Let’s start off with the fact that Spain’s healthcare system was voted seventh (7th) best in the world by the World Health Organization. Every Spanish citizen has a constitutionally guaranteed right to healthcare. The program is non-contributory and paid for entirely from tax revenue. There is a catch…you have to live and work there, don’t forget he pay taxes part. If you are not a resident you can get coverage through the Convenio Especial. The Citizens Advice Bureau offers information on where you can buy into the Spanish Healthcare system.
Once you have decided to pack your bags and move to another country, you need to be fully aware of the ramifications of your decision. One of the first things you need to prepare for is health care, aside from the other aspects of your life that would be changed with this life altering decision.
One of the most magical countries to immigrate to is Spain. The country is located on the Iberian Peninsula located between the Mediterranean Sea and the Atlantic Ocean. Aside from the landmass in Europe, Spain also governs two autonomous cities in North Africa. The country shares borders with Andorra, France, Portugal, Morocco and Gibraltar.
One of the country’s biggest expenditures goes into the system of healthcare in Spain. The system is a public parallel health care institution working together with a network of private health insurance providers. This system is availed of by over 90% of the Spanish population. If you are a citizen from a European Union state, you can avail of free medical and hospital care after presentation of your European Health Card. You can also avail of this free care with house calls. Once a specialist is needed for your medical concerns, you can then be referred to one and be issued a medical certificate.
As can be seen, the European Health Card allows a tourist or an expatriate to avail of the medical services that a Spanish citizen can receive. You can obtain these cards from healthcare organizations from your country of origin. The main problem though with the system of healthcare in Spain is that private hospitals and doctors do not accept the EHC. Once you are attended to by a private doctor or admitted to a private hospital, you either must have money to fork over or have adequate medical insurance coverage for your condition.
In order to be better prepared for the system of healthcare in Spain, you need to fill out form E112 as this allows for specific treatment to be done to you while in the country. You also need proper authorizations from your local institutions to be able to avail of the same or similar medical services. Should you forget your EHC card, be prepared to pay for your medication and hospital bills on your own and then seek reimbursements from your health care organization.
If you are a national of a non-European Union country, then you need to be properly apprised of the costs you would face should you need to go into healthcare in Spain. There are countries that Spain provides reciprocal medical benefits, such as Liechtenstein, Iceland, Norway and Switzerland. There are those with bilateral agreements with Spain, such as Peru, Paraguay, Ecuador, Chile, Brazil and Andorra. What you need to do when in Spain is provide the proper health certifications to avail of the free hospitalization and medical care during emergencies or accidents.
Overall, the system of healthcare in Spain is very good as the hospitals are modern and well-equipped. The doctors and specialists are excellently trained. The Expat Forum though provides advice such as “Just make sure that it is available in the specific area of Spain that you intend to live in.”
Private Health Care
When we first moved to Spain, we had very little experience of the lifestyle and that included provision for healthcare. As we were both reasonably healthy and because our knowledge of the language was still limited, we were somewhat scared of approaching social security offices and medical centres to gain more information, putting it off for another day.
However, with the rise in older men developing problems with their prostrate and my awareness of prostrate cancer, I decided I needed to see a doctor for a check up. Not being eligible for the Spanish health service at the time meant I had to go private. I had this dreaded feeling “This is going to cost a fortune”. Not necessarily so.
The couple that we rented our villa from in Mojacar recommended an English speaking lady doctor in Garrucha and we found to our surprise her fee was only 40 euros per consultation. On my first visit, all my details were entered into the computer and then a comprehensive examination was done including arrangements for a blood test.
Everything was extremely thorough and the staff was very helpful wanting to get a full picture of my current state of health. I was given a letter indicating what blood tests were needed and directions to a nearby blood analysis clinic. At the clinic I was seen straight away and the necessary blood sample was taken. What was most impressive was that I was called back the very same day for my results. Back in England I would have had to have waited ten days. Even better, when I phoned the doctor an appointment was made for the next day.
Spain National Health Service
If you have ever visited Spain you will know that pavements either don’t exist, which means you walk in the road, or are uneven and have a kerb that is about 18 inches high (how disabled people in wheelchairs get by I do not know). You will also notice that the local Spaniards always walk in the road, apparently fearless of being hit by a passing vehicle. They obviously would rather face the car than risk walking on the pavement.
Anyway, to begin our story, one Sunday morning, my wife was on her way back from the newsagent, when she tripped and fell off the pavement. Ouch! We later found out she had broken her little finger and fractured her wrist.
At the time we had just started our estate agency business and as such we had to make social security contributions which meant we qualified for free medical care. If you do not have private health insurance, you should join the Social Security system.
Once you take any job in Spain your employer is obliged to process all the paperwork for you, pay part of your contributions and deduct the other part from your salary. If you are self-employed you will have to go to the local Social Security office and fill in all the paper-work yourself. Beware of using a British accountant who doesn’t speak Spanish fluently – you may find that you have not been registered correctly.
