. His subsequent recovery also required specialist rehabilitation, adding to the bill that he was left facing. The court’s decision means those costs will now be paid by Osakidetza.

The case also comes as the Basque health service is planning to expand its own capacity in an attempt to reduce the number of operations sent to private providers. Osakidetza has plans for new operating theatres in Gipuzkoa, with the health service looking to increase the number of procedures that can be carried out within the public system. 

When public treatment is not enough

The case comes as Osakidetza prepares to expand its own capacity, with new operating theatres planned in Gipuzkoa. The aim is to carry out more procedures within the public system and reduce reliance on private clinics. There is also a Supreme Court precedent for patients seeking reimbursement after turning to private healthcare in exceptional circumstances.

In a 2024 case, the court considered the claim of a patient who developed severe complications after being discharged from Madrid’s Gregorio Marañón Hospital during the Covid-19 pandemic. He was admitted to a private hospital the following day and spent 35 days in intensive care. He subsequently sought reimbursement of more than €80,000 in private medical expenses.

The Supreme Court accepted that the circumstances met the requirements for reimbursement, but only €2,013.44 was ultimately recognised because that was the amount properly documented. The latest Basque ruling therefore adds to an existing body of case law on the circumstances in which Spain’s public health services can be required to cover private medical treatment.