Interesting, I was unaware of that. I spent 53 days in Spain in 2016 (which was awesome by the way) that started off with me going directly to the hospital on arrival because a prior case of bronchitis had escalated into severe pneumonia (more severe than I realized). I was hospitalized for just shy of a week and had to pay a 3000 EUR deposit up front to be admitted and receive treatment. I don’t remember the exact amount of my total bill, but I got the bulk of my deposit back in the end.
Maybe they’ve changed the rules since then, but at least my personal experience was the flow was to establish whether I was a Spanish or EU citizen, as I was not I was obligated to pay a sizeable deposit before even being seen for triage. There was certainly no indication any other foreigner would have been treated differently.
There's usually a distinction drawn between residents and mere visitors. That is, between people who ordinarily live in the country and those who are just here temporarily.
That distinction can be in addition to, but will more often wholly replace a distinction between citizens and non-citizens.
You can make a purely economic rationale for this if you want: Residents pay tax, and non-residents don't (in the US some non-residents still pay tax but that's not usual for any other country). If your universal healthcare is largely paid for as an "insurance" scheme, such residents are probably obliged to join the scheme, so it makes sense they'd also get the benefits.
I don't know how it works in Spain, but in France where illegal immigrants can also get some form of coverage, the process is definitely not done in hospitals: you have to apply for it, and then you are issued a specific insurance card. As far as I know you can't get it if you've been in France for less than three months: it's for immigrants, not tourists.
I was reading another website about Spain. From what I gather (not sure the accuracy), but if you're in Spain illegally, you can convert to legal status if you show continued residence, employment, no trouble with the law. Maybe it's that type that gets non-emergency healthcare?
I assume if you're in Spain, with no proof of residence you'll be asked to pay?
Yes, this was a private hospital it seems (I just checked). I went where I was instructed by my travel safety program / travel insurance, which ended up reimbursing most of my costs involved anyway. It was selected because it was the only hospital in the area with a foreigner's department.
My experience may not have been representative then, as it could have gone differently in a public hospital, but I am unsure. It seemed based on what I was told at the time that I could only seek treatment at hospitals that accept foreigners except in the case of an emergency severe enough to require an ambulance (I called an Uber to take me). I think any hospital would have ensured I was stable but not admitted me for multiple days of care other than one with a foreigner's department. But, it may be that a public hospital would have treated me without any concerns about my citizenship or residency.
I'm glad to hear you've recovered most of the money. Yes, I also think you would've been treated and hospitalised anyway. I don't think (but I may be wrong) that hospitals in Spain have a "foreigner's deparment". That may go against some EU laws.
Nearly every country I visited in Europe had defined foreigner's departments in the hospitals (but not in all hospitals). The entire purpose of those departments was to work with people who did not reside there and likely did not speak the language. For instance, in the case of the foreigners department in Spain, they had translators on staff during the day for communicating with specialists or the doctors as well as English speaking nurses during the day, which was not guaranteed in other parts of the hospital.
In some countries I visited the foreigner's department was more involved in handling currency exchange and payment details, but less concerned with care or providing services (Czech Republic was this way at FN Motol for instance: https://www.fnmotol.cz/en/samoplatci/).
If you are a resident citizen of an EU country, you can often seek treatment in other EU countries under the same social medicine scheme they have and your citizenship/residency paperwork covers you. I'm not sure if Country A bills Country B or how that works exactly, but it was pretty clear that the foreigner's department concept was for non-EU citizens who were private pay and ineligible for social medicine.
Maybe they’ve changed the rules since then, but at least my personal experience was the flow was to establish whether I was a Spanish or EU citizen, as I was not I was obligated to pay a sizeable deposit before even being seen for triage. There was certainly no indication any other foreigner would have been treated differently.