A Look at Spanish Healthcare
The World Health Organization ranks Spain’s healthcare among the best in the world. Facilities tend to be modern, with state-of-the-art equipment, and Spanish doctors must pass rigorous qualifying exams to get their license to practice. The central government used to be the sole regulator of healthcare, but now each of the country’s 17 Autonomous Communities takes individual responsibility for implementing and executing healthcare.
Spain has both private and public healthcare systems.
As a North American expat on a non-lucrative or golden visa, you are required to carry private health insurance for your first five years of residency. Proof that you have purchased the required policy must be included with your initial visa application and renewals.
Public Healthcare in Spain
Spain’s public healthcare system, known as the seguridad social, covers a range of healthcare services, including general medicine, family practice, pediatrics, and a range of other specialties, nursing, and physical therapy. The seguridad social is paid for out of taxes, and all tax-paying citizens in Spain belong to it.
The system has its own doctors (many of whom also have private practices), clinics, and hospitals. Healthcare centers (centros de salud) are all over the country. In cities and towns, a clinic should be within 15 minutes of your residence; even small villages have at least one clinic, although it may not be open every day.
Expats from European Union countries have the right to medical treatment in Spain under European-wide reciprocity agreements.
The situation is different for expats from non-EU countries like the U.S. and Canada. If you are legally working in Spain (either as a self-employed individual or as the employee of a company in Spain) you will automatically have access to public healthcare. That’s because you’ll have a Spanish social security number and will be contributing to the seguridad social. (While the term seguridad social is popularly used to mean the healthcare system, in fact the system also includes pensions and unemployment benefits.)
If you are a non-EU retiree or are otherwise getting only a residence permit for Spain, you must carry private insurance for five years. However, in some communities, you can request access to seguridad social after one year of residence. If accepted, you buy in by paying a monthly fee of $70 for under 65, $157 for 65 and older.
If you’re in the public healthcare system, you’ll receive a health card that you’ll present for treatment at your local clinic or doctor’s office. You’ll usually be attended by a general practitioner as your primary-care doctor (médico de cabecera). You can choose your own doctor; however, if you use a clinic that has several doctors, you won’t necessarily get the same one every time. Your médico de cabecera will refer you to a specialist as needed. (As with any public healthcare system, you may have to wait for an appointment with a specialist or for non-urgent procedures.)
The seguridad social normally pays most or all the cost of medical treatment and hospitalizations and up to 40% of the cost of prescribed medications. The patient pays the remainder—or buys supplemental insurance to cover the difference. (Note that dental care is not covered under the seguridad social.)
Private Health Insurance in Spain
There are dozens of insurance companies offering private health insurance for Spain. Online brokers can help you assess your choices. You can choose national plans that cover only Spain, choose Europe-wide plans, or even opt for full international health coverage. It all depends on your personal needs and situation.
As with private insurance anywhere, plans may exclude pre-existing conditions, have a wait time (normally 12 or 24 months) for certain wellness care visits, or have an age limit for accepting new policy-holders, among other things.
However, private insurance that meets the requirements for a residency visa must not have any co-pays, deductibles or excluded pre-existing conditions. A rider for repatriation (which is sending your body back to where you came from) must be included. Many companies do not take new clients over 74. A broker can help you find the ones that do.
To give you an idea of price, a plan with Sanitas, a subsidiary of BUPA International and one of Spain’s larger private insurers, which would meet the requirements for a residency visa, would be $324 a month for a healthy 64-year-old couple. Prices increase as you age. Prescription medications are not covered but are astoundingly cheap by US standards.
Pharmacies in Spain
Pharmacies in Spain are often signposted with a large green cross above the door—they’re easy to spot. Pharmacists are well trained and knowledgeable—you can often consult them for minor ailments and avoid a doctor’s visit. Many medicines that would be by prescription only in the U.S. or elsewhere in Europe are available over-the-counter in Spain.
