Good
health Christopher Nye explains how Spain's healthcare system works, how long it takes to get an appointment with a GP, and exposes some surprising translations.
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Illustrations: Gail Hodson-Walker he Spanish enjoy the longest lives in the world, the men averaging 78 years and the women 84, and claim their pensions for three years longer than their neighbours in Portugal. Can it all be put down to a siesta in the afternoon and a diet of olives, meat and red wine? Certainly these days the Spanish health service is among the best in the world. There are 3.6 doctors per thousand people compared to just 2.5 in the UK, and better survival rates from conditions such as cancer. But that doesn’t mean that people going there either for a holiday or to live, can afford to take good treatment for granted. Dr Nigel Lewis is a British GP with a private practice in the Andalucían village of Coín, and he urges people to do plenty of research before making the move. “People come here totally unprepared, with no idea how they will be looked after, and what regulations they will have to comply with to get treatment. Maybe they come when they retire in their 50s and assume they will get healthcare – but they won’t; not until they start receiving a UK pension.” Holidaymakers and short stay visitors are covered by the EHIC – European Health Insurance Card – which is free and easy to apply for online from www.ehic.org.uk. It covers temporary visitors both for basic treatments such as sunburn and routine maternity care (but not birth!) but also for emergency treatment after an accident. For this free treatment however, even if an ambulance is called, it is essential to ask for the public health service, since hoteliers and tour operators have a habit of calling out private ambulances from private hospitals, or steering guests towards a private doctor, saying they can claim back the fee from their insurance. Often you cannot. If in doubt, insist on seeing the public doctor, even if it means a longer wait – you have every right to do so. Dental treatment will not be covered by the EHIC, and neither will repatriation should you need to be flown home. For those moving to Spain, the rules are quite clear. You are entitled to free healthcare if you are: a) a retired EU expatriate in receipt of a state pension who has registered and filled in all the formalities, b) legally employed by a company, since the employer is required to pay your social security payments, or c) a self-employed person who has registered and paid the social security fee. Those not covered are 'illegal' workers not on the tax system, and expats or pensioners who haven’t registered.
54 Living Spain AUTuMN 2010
ADVICE Healthcare
Preparation in the UK
Pensioners planning to spend more than three months in Spain need to speak to their local Department for Work and Pensions before leaving the UK and fill in form S1 (the old E121 and E106). This will transfer them into the Spanish system, which they will access when, within three months of arriving in Spain, they go to their local Foreigners Office, or police station, with their passport, proof of address and S1 form, to get their residence card. They then take this to the social security office, the 'Seguridad Social', to register for healthcare. Once this happens, the British government pays a fee to the local Spanish health authorities each year to care for you, since you have paid no tax over there. It also means that resources are allocated to that region of Spain. However, the fact that many British people (and Germans, Dutch etc) living permanently in Spain ‘forget’ to do this, relying instead on their EHIC, has built up serious resentment, understandably, against such foreigners. People retiring to Spain before the pensionable age may still qualify for healthcare for a while, so long as they have kept their National Insurance payments up to date prior to leaving the UK. They should check this with the DWP, get their S1 form and take it along to the Seguridad Social in Spain to register. However, this will not last for ever, and if still not of pensionable age they will need to consider taking out private health insurance to bridge the gap. If you’re employed in Spain your employer must make social security payments on your behalf, with you making a contribution out of your wages, just like with National Insurance in the UK. You will receive a social security card – a bit like a credit card – and use it to register with a local doctor. If you’re self-employed you have to organise your own monthly payments, which will total around €2,500 per year and entitle you to your own social security card and one for each dependent. Once you are all registered, you’ll need to get a GP, and it is often best to ask other local residents for recommendations. It will be helpful, for example, to find one that speaks English, if possible. Although the Spanish authorities have worked so hard to welcome the British into their schools and society, there is no automatic right to see an English-speaking doctor. Don’t assume either, that saying something that sounds a bit English but with a hint of Spanish will work. Any guesses for what “estoy constipado” means? Wrong! It means “I have a head cold”. The Spanish health system hasn’t had the same preoccupation with sameday appointments as in the UK, so you might have to wait a week for an appointment to see a doctor, and as one expat warned, “In our village near Valencia you have to get there at six o'clock in the morning to get your name
