ESTEPONA, Spain (Reuters) — From lager louts breaking their noses in fights to pensioners tripping down stairs, thousands of foreigners pouring to the coast in search of sun run up a hefty public hospital bill for Spain.The world’s second-most popular holiday destination after France can reclaim treatment costs from Brussels for European visitors as part of an EU system for member states.

Now Spain is cracking down on billing methods to ensure it gets every penny of compensation from the European Union.

Many visitors do not bring the right papers for hospitals to file claims. Overworked doctors usually see patients anyway, says Ingrid Rogers, who interprets for non-Spanish speaking patients at a hospital in the Marbella area.

“An Irish couple came in, he had fallen (while getting) out of the bath and really hurt himself,” said Rogers. She also helps out as a volunteer in an Age Concern charity shop on a narrow, white-washed street in the old part of Estepona, a popular beach resort on Spain’s Costa del Sol.

“He didn’t have anything, not even a passport, so I took them down to emergency and they saw to him, even though he didn’t have his papers,” she said.

Hospitals will never turn away a patient in pain, said Jesus Huerta Almendro, director of finance, planning and infrastructure at the health department of Andalusia’s local government: “That’s not the Andalusian way.”

But the more cases doctors note and invoice, the more money Spain can claim back from Brussels.

Meticulous costing rather than a surge in tourist injury means Andalusia province will charge the European Union more than 25 million euros ($34 million) in 2007 for the medical care of tourists, five times more than the 2005 bill, says Huerta.

A greater challenge lies with getting compensation for the medical treatment of foreign residents. In Estepona, signs abound that Spain has become the European Florida for northern Europeans looking to retire in the sun.

Huge mustard-yellow newly built developments sprawl back into town from either side of the beach front.

Elderly, sunburnt ‘guiris’ — the Spanish tag for fair-skinned foreigners which is used rather like ‘gringo’ in Latin America — walk along the palm-lined promenade.

From an English opticians to a bingo hall, businesses on the coast road pitch to older, northern European customers.

“This was just a small town 20 years ago, it’s become overwhelmed,” says Jocelyn Hodgson, an English resident who has lived in Spain for over eight years and also helps out interpreting for visitors seeking medical care.

Some of the retired patients haven’t learnt Spanish despite having lived in the country for years, to the irritation of Spanish doctors.

“I know we have a few doctors that get very peeved when a pensioner comes in who has lived here for 15 years and doesn’t speak a word of Spanish,” said fellow interpreter Rogers.

Hodgson herself has nothing but praise for the thorough checks and care she received when she was diagnosed with a slight heart problem: “I think the hospitals are fantastic.”

Spain charged the European Union 270.37 million euros for the medical treatment of European residents in 2005, dwarfing the 43.5 million euros it charged for tourists.

The higher figure reflects the expense of complicated care needed by elderly patients, and the greater frequency of their need for help.

The money received from the European Union does not fully compensate the cost incurred by the Spanish healthcare service, says Octavio Granado Martinez, Secretary of State for Social Security, referring especially to harder-to-quantify items like doctors’ time and training.

“It is clearly insufficient,” he said. However, the pay-off for the Spanish state is the amount of cash it gets from healthy pensioners and tourists pouring money into the economy, said Granado.

Spain reported a record number of foreign tourists in 2006 with over 58.5 million people visiting, contributing to an industry which accounts for 11 percent of national product.

Nearly 500,000 foreigners are permanently resident in popular retirement spot Andalusia, although unofficial estimates put the figure at closer to one million. “These people invest in Spain, they spend money in Spain,” said Granado. “I think paying their medical bill costs much less than what they bring into Spain.”