We are often asked about state Spanish healthcare. Is it any good? Are there long waiting lists? What if I don’t speak Spanish? Are the doctors and nurses helpful? What about serious operations? Well, let me put your minds at rest by telling you that Bloomberg’s latest report on world healthcare places Spain at No 3 for efficiency of patient care and 8th of 195 countries for patient care. That’s above France at no 88 and the UK at no 30. Statistics are all well and good but what is the health service in Spain really like? I have lived 12 years in Catalonia and unfortunately have had to call upon medical services far more often than I would like, so I am going to tell you my experience here from day one.
CAP or Centro de Salud – Health Centre
Every town has a national health centre called the CAP. Here you‘ll find GPs, pediatricians and gynecologists. This is frontline medical care. Having signed onto the padrón at your town hall and with the other usual documents you can go to the CAP and request to be put on a doctor’s list. Then, you can access Spanish healthcare.
My first doctor was a charming man who spoke excellent English. (Not all doctors do, so say you need a doctor who does). His job was to assess whether my medical problem could be treated there or whether I would need to see a specialist at the local hospital, which in my case is in Palamòs. He was a caring and excellent GP and we got on very well. Owing to an ongoing serious problem, I was directed to a specialist and both she and I met on our first day at Palamòs hospital. Once again, I had a wonderful doctor with perfect English who cared for me for 4 years until she was moved up to higher things in the capital city of the province, Girona.
I moved to another town and had to enroll again at the local CAP. This time I was assigned a quite unpleasant lady doctor who didn’t speak English which didn’t matter as I speak Spanish but who was distinctly unsympathetic. I was advised by a Spanish friend to write a letter to the head of the CAP asking to be transferred to another GP and giving my reasons why. This was quite a delicate letter to write as I didn’t want to appear rude or difficult but needed to change doctors.
Shortly after, I was put under the care of a really good and helpful doctor who, as it happens, had been a GP in Liverpool for 9 years and so spoke English. She has been my doctor ever since and I cannot complain about her care for her patients. The only problem with her is that she ignores the time rule for each patient and spends however long the patient needs with them and that makes her very late for each person coming to see her afterwards. To get round this, I try to get the first appointment in the morning or afternoon, which often means getting up early to be there by 8.00 a.m.
The system of taking blood tests here is quite unlike the UK. Around 50 people are given appointments between 8.00 and 9.00 am and wait altogether in a room for their name to be called. Then with phials in hand, you wait in a queue to have blood taken, It isn’t cosy but it is very quick and efficient. I’m usually out within 20 minutes of arriving.
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Prescriptions are not free in Spain. Each region has its own rules and the payment will depend on your income tax return for the previous year. Most pensioners will pay around 10% if their annual income can be shown to be less than €18,000 and the amount is capped at €8 a month. If you are not taxed in Spain, you will have to pay the full cost though there are companies that will cover some of the costs – they are called mutuas. Working people and those with an income of more than €18,000 are expected to pay 50% of the cost. Non pensioners who have an income of under €18,000 will pay up to 40%.
In Spain you can buy many medicines at a chemist without a prescription, far more than in the UK. There are no national chemist chains as the pharmacist owns his pharmacy with limits to the number allowed in each town. There is always a chemist on duty 24 hours a day and each pharmacy is placed on a rota to provide this service.
The CAP is open 24 hours for emergencies. I am asthmatic and have been seen immediately on the rare occasions that I have had a serious attack. The staff are quick to respond to the most urgent situations. Otherwise I have to wait until serious cases have been seen to, which is fair enough.
Local Spanish healthcare
Each area has its own state-run hospital plus several private ones. As I mentioned, my local hospital is in Palamòs, about 10km from where I live. All medical services are available here, from emergency to trauma specialists, rheumatologists, pulmonologists and oncologists. The local hospital will usually take care of operations and after care. Palamòs was recently extended by adding a floor onto the existing building to provide more rooms for patients as the local population has increased significantly since it was built in 1986.