Pharmacies are normally open Mondays to Fridays from 9:30 a.m. to 2 p.m. and then again from 5 p.m. to 9 p.m. or 9:30 p.m. They normally close in the afternoon for siesta, which is still a custom in Spain, and they close for the weekend on Saturdays at about 2 p.m.
For after-hours pharmacy service, each town maintains at least one pharmacy on 24-hour call, known as the farmacia de guardia. The address and phone number of the nearest farmacia de guardia are listed in local newspapers and often posted outside pharmacies.
Spain’s Healthcare System Saved My Life
By James Alred
I fell hard upon the terracotta tiles. My body was completely useless, my limbs flailing uncontrollably. I couldn’t stand. I thought I was dying; I was terrified.
Suffering a stroke is nobody’s plan for an overseas retirement, but it happened to me, in Spain. It was an ordeal, and I wouldn’t wish it on my worst enemy. But the good news is that with the help
of some excellent medical care, I’m well on the road to recovery.
I cannot say that there is anything about this experience that I am happy about, but I am happy that I am in Spain. The healthcare professionals who treated me were proficient, compassionate, no-nonsense, and they saved my life. I am on the road to rehabilitation, and it did not cost me my home or retirement income.
Up to my stroke, I had been living a dream life with Claudine, my amazing French wife, on the sunny Costa Blanca in Dénia, Spain. I was retired, healthy (I thought), had a great motorcycle, and I was jubilantly exploring the mountainous Spanish coast. I’d started a novel and just had my first ever article published in International Living magazine. I had it made, living the dream, when it so suddenly came crashing down.
I had driven to Valencia to collect a friend at the airport. We had lunch, spent a little time walking around beautiful Valencia, then drove back to Dénia. It’s a small town of about 42,000 people on the sea, exactly between Valencia and Alicante. It’s a lovely little spot, just the right size, with a vivid culture. That evening, along with my wife, we had dinner cooked outdoors on the plancha grill and dined with a view of the Mediterranean.
After dinner I suggested that we walk to the beach. My wife and our friend went ahead while I went back into the house for my shoes. I sat on a small stone curb between the garden and the terrace to put my shoes on and, when I tried to stand, I couldn’t. That’s when I fell, and I knew something was badly wrong.
All I could think of is how this would affect Claudine. I knew she would be heartbroken. I didn’t think about my guitars, which I had been playing all of my life, or my lovely motorcycle. I only worried for my life and my wife. I even prayed, which is not part of my regular behavior. I laid there between 30 minutes to an hour. I was still there when Claudine and our guest returned from the beach.
Both intelligent and experienced women, they assessed the situation quickly and called for an ambulance. So began my experience with the Spanish medical system. Although being in love with most things Spanish, this was a perspective that I did not expect or indeed desire. I had heard that Spain is supposed to have an excellent healthcare system. I’d soon find out how true that was.
The ambulance arrived quickly. The attendants wasted no time in examining the dilemma, hoisting me onto a gurney and into the vehicle. Then we were off on what seemed like a long and bumpy ride to Hospital Dénia (it’s actually less than 10 miles, but at the time it felt longer).
They wasted no time at the hospital in getting IVs going, running EKGs, and getting me into CT scans. During this time my body would recover briefly and then go haywire again. I had never spent a night in a hospital, and I was panicked. A very young-looking emergency room physician with a pasted-on smile came up and said, “We know that you have had a stroke, but the most important thing that we need to know now is why.”
They ran more tests and scans, and then I was told the good news that the clot in my brain had subsided and no emergency surgery would be required. The bad news was that I would be in the hospital for weeks, partially paralyzed, and in rehab for months. They think my stroke might have been caused by high blood pressure. That figures. In the time leading up to the stroke I ran out of blood pressure pills and, procrastinating, neglected to take them for a couple of weeks.
I spent the first three nights in the emergency ward under constant monitoring. Then they moved me into a private room with a large window allowing natural light.
Two weeks in the hospital…not charged a cent.
