# Spanish State Healthcare



## xicoalc (Apr 20, 2010)

The subject of healthcare comes up quite a lot here and I have seen people asking about the opinions of the state system. I had an experience yesterday that I feel justifies being posted.

For years I have had high blood pressure but done nothing about it(i know i know, silly). Anyway.. when I first came to Spain I had private but since I have been paying into the SS system for a couple of years now I decided to scrap the private and take my chances on the "nhs" if I needed it.

Yesterday I was taken ill... head pains like never before, I thought I was going to explode and my OH insisted on taking me to hospital to be checked. I have nothing but praise for the service of the Urgencias department staff. On arrival we informed the receptionist that I have a history of high BP and within seconds a nurse appeared with a wheelchair insisting that I sit down and relax. I saw a nurse within 5 minutes who checked my BP and it was literally off the scale.

Within a further 10 minutes I was with a Doctor who immediately gave me pills and told me they would check again in 30 minutes. The pills hadn´t done much so now was injection time and the injection seemed to start to reduce it.

They monitored me closely for a few hours before agreeing I could go home once the pain had subsided providing I saw my GP this morning which I did. He put me on pills and gave me a ticking off for not treating it sooner.

I think the bedside manner is a little different to NHS hospitals in the UK. They don´t mamby pamby about, they get on and do their job but they were very pleasant, ever so helpful, and tended to my situaion swiftly. They dealt with the problem, made me comfortable and safe and let me go home (although they offered a bed for the night if I wanted to that I could be monitored)...I declined the bed for the night and promised to return if the headache returned.

All in all... I was amazed by the service, amazed by the helpfulness of the staff and I have no regrets about going on the state system. Big thumbs up for the local hospital!:clap2:


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## xabiaxica (Jun 23, 2009)

steve_in_spain said:


> The subject of healthcare comes up quite a lot here and I have seen people asking about the opinions of the state system. I had an experience yesterday that I feel justifies being posted.
> 
> For years I have had high blood pressure but done nothing about it(i know i know, silly). Anyway.. when I first came to Spain I had private but since I have been paying into the SS system for a couple of years now I decided to scrap the private and take my chances on the "nhs" if I needed it.
> 
> ...


glad you're OK steve

& I agree - the bedside manner might be lacking compared to the UK - but I would rather have the cleanliness & efficiency - & the way they actually tell you what is going on, rather than the 'I'm the all knowing doctor/god & you just do as you're told without question' attitude of the docs in the UK


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## xicoalc (Apr 20, 2010)

xabiachica said:


> glad you're OK steve
> 
> & I agree - the bedside manner might be lacking compared to the UK - but I would rather have the cleanliness & efficiency - & the way they actually tell you what is going on, rather than the 'I'm the all knowing doctor/god & you just do as you're told without question' attitude of the docs in the UK


Yes.. the hosp i went to was fairly old but perfectly clean. I didn´t feel the urge to come home and shower immediately like I do when I visit uk hospitals!


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## bob_bob (Jan 5, 2011)

You must have had some truly awful UK experiences mate, but remember, looking clean and actually being clean are poles apart.


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## DunWorkin (Sep 2, 2010)

Steve, sorry to hear you have been unwell but glad to hear you are ok.

I agree with all that has been said about the health system here in Spain. 

I have been having a few health problems over the last couple of years. I started by going privately and attending the Levante hospital in Benidorm thinking that it would be better. How wrong I was. After about 9 months of having about every test known to mankind (and spending a small fortune) we were getting nowhere so I decided to go to the local clinic.

I spent a week in San Juan hospital and was really impressed by the cleanliness and efficiency of this state hospital.

Things are done differently here in Spain where a lot of the non-medical care is done by the patient’s family (including food). Outpatient visits to the hospital seem to be about the same as the UK in terms of length of time having to wait for an appointment.

I just wish I had gone to the state health system to start with.


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## xicoalc (Apr 20, 2010)

bob_bob said:


> You must have had some truly awful UK experiences mate, but remember, looking clean and actually being clean are poles apart.


Agreed but my ex was in and out of hospitals in the UK and we saw it all from an A&E cubicle with blood on the floor from the last patient, to young doctors who are bairly out of uni and clearly have no clue, to wards stinking, toilets with overflowing bins and urine all over the floors, and even doctors sending him home when he needed to be admitted so that they can keep their "3 hour" target in order (later he needed ambulance and his condition had deterirated so much he had to go to ICU).

Here it was clean, smelt of cleaning fluid in fact. The doctors were clearly very experienced, and found the rpoblem and