The Spanish Health Care System
No, I never get sick, I'm always in perfect health. So why on earth would I want to waste my time absorbing tedious blurb about something that is never going to affect me. That is fine if you are just coming on a short holiday but if you are going to live here for the rest of your dotage or throughout the winter months, at some stage you will need to see a doctor, even if it is just to get a check up.
So let us explore the possibilities of what actually happens if when needing Medical services here in Spain. Back home being sick in itself is stressful enough. With under resourced medical services and over worked health care providers today's question is, will the stress of trying to get better finish me off before the illness does? Now, come to Spain, add lack of language skills and ask, on the chance of becoming ill, how would I feel trying to communicate what is wrong with me. How would I understand what action to take. How do I go about organising to spend time in hospital with nobody being able to understand what I say and nobody available to communicate what is wrong with me and what they are planning to do.
Take note please of this simple very important fact. Public Health workers in Spain do not speak English. One elderly English lady was very ill in a Spanish Public Hospital and has wondered very anxiously why her husband hadn't been to visit as usual for the last three days. Regretfully he had died at home in his armchair. The traveling back and forth to the Hospital had been too much for him. If this is how you want to end your days then carry on, do nothing, plan nothing and live with what happens.
Please believe us, you will want to speak to an English speaking doctor. They are available but only privately. For this you will need some form of insurance cover. It starts from as little as €25 a month with cover provided by reputable English Insurance Companies, you can understand the small text and know exactly what you are entitled to before you need to use the service not while you are trying to get better. Even if you are here for only six months a year you will feel far more secure knowing that an English speaking doctor is available, if not for you then at least for your partner.
Like most administrations there are lots of bits of paper designed to cover different sorts of people and situations. In matters medical we have E-numbers and just like their cousins in food ingredients they are equally as obnoxious. They are,
For tourists from the EU the old E111has now been replaced by a European Health Card. When needing medical services here on your fortnights break or winter escape, take it to the nearest Health Centre (Centro Medico, Centro de Salud or Ambulatorio). Queue up, yes you have to here as well, and make an appointment with the Doctor. This is best achieved by looking up the words in the Dictionary for your sick bits, or at worst point to your ailing parts and wave your health card at them. Then sit and wait until someone gestures you into the doctor. There are no flashing lights or colour codes here announcing when the doctor is free. You may be asked to contribute up to 60% of the costs, which are reclaimable on your return to the UK. Pensioners and babies won't have to pay. Many pensioners use this health card as part of their paperwork to apply for a Residents permit. But using it for 5 years before deciding to become a resident simply is not on. You may end up paying all the costs incurred and not be able to reclaim them from the UK authorities.
For people working in Spain but paying National Insurance back home form E112 should be used.
For people working in Spain and paying National Insurance in Spain you are entitled to free Medical Services but will have to pay for medication.
For people of all ages who are staying in Spain for short periods such as just for the winter Form E106 is used. You can be asked to pay up to 60% of the costs of any operation and medicaments, but you can reclaim what you have paid using this form. Make sure you keep all receipts.
For Pensioners (that is those in receipt of a state pension only) and disabled persons a Form E121 is needed. You will need to register with the local Office using this form, for this application you will also need your passport, an NIE number and an escritura (deeds of your property) or a rental contract. You will then be issued with a credit card for Social Security purposes with your NIE number on it. Just present this whenever you need to see the Doc. You will also be entitled to receive free medication.
What can you expect in terms of medical services here in Spain?
The medical centres here are very different to back home where the waiting room is deathly quiet except for the accompanying music of intermittent coughs and sneezes. The Health Centre (Centro Medico, Centro de Salud or Ambulatorio) in Spain is very different. They always seem to be full of people, it's a bit like going to a football match with everyone chattering at full volume about the potential result. This is because when one Spanish person is a bit below par and needs to get checked out by the Doc. then all the family go too. Each family member is of course a medical expert and wants to help the doctor reach an accurate diagnosis. They are meant to be allowed six minutes each with the Doctor and the Doctor has to see up to 100 patients a day. They rattle through quite quickly. You are, like back home, meant to make an appointment to see the Doctor and come back later to see him. In reality, like back home, it takes as long as it needs to take to give each patient a fair crack at having the Doc solve their problem, so don´t expect to see the Doc at your appointed time. Some Medical Centres have an emergency department to deal with minor injuries, but anything a bit drastic will see you being wheeled off to the nearest Hospital in an ambulance service that is first class.