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Some useful phrases Seguridad social = social security
Celador = attendant at enquiries desk
Centro de salud = health centre
Farmacia = dispensing chemist
Receta = prescription
Cita previa = appointment
Consulta = surgery
Tengo fiebre = I have a high temperature
Urgencias = casualty
No puedo dormir = I can’t sleep
Cartilla = social security card
No puedo respirar = I can’t breathe
Médico de familia (de cabecera) = family practitioner
Estoy mareado = I feel dizzy
Enfermera = nurse
Tengo nausea = I feel sick
ATS (Asistente Técnico Sanitario) = similar to a nurse
Necesito aspirina infantile = I need children’s aspirin
AUTUMN 2010 Living Spain 55
ADVICE Healthcare
Useful CONTACTS EMERGENCIES Emergencies in Spain (ambulance, police, fire service): 112
registering in Spain Department for Work and Pensions (DWP): 0191 218 1999
HEALTHCARE For enquiries about healthcare either when visiting or residing in Spain, the UK Department of Health offers two addresses. If you have a query regarding healthcare when in Barcelona, the Balearic Islands, the Costa Blanca, Costa Dorada or Costa Brava, contact: The Pension, Benefit & Healthcare Team, British Consulate, Alicante. 0034 965 216 022 If you are in Madrid, the Canary Islands, on the Costa del Sol or in another region of Spain not mentioned, contact: The Pension, Benefit & Healthcare Team, British Consulate, Malaga. 0034 952 352 300 You can also contact the Spanish Health Ministry at: Ministerio de Sanidad y Consumo, Paseo del Prado 18-20, 28014 Madrid. 0034 901 400 100, www.msc.es
on the board to see the doctor, or you’re behind a long queue of black-clad, elderly ladies who want to spend a long time, and I do mean long, chatting away with the doctor.” In the past you could avoid the queues by buying a far larger range of products over the counter at the pharmacy than you can in the UK, including antibiotics, valium-based drugs and sleeping tablets, but EU rules have now banned this practice (though some pharmacies will still do it anyway).
Aftercare
Emergency care in the Spanish health service is second to none, but the big difference between there and the UK is with the aftercare. Sally Harrison, an estate agent for Axarquia Properties, has had experience of the sharp end of the health service when a close relative had a heart bypass operation. “The health service is fantastic for emergency treatment, but here, after the operation, when you’re in the ward, you won’t get hot and cold running nurses like in the UK; your family is expected to come in and take over, even sleeping in a chair next to you at night if necessary.” Dr Lewis agrees. “The nursing care is different – not worse, but you are expected to have a friend or family member along to help with getting to the loo, feeding you and so on. If you’re out there on your own that can be a challenge.” For this reason, many people living in Spain, including nearly one in five Spaniards, choose to go private. Insurance plans cost from as little as €20–€30 per month, right up to €5,000 per annum or even €10,000 for elderly patients with pre-existing conditions. With the cheaper options there can be long waits and no choice of where and when you’re treated. Going to a private doctor such as Dr Lewis guarantees always having
56 Living Spain AUTUMN 2010
someone to speak English to, which is more than a convenience; it can greatly reduce the risk of misdiagnosis. It often allows more time with the doctor than you might be used to. Dr Lewis has cheerfully swapped a higher earning but higher pressured lifestyle in the NHS for something more patient-focused in Spain. “I’ve got back to where I look forward to seeing my patients; it isn’t a struggle like it often was back in the UK. I’m happier, and have more time to devote to them.” Many people find that the lower pollution and warmer climate of Spain improves their health. For example arthritis sufferers report easier symptoms in Spain. The hayfever season is shorter, but some Britons suffer from allergies to unfamiliar pollens such as from olive and orange trees. Dr Lewis also sees the consequences when expats view life in Spain as a permanent holiday. “Smoking and drinking to excess is a big cause of high blood pressure and liver problems here.” The biggest problem though is people simply being unprepared for deteriorations in their health in later life. Stepping in to help pensioners with failing health is Age Concern España, which says that falling interest and exchange rates have damaged pensions and added financial hardship to people’s problems, just when they need the money to help with treatment. It is hard to imagine anything more distressing than suffering a condition such as Alzheimers, and in a brief period of lucidity finding yourself in a hospital with everyone talking Spanish and no family within a thousand miles. So anyone going to live in Spain permanently should think carefully about who will care for them in the long term. However, with that taken into consideration, nobody should be put off heading to Spain. They can be confident that they will be in the best possible care.