The Spanish national healthcare system is in dire straits. Budgetary cuts for public hospitals are the order of the day. Therefore, it is hardly surprising that cash-strapped hospitals are resorting to any means in order to try and alleviate their financial situation. One such method is to twist the clear intent of European Community (EC) law and force private insurers to pay for medical care provided to foreigners in spite of them having an EHIC.
Spanish law forces public hospitals to "find" the "third party" obliged to pay. If the tourist is in possession of a travel or private insurance, then the insurer is supposed to foot the bill. But such reasoning is completely wrong.
The "third party obliged to pay" is not the private insurer, but the social security institution of the country of residence of the tourist. Article 19 of EC Regulation 883/2004 states that: "An insured person and the members of his family staying in a Member State other than the competent Member State shall be entitled to the benefits in kind which become necessary on medical grounds during their stay, taking into account the nature of the benefits and the expected length of the stay. These benefits shall be provided on behalf of the competent institution by the institution of the place of stay, in accordance with the provisions of the legislation it applies, as though the persons concerned were insured under the said legislation."
Spanish public hospitals are obliged by EC law (i.e. under EHIC) to provide medical services to tourists. The wording is clear; it is not facultative for Spanish hospitals but mandatory.