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Spain - Health Service
The Spanish enjoy long lives with the average life expectancies for men totalling 80.1 years and 85.1 years for women Spain in the top 5 countries for the longest life expectancies in the world. Spain's top causes of death are coronary heart disease, stroke, lung cancers and dementia/Alzheimer's. The World Health Organisation states that nearly 1 in 4 people are obese (23.7%). This may seem surprising given the Spanish eat more fruit and vegetables and less bad fat than other countries in Europe and yet appear to be more affected by heart disease.
Foreigners can be treated in hospitals but costs may be high as they have not been paying social security contributions (seguridad social) which allows for access to the state run health system. EU and Swiss nationals can use the EHIC listed below in some circumstances for discounted medical rates and non EU nationals will always need medical insurance cover (until they have residence status) which will also be shown as evidence during the visa application process. Doctors issue patients with a booklet known as the Charter of Rights and Obligations (Carta de Derechos y Deberes) during treatments in hospitals so reading this before setting off can help clear up where costs may incur.
Originally, the healthcare system in Spain was managed by a centrally controlled government but nowadays the government decides the budget only and each of the 17 different autonomous communities takes responsibility for their own health care. The Spanish National Health System has a large range of well resourced health care centres and hospitals all over the country. Hospitals can comes in the form of private or public with some hospitals containing both facilities. Locals who pay social security contributions are entitled to free and discounted treatment at public hospitals. 18% of the Spanish population choose private health care and others who are registered attend state healthcare centres and hospitals. The General Health Law of 1986 (Ley 14/1986 General de Sanidad) states a right for foreigners and locals to access to healthcare services if they live in Spain so there are a number of options for those that will visit or live in Spain. Below is a breakdown of types of healthcare available and the eligibility of foreigners.
The examples below are entitled to free public healthcare:
• A person under 26 and studying in Spain
• A child who is a resident in Spain
• A woman who is with child in Spain
• A resident in Spain who is self employed or employed in the country and pays social security contributions
• Staying in Spain temporarily and with an EHIC
• A state pensioner
• A recently separated or divorced person from a partner who is registered with social security
• A resident in Spain who has been receiving specific state benefits
Those who can use the public healthcare system
Having an electronic or card version of the EHIC (European Health Insurance Card) will aid a European foreigner access the state funded healthcare system which will allow for discounted or free costs for medical treatment in a public hospital. Only those in Europe are eligible for this card. If you can, make it clear whether you need a public or private hospital. The EHIC only covers services you receive from public hospitals and for visitors who are visiting Spain temporarily. If you are going to Spain specifically for medical treatment or to give birth, the EHIC doesn’t cover you. For more information check here.
Bi-lateral emergency treatment agreement for certain countries (temporary)
Non EU members from Peru, Chile, Brazil, Ecuador and Andorra (plus Tunisians and Moroccans working in Spain) who go to Spain for short visits can receive free emergency medical treatment in a preformed bi-lateral agreement.
Tarjeta sanitaria The tarjeta sanitaria is a medical card which allows EU members to access the same medical treatment as a Spanish local. It is dependant on the applicant on having a social security number (Documento de Afiliación a la Seguridad Social). You should go to your local social security office (Instituto Nacional de la Seguridad Social) to register to check your eligibility. Also needed is a Certificado de Empadronamiento, otherwise known as Padrón, a form indicating local registration to say you are officially residing in a location/neighbourhood. This is not an option for non EU members who have never contributed to social security tax to an EU country but those that have done so are be eligible.
For those who are not entitled to healthcare from the UK or Spain the Convenio Especial may work for you. The pay in type Spanish government run healthcare scheme requires those applying to have resided in Spain for at least one year, to have their Certificado de Empadronamiento which has been applied for and granted from the town hall and to not receive healthcare from the UK. Over 65s pay a monthly payment of monthly payment of €157 and those under 65 pay €60.
