None of Spain's regional health authorities is charging patients for hospital-dispensed drugs – nor will they in the near future

In some cases, this is through a conscientious objection – particularly in socialist-governed regions where the party's leader has slammed the move as forcing the chronically-ill to 'pay up or die'.

But in other cases, this is because the cost of implementing the systems would far outweigh the money clawed back through charging for these drugs.

And those regions where their governments are in favour – including Castilla-La Mancha, run by Mariano Rajoy's second-in-command María Dolores de Cospedal – are waiting for others to be the first to apply the rules.

Catalunya, the Basque Country, the Canary Islands, Andalucía and Castilla y León have all presented appeals against the charges, and although Navarra has not, it has expressed its condemnation of the move.

All these regions say forcing patients to pay could put the lives and health of those affected in serious danger, and that it is an 'unfair' practice which breaks with the principle of healthcare being a universal right.

The drugs affected are those dispensed in hospital pharmacies since, due to their expense and the danger of those who do not need them getting hold of them, they are not available at high-street chemist shops.

They include injections, pills and patches for patients with HIV or AIDS, cancer in active treatment, rheumatoid arthritis, cataracts or glaucoma, hepatitis, or women undergoing fertility treatment.

Patients are expected to pay 10 per cent of the cost up to a maximum of 4.20 euros per box, but with many of these conditions requiring several different types of drug and high doses, this can add up and reach as much as 42 or even 84 euros a month – prohibitive for those on extended unemployment assistance of 426 euros monthly, or on a very small pension or part-time wage.

The drugs affected do not include those administered in hospital to either in-patients or those receiving day treatment – meaning chemotherapy given to outpatients, for example, or any treatment given during a hospital stay or a visit to A&E, are not charged for.

All regional governments were required to adapt their dispensaries to accommodate the new rules by January 1, and to apply the patient contribution by April 1 at the latest – but two weeks on from the obligatory six-month deadline, not one health authority has done either.

Murcia and Galicia have their computer systems up and running and ready to apply the charges, but do not wish to do so until everyone else does as this means patients will be discriminated against by postcode – those living on regional borders may simply go to their nearest hospital in a neighbouring federal state and pick up their medication free.

This is a view shared by La Rioja, Cantabria and Aragón which, like the others are run by the PP, and Asturias, run by the socialists – although in the case of Aragón, they have not found a 'suitable system' to allow them to charge patients and do not believe they will be able to apply the contribution until at least the summer.

The regions of Extremadura, Madrid, Castilla-La Mancha and the Balearic Islands – all PP-governed – say they have been searching for 'legal formulae' which allows their governments to bear patients' portion of the costs.

They initially considered offsetting these against patients' tax declarations, but those who do not earn enough to qualify to pay tax or whose income is from one single source often choose not to file a declaration – and in any case, this would mean a delay of between six and 18 months before they got their money back.

Finally, in Valencia, regional health minister Manuel Llombart says his will be the 'last authority in Spain' to put the contribution rules into practice.

“Until it is up and running in the rest of the country, it will not be applied here,” Sr Llombart stated.