Healthcare options

Depending on personal circumstances you have various options when it comes to healthcare provision.

• If you are resident and working in Spain you will have to pay into the Spanish social security system and this will qualify you for entry into the equivalent of the Spanish national health service, INSALUD.
• If you are a retired EU pensioner you automatically qualify for state healthcare so long as you register for it.
• If you are not employed in Spain, outside the social security system and under retirement age you will need private healthcare insurance and you may need to produce evidence of membership of a private scheme in order to obtain residencia.

In practice many people who can afford it use a mixture of private and state healthcare and the two systems co-exist quite happily. If only this happened in the UK.

Organising your healthcare

Before you move to Spain you should contact the Pensions and Overseas Benefits Directorate in Newcastle and request an E106 certificate and the relevant forms for you and your family. This provides you with medical cover equivalent to that expected by a Spanish national for a stated period or until you have organised your personal healthcare provision on the Costa del Sol. In our case we had 18 months guaranteed cover at the expense of the NHS should we need to call on it. Cover can be granted for up to two years at the discretion of the NHS.

By the time the certificates expire you should either be in employment in Spain and therefore contributing to Spanish social security or you should have taken out private healthcare for yourself and your family. Until that point the E106 could be a real lifeline. If during that period you become a UK pensioner or the recipient of Incapacity Benefit you may then request another certificate, E121, which will provide you with further medical cover.

State healthcare

If you qualify, the state healthcare system is very good, particularly at hospital level. It is free at the point of use and prescriptions are also free. However, you may be given unbranded (generic) drugs. When entering into the system you need to visit your local social security office and fill in a few forms and produce the documents that prove you are entitled to state healthcare provision. You will then be allocated a doctor at a medical centre near your home for yourself and your family.

If you are retired from the UK or you are registered as disabled you need to obtain a form from the UK social security office, the E121, and take this together with your passport and a copy, residencia card (or proof of application), and NIE number. Once more the Spanish social security office will allocate you to a local doctor.

The negatives to the state system are potentially very real. GP surgeries can be very full with long queues and correspondingly long waiting times followed by short appointments with the doctor – much like the UK. The doctors are very well trained but they are under pressure and are more interested in treating the existing condition rather than getting involved in preventative healthcare. In other words, there is a good national illness service. Many of the doctors in the state system may not speak fluent English and this could cause you problems if you do not take along an interpreter. You are also unlikely to find large group practices such as those found in the UK. Many GP practices are single handed with the doctor’s wife often working as the receptionist. The UK is also quite unique in having so many practice nurses who spend a lot of time working on prevention rather than cure. You will not find this in Spain.

The other major difference between the Spanish system and the British is that in Spain individual provinces have the decision-making processes on healthcare devolved to a local level. For this reason healthcare standards do vary from province to province but I have to say from personal experience and information from talking to others who live on the Costa del Sol that healthcare here is very good.

Hospitals

When it comes to hospital care the UK is left standing compared to the Costa del Sol. This may be due to the fact that hospitals are jointly funded by the state and by the payments made by the health insurance companies but both types of patient receive equal treatment. The major hospitals are very well equipped, very modern and with state-of-the-art technology. The Costa del Sol Hospital in Marbella probably has one of the best cardiac units in Europe – partly due to an endowment from the Saudi Royal Family who have a ‘palace’ in Marbella and wanted to ensure their own health. Waiting lists are generally much shorter than in the UK, certainly for the more minor complaints.

Emergency care is second to none and we have only heard praise from patients who have experienced heart emergencies, strokes, cancer and other life threatening conditions. The only negative comments we have heard are that there are too many large meals served in the hospitals!

There are also very good hospitals in Malaga and in Seville with a number of smaller hospitals in other towns. This is however potentially one of the negatives with respect to hospital care on the Costa del Sol. The treatment may be superb but the centre of excellence to which you are sent may not be particularly close to where you live. This can be a problem especially when people want to visit you. One of our friends spent a couple of weeks driving 50 miles each day, each way to Malaga to visit her husband. Not only did this take time but it also cost her a lot on motorway tolls. Similarly another friend’s husband is currently being treated for cancer and his centre of excellence for treatment is in Jerez de la Frontera or Seville – a two-hour drive away.

In Spain it is the hospital service that, at the moment, is more interested in preventive medicine – unlike the UK where prevention of illness is now encouraged in general practice. This is a positive aspect of the hospital service but sometimes it can be a little bit too late to start advising on prevention after the illness has developed. One of my friends here who is a Spanish GP in the private sector has commented that preventive medicine must improve in the future in order to save money in the long term. He believes that general practice has to become more involved in preventive medicine and that it will happen.

Private healthcare

If you do not qualify for state healthcare you will need a private insurance policy but this is not as drastic as it might sound. Private healthcare in the UK is very expensive and usually only covers hospital care in private hospitals rather than in state hospitals. Private GP care is almost unheard of in the UK apart from in the expensive areas of large cities. In Spain the public and the private systems work side by side so the actual costs the insurance company may have to pay are probably lower therefore the insurance policies cost much less. As a result more people take out private policies.

In an earlier chapter, which discussed the cost of living, I recounted the fact that my supplier of private health insurance (through my company) invited me to continue the policy when I left the company. The monthly cost was £170. This was in the year 2000 so I shudder to think what it costs now. I declined their offer and returned totally to the state system.

When I arrived in Spain, I contacted various private insurers and finally took out a policy with one company which offers GP cover, hospital cover, emergency ambulance cover and one visit to the dental hygienist every year for about a quarter of that cost. The one thing it does not cover is the cost of prescriptions but generally they are not too expensive. I believe this is very good value for money and if it were available in the UK there would probably be a large number of people who would take up such an option. To be fair this monthly payment will rise by 20% when I reach the age of 60 and when I reach the age of 75 it will not be available but by then I will qualify for free healthcare anyway although I hope I will still be able to afford a visit to see a GP on the private system.

Many of our retired friends who live on the Costa del Sol do consult a GP privately – the costs are quite reasonable – and then fall back on the state system for the necessary treatment. A visit to the GP costs less than a meal for two in an inexpensive restaurant.

Doctors

The benefits to the private option are considerable. There are many doctors from northern European countries as well as Spanish GPs who have trained in other countries who now operate in the private sector, particularly in the larger cities, towns and resort areas and they all speak fluent English. This can make a visit to the doctor much less stressful, even if you speak Spanish.

The other major benefit to using the private sector for GP visits is that since you are paying for the doctor’s time and you are given time to discuss why you made the visit in the first place. It is not in and out in ten minutes!

Spain trains more doctors than it needs for the public sector so those doctors who cannot find employment in the state system are perfectly at liberty to set up in private GP practice. Our doctor here is Spanish but after Spanish training he moved to England where he worked in health service hospitals and in British general practice before returning to Spain to set up his own private practice. Private GPs in Spain are also able to advertise their services in the same way as any other professional and as a result there is competition between them which helps to keep the fees charged at an affordable level. Their services are totally professional but since they are running a business they also have to offer a service that the client will buy again.