Non EU nationals
Non EU nationals once they are a resident of Spain are able to access the public healthcare system too and should have sufficient medical insurance/coverage until that date.
Private health Insurance/plan
Private medical insurance is highly recommended for non EU members and anyone who doesn’t have a EHIC or qualifies for other medical discounts. This is also recommended for anyone visiting Spain for a short period of time. This health insurance will also cover you before you get your Tarjeta sanitaria. Private hospitals do not accept EHICs.
The standard of healthcare in Spain is excellent offering a top quality and widely available public hospital system and private hospitals too. Equipment is state of the art and professionals who work there are skilled, knowledgeable and may speak a good level of English depending on where you go. The following is information on types of healthcare services.
Unlike the UK for example, you will not find publically or privately run dentists or surgeries. All dentists charge fixed fees for patients. Generally, it is not expensive to go to the dentist and is cheaper than much of Europe. A standard check up with clean and x ray is €60. Payments are upfront and although teeth examinations, an initial consultation or check ups do not cost anything, you’ll need to pay for other services as standard. For emergencies it is common for A&E departments to have a dental ward where you can go. A useful phrase is ‘“necesito un dentista” (I need a dentist). EHIC will not cover dental emergencies.
Health centres (centros de salud)
Health centres are the most commonly found medical practices in Spain. They are the most commonly used by locals too. They are always local to a village or town and many are located in cities. In more rural areas and lesser populated regions local surgeries open their doors on specific days which see visits from staff who are on rotation to visit healthcare centres in the region. If needed, patients can receive a home visit too. This is where locals and foreigners can go to get referrals to hospital, to see specialists and register with a doctor.
Hospitals come in the form of private hospitals (privado) and public hospitals (asistencia sanitaria pública). If traveling to a hospital, try to bring a Spanish speaker/friend with you to help you. Some of the larger hospitals will have an A&E ward (urgencias) and this is where you will be taken in a medical emergency. Standards in private and state hospitals are comparably similar. Paying for private medical care like 18% of the Spanish population will get you quick referrals, vastly reduced waiting times and direct contact with medical specialists if required. The Public hospitals offer the same standards of care but longer waits for appointments, referrals and visits to specialists. It should be noted that different areas of Spain provide different treatments so traveling for treatment is something which can occur.
For full care for patients, the emphasis is on family to help out with the upkeep of the patients needs. Family come in with meals, clean bedding and clothes and look after the patient's basic needs. Usually medical assistance is carried out by nurses and doctors and family and friends help with much of the rest. Visiting hours are casual and those who know the patient can spend many hours with them watching tv or talking.
Tips for visiting the hospital
During every visit to public and private Spanish hospitals, you are required to bring your government issued health card (Sistema de Información Poblacional or SIP) or proof of private insurance and another form of ID to claim free or subsidised healthcare services. It is only in an emergency that you are admitted to hospital, all over instances would require a referral from a doctor. To get a designated doctor you must have your health care in place then choose your doctor (médico de cabecera) to be the provider of your primary care. They advise and refer you to the hospital or to see a specialist if necessary. Hospital doctors don’t give out prescriptions so if you leave the hospital and still require medication it is important that you retrieve the hospital medical report to take to a pharmacy so that they can get you the prescriptions you need.
Counseling services available in English
Costa Blanca Samaritans
Confidential helpline with English speaking staff based on Costa Blanca. Monday to Friday, 19:00-22:00.
Tel: 902 88 35 35
Suicide, crisis and support line (El Teléfono de la Esperanza)
Helpline for Spanish and foreign citizens.
902 500 002
UK charity offering help to those with depression in Spain with a helpline for contact.
0044 845 123 2320
Charity which helps immigrants, the elderly, minors, those with drug addiction and those with HIV. The helpline offers its services to family and friends of those concerned too.
Tel: 915 336 665 or 915 334 120
Tourist helpline and emergency number:
Helpline for foreigners who need assistance during their travel. English speaking staff.
Tel: 902 102 112
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