The upgraded emergency department is excellent and people are seen according to the urgency. Since the financial crisis in 2008 there is no doubt that waiting times for an appointment have increased but are usually between two and three months unless extremely urgent. I might get a phone call to tell me that I should come in for an x-ray at 7.45 pm or on Saturday at 8.00 am, or I might receive a text message. Sometimes I even get emails stating the time of an appointment. There is always a follow up text to remind me a couple of days before the due date. The system is very efficient and I’m always given a telephone number to call in case I have to change the date or time.
I spent nine days in Palamòs Hospital in 2009 suffering from double pneumonia. I took myself to A&E. After some hours it must be said, I was admitted as an in-patient. In Spain there are no wards as such, but rooms for two people with a shared bathroom. It is a bit of a lottery as to whom you will share the room but always with someone of the same sex. There is also a TV in the room which in most regions is paid for by the patient. This can be both a blessing and a curse as if your neighbour has paid, he or she can watch it for as long as they want, often at full blast! Nowadays, you can take your laptop or Ipad plus necessary earplugs and watch whatever you want.
Another thing you should know is that it is a long held tradition in Spanish healthcare that the person in hospital is accompanied by a family member 24 hours a day! This means that there will probably three of you in the room all the time. Once upon a time this was expected, but now it is not mandatory as people work away from their hometown. I try to make friends with my neighbour and their extended family – it makes for a much easier stay and often you get to meet interesting people.
Visiting hours are generally in the afternoon until 9.00 pm. This can be quite a noisy time, hence my advice to take good quality earplugs or headphones. The food in hospitals has much improved since 2009 and is generally quite palatable. In some cases you can choose your meal from a menu but usually it just arrives. Each day you get breakfast, lunch, a snack at around 6.00 pm and then dinner.
Last month I had to go to the university hospital in Girona for an operation on my spine. It was a long process to be honest with numerous visits to Palamòs to see various specialists, x-rays. MRI scans, a visit to a private clinic in Girona (paid for by the Spanish health service) and finally visits to the hospital in Girona to see the surgeon. All in all, this took a couple of years with 11 months from seeing the surgeon to the actual operation.
This type of operation is highly specialised and Palamòs doesn’t have the doctors to do it. The hospital in Girona is a centre of excellence for many conditions including heart, cancer and spinal problems. Dr. Trueta Hospital has a helicopter service, often used for cases of heart attack and road accidents. It is older than the hospital in Palamòs but has an excellent reputation. The problem they have is that there aren’t enough doctors and medical staff, which makes for long waiting lists. In fact they were short of six anaesthetists in October, when I was originally called for my operation and after a very long wait, prepped and ready, the operation was cancelled! My surgeon was devastated but obviously the operation couldn’t go ahead without an anaesthetist. My guess is they need to pay more to keep them.
3 weeks later, I had my operation and found myself in a room with a charming elderly lady and various members of her family who took turns to be with her. She had fallen and had broken her femur and waited 24 hours for her operation. The nursing staff and assistants were caring and kind to us both, apart from one rather brusque night nurse and within four days I was allowed home. I did not mind being alone and a couple of friends came to visit me on the Saturday. I speak Spanish so communication was not a problem and I discovered that several of the nurses spoke English and in fact wanted to practise with me.
If you are alone in a hospital in Spain, try a little Spanish if you can but you will always find someone with English to help. Here in Catalonia there are two official languages, Castilian (‘Spanish’) and Catalan. Some of the older nurses preferred to speak to me in Catalan which I understand but don’t speak well. I asked them to use Castilian and they did, perhaps reluctantly.
One of my sons came from London to take me home & spent 3 days with me. His brother came from Italy to take over for 5 days. They would not have allowed me to leave hospital so quickly if I had gone home alone. Once home, I was under the care of the CAP. A nurse came to change the dressing and I went there to have the 23 staples removed from my back. If I needed anything, I contacted them. My GP rang to tell me I could drive again which was very welcome news. A month after the operation, I have an x-ray and an appointment with the surgeon in Girona to check that all is OK and another in February, 3 months after the operation.
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Apart from the cancelled operation, I cannot find much fault with Spanish healthcare, which has seen me through many difficult times. A nice bedside manner is sometimes lacking. However, their attitude is “we are here to cure you” and that is what they do extremely well. I have no qualms in saying that I am happy to be under their care and wonder whether I might have received such excellent treatment in other countries.