We needed to find a hospital quickly but not ever needing emergency medical treatment in Spain we hadn’t a clue where the nearest hospital was. We found a place near the beach with a red cross painted on the outside of the building but were then advised they only take private fee paying patients. Fortunately, they directed us to a health centre on the other side of town.
As opposed to my wonderful private health care experience with English speaking staff, at this health centre, the receptionist only spoke Spanish and we had some trouble understanding each other. Fortunately for us, a doctor was passing by and kindly offered assistance. However, to our dismay we were told we had come to the wrong hospital. In fact, you are supposed to attend the hospital that is registered for the district where you live. We were then given more directions and this time found the right health centre.
We were seen straight away, only to be told that the diagnosis of a suspected broken finger needed an X-ray, but that the centre did not have an X-ray facility and we were told to go to the main general hospital in Lorca, which was 35 km away. All this time my wife behaved remarkably well even though the pain was excruciating.
As with most things in Spain everything is located in the town centre and parking was difficult. We walked to the A & E department and just like the UK – it was very busy. After explaining our problem to the reception desk, we filled in a form, and proceeded to wait. Of course, we assumed we were going to be here for hours. Actually things were very fast and after a very short wait, Carol was examined and whisked off to X-ray. After the x-ray, we waited only another ten minutes before a doctor confirmed the broken finger and fractured wrist. Carol received the necessary treatment and an appointment was made to visit the hospital in another seven days.
In all fairness if we had been better prepared it wouldn’t have turned into such a drama. The lesson to be learnt from this experience was that accidents do happen and you do need to be prepared. When you arrive at your final destination, register immediately with your local health centre, find the location of your local hospital, drive there and have a look around. Also, make a note of useful telephone numbers that you are likely to need in case of emergency and keep them close by a telephone. You never know when you may need them.
We have put together a list of various forms and information that you may find helpful.
Form E121 –
If you are a pensioner from the UK, 65 for men, 60 for women, and intend to live in Spain permanently then you can get free medical care and medications under a reciprocal agreement between EU governments; you should obtain form E121 from the DSS in the UK prior to your departure. You may need a separate form for each member of your family. This form should be handed in to the Seguridad Social (Social Security) in Spain. It provides permanent health cover and does not need to be renewed. You will receive a temporary health card and eventually you will receive a letter giving the name of the medical centre you are to visit in case of illness and a permanent card. Until the form has been registered at the social security office you are not covered for healthcare. Private health clinics will not accept this form as payment.
Form E106 –
The period of medical cover commences from the date you leave the UK. You must however apply and receive your E106 entitlement form before leaving the UK to ensure you are covered and to know what that cover entitles you to.
Form E111 (EHIC) –
The best solution for someone wanting to stay in Spain for a short period of time without becoming a resident is the form E111, now replaced by the EHIC (European Health Insurance Card), this card is issued by the National health Service in the UK, and you should carry it with you together with your passport at all times, in case of an emergency. This card is only to be used in cases of emergency and is not for the treatment of chronic illnesses.
Private Health Service –
If you aren’t covered by the Spanish social security, then it is imperative that you have private medical insurance. If you have private health insurance in the UK, then find out from the insurance company if they will pay your medical bills in Spain. There are a large number of private Spanish or English companies offering health insurance.
Health care points to remember when moving to Spain –
o Make sure you know where your nearest hospital is located.
o You need to go to the hospital registered in your district.
o If you are working in Spain then make sure you make social security payments in order to qualify for the Spanish National Health Service.
o Make sure you find a local gestor that can handle the social security paperwork for you.
o If you paying private healthcare insurance make sure you are aware of any limitations.
o Keep a list of useful telephone numbers of places to contact in case of emergencies.
o Try and learn some useful Spanish words, do not expect everyone to speak English.
If you are planning to live in Spain permanently, then you should know about your options when it comes to health care, especially if you are moving together with your family. Although most people overlook the importance of health care, it is vital that you have some type of health care insurance until you get your Spanish medical card.
Spain offers an excellent hospital and healthcare facilities. In fact, the country has almost the same level of healthcare facilities that the United Kingdom has. If you are from a European country, you are in luck for the Spanish health care system automatically covers you. If you have just migrated to Spain, it is important that you obtained a newer version of E111 form or known as the European Health Insurance Card (EHIC). Through this, you are assured of being covered in any general hospitals during your entire stay in Spain.
In addition, it is highly recommended that you go to the nearest social security office in your area to register for a medical card. You need to present valid IDs together with your passport and proof of residence to get your medical card.
Lastly, one important thing to consider about your EHIC is that it would neither replace any type of travel insurance in Spain nor would allow you to get any type of non-urgent medical treatment. Hence, it is vital that you get your medical card in Spain the soonest possible time. Without your EHIC, you might also be asked to pay upfront if you need any urgent medical treatment in Spain.