Spanish State Hospitals and medical centres are probably as equally under resourced as the British. However, the average time from consultants appointment to operation is only 49 days. An artificial hip needer recently had to wait six weeks for a consultants appointment, 90 days for the operation, she didn't need a general anaesthetic and was home in ten days walking on sticks. She did not have to go to France or Germany or wait in a corridor, in fact she had a twin bed room with en suite loo and TV, and could receive visitors more or less whenever she wanted. However, it turned out that they only did half the operation and she had to go back a year later to get the other half done. In hospital, whilst there may be only two beds to a room, don't expect to be recuperating in peaceful isolation. Spanish families also come along to assist where possible in nursing their relative. This often means that they stay the night in a chair or on the floor. Bringing in a take away paella and watching the TV and talking all at the same time. Visiting hours are much more flexible here and the hospital staff while being under resourced are very helpful. They tend also to behave less like army sergeant majors and don't wake you up at six in the morning just to suit their routine.
If you are coming here to live some or all of the year, it is important to realise that an outdoor life in the sunshine and the healthy Mediterranean diet and moderate amounts of alcohol can extend healthy life spans. This quality of life can ease many of the typical northern European illnesses such as asthma, bad circulation, joint pain and arthritis. But it doesn't mean that you won't get sick. Learn as soon as you arrive where to register with the doctor and do so prior to any illness. It means they can deal with you so much more quickly if they have a file and a number for you somewhere in their computer. If you live in an area where there are a lot of English speakers you may find that there are voluntary translators at the Medical Centre to help you understand the paperwork and communicate with the staff and doctor. Registration with your Residents permit is a simple matter of getting a form from the local social security office (in bigger towns this office is actually in the Centre. In smaller you will have to go to the nearest town that has a proper hospital. Towns over 25.000 people are entitled to a Hospital and a National Police Station).
If you are going to be here for less than two months a year then the Health Card/106 is just fine. But if you are going to live or spend winters here firstly do not deregister with your doctor in the UK, do not even inform him that you are leaving, and do not tell the Health department, they will confuse you with more E-numbers. You might want to come back in a couple of years and getting back in to the UK system is worse than coming to Spain. Use the Health Card/106 then take out some private medical insurance until you decide that you like it here. As a pensioner or non working person in Spain you will need a residents permit if you live here for more than six months in any one calendar year. Application for a Residence permit needs to show how you are going to pay for your Medical treatment as well as other matters. The Health Card isrecognised in the nearest Comisario de Policia where you go to apply for residents permit. Pensioners can register with the doctor here with no residents permit using an E121 and your Passport and your NIE number and receive totally free medical services from the state. Then when you apply for your Residents permit you can use your Social Security Card to demonstrate how you will pay for Medical services. Non Pensioners however, have to pay for all their medication outside of the hospital (Chemist is Farmacia). If you are under 65 it is possible that they will not take on any pre-existing conditions such as diabetes. Diabetics should return home every three months and sustain a UK address to continue to get free insulin, here you will have probably have to pay for it, it costs about €300 a month!
The Spanish medical services do not include dentistry, but any surgery, for oral matters will be treated as medical and not dental. There are many English speaking dentists of all nationalities around the coastal areas of Spain, ask your neighbours which they prefer. Try two or three until you are happy.
The Private Medical Services in Spain are first class. Fully equipped Hospitals are more like luxury hotels. Your partner can stay with you and if you are up to eating, well it's not bad. Private Medical insurance is a fraction of the price in the UK (from 25 Euros per person per month) even by the same Companies. Policies can bought online or you can phone for advice.