There are a few things immediately apparent on comparing the Spanish and the U.S. health systems. One is that money or insurance was never mentioned before going to work on me, and for the two weeks that I spent in the hospital, I was not charged a cent. My wife simply handed over the insurance card and everything was taken care of.
When we came to Spain, we had purchased, through our Spanish bank, an inexpensive healthcare plan. In fact, at $170 a month, it was about the same price that I was paying for Medicare Part B in the U.S. The Spanish do not seem to be as obsessed with shiny stainless steel, glass, and pretty starched uniforms, but more, it seems, with practical and cost-effective healthcare.
I was told that the Spanish, generally having large and close families, usually expect family members to take an active role in the care of patients. Every room was private, and they all had fold-out beds for a family member to stay with the patient, not only to help with the care, but as a benefit for the patient’s morale.
My wife, being smart, proactive, and apparently loving me, got me checked into a rehab facility immediately upon my release from the hospital. I spent seven frustrating and memorable weeks in the Casa Verde rehab facility in Mutxamel, a suburb of Alicante.
I had a large room with a view of a garden.
Although my Spanish is not quite proficient, the staff there were very nice, understanding, and professional. The facility is pleasant. I had a large room with a view of a lovely garden, and I met many of the other patients’ families. Some visited every day. The father of a fellow who fell out of a tree onto his head drove an hour each way every day to be with his son. At times the entire family would be in attendance. In the afternoons I would walk in the garden, which was usually filled with visiting families.
The therapists are the heroes and heroines of the institution. They worked tirelessly and cheerfully, devising different exercises for each injury, because every injury is different. The occupational therapist, working with my arm, would repeat the same movement over and over, with infinitesimal results. They work tirelessly to get patients back on their feet.
There were patients from automobile and motorcycle accidents, brain surgeries, strokes, and more. Patients ran the gamut from those who would be there for a few weeks and return to a fairly normal life, to those who would be there for years. I would ask the therapists how they did it. They said that their reward came when they saw any improvement in their patients. I had no idea that there were places like this or of the courage, grace, and perseverance of the injured human being. It was dramatic, depressing…and inspiring at the same time.
I started in a wheelchair, needing help to get into my bed. Within about four weeks they had me walking with a cane. I saw physiotherapists, occupational therapists a speech therapist, and a psychoanalyst. My speech was not terribly affected, so the speech therapist and I mostly talked. She was a lovely and bright young lady, so that was pleasant. The psychoanalyst gave me many cognitive tests and said that my mind had not been affected. He said it was quite normal to be depressed and worried. Then we talked mostly about music; he was also a musician.
At one point he went on vacation, and another psychoanalyst stepped in to take his place. She was normally engaged in neurologic research at a university in Valencia, about an hour north of Dénia. She and I spoke extensively about brain science, as I was reading a couple of books on the subject. She convinced me that, although my life would be changed, it could still be rewarding.
I could complain about a couple of things. The cuisine left something to be desired. It was understandably institutional, given that they cooked for 60 to 100 patients in three dining halls. Most of the attendants were very nice, but a few sometimes seemed annoyed. That is understandable, considering how hard they had to work and some of the duties they were required to perform. There are few rehab facilities in Spain and they are not cheap (mine cost $6,900 a month), but they are less expensive than in the U.S.
I am happy to say that I am home now, attending outpatient therapy. The new therapists are good, and I am building muscle. I am walking fairly well with a cane, which I hope to be discarding in a few months. My left arm is still pretty useless but it does have movement, so I hope to recover fully. In fact, the exercises I do in rehab have my blood pressure down to 130 and, in some ways, I am in better shape than when I went in.
I am lucky because this will pass. As Claudine says, it’s just “a bump in the road.” In a few months it will be just a dark memory and a potent reminder to take nothing for granted, to be grateful for everything, and to never forget to take my blood pressure medication. I may even play guitar again. In fact, I’ve already managed to play a simple E-minor chord. Usually, that’s a sad-sounding chord, but not this time. I have hope.