Health Care in Spain

This Sunday in Spain I am going to be watching the health care vote in the United States. Whether it passes--and whatever it may be that eventually squeaks through--it will still be years, or decades, before the U.S. has overall health care as good as that in Spain.

The key word, of course, is "overall." The U.S. has excellent health care for those who can pay. It's just that fewer and fewer individuals and companies can afford to pay exorbitant rates for health insurance and procedures. In Spain, if you are a legal resident, you can get pretty good health care for free, and if you want to pay, you can get health care equal to the best in the world. Spain has a public healthcare system that is administered through its 26 autonomous regions. That's why, when we moved from Roquetas de Mar in Andalucía to Alicante in the Valencia region, we had to get new health cards. Spain also has a thriving industry of private healthcare providers. I have used both public and private services during the years I have been in Spain.

This week I was approved in the public system for a cataract operation. Yes, I have to wait. There are three boxes on my authorization form: my condition is not Urgent, nor is it Preferred. It's just Ordinary. Within three months, the ophthalmologist at my regional Centro de Especialidades told me, I will get a phone call from the Vega Baja hospital. Then I will go in to talk with the specialists there, and it may take up to a month after that before the operation can take place. Well, I don't mind waiting, since with my particular eye history and my complicated schedule, I'm not quite ready to look this laser in the eye just yet. But it is amazing to me, as an American who has experienced several private insurance plans over the years, been in a few HMOs, and paid a lot for private individual insurance, to think that I might have this surgical procedure without producing money or processing paperwork. All I have to do is show my card.

All my previous eye care in Spain has been through private providers, because it occurred before I became a legal resident and obtained my health card. It was excellent, with the most up-to-date equipment and knowledgeable personnel. Because I had experienced the same procedures in the U.S., I can say that the Spanish care was equal to that in the U.S. The costs, though considerable, were significantly less--about half.

I have also used private care for a couple minor walk-in problems--a bad back spasm, a mysterious skin rash--and paid prices that I believe are comparable to what I would pay in the U.S. as a non-insured patient. When I severely twisted my ankle on a Saturday night just before getting ready to leave for Argentina on Monday, however, I went to the public clinic, because it was open on Sunday, and they sent me on to the public hospital for X-rays, binding up, and prescriptions for crutches, a painkiller, and injections to avoid complications during air travel. Since I did not at that time have my health card, I got a bill for that service a few weeks later, payable to the teller at the corner bank--a total of something like 117 euros and some cents, obviously the amount that some accountant has figured that particular event costs the system.

I do have some complaints about health care in Spain. Over-the-counter medications are expensive, so my suitcase on returning from the U.S. is always packed with the Meijer or Target equivalent of aspirin, vitamin and mineral supplements, and Ocuvite (which I can get here, but at more than twice the price). Medications prescribed by a private practice are also expensive, but the same compound prescribed through the public system is free. Dental care is not a part of the public system, so there is lots of competition among lots of dental practices.

Spaniards can buy medical insurance if they want to use the services of private practices, and judging from the number of Spaniards I have seen in the waiting rooms of the private clinics I have been in, they do. Private practices are also heavily used by foreigners who do not have access to the health card or who prefer medical staff who speak their own language, or at least English.

Public and private health care seems to work quite well in Spain, providing several options for the diverse population. I expect to continue to be a consumer of both. I wish the options were as good for people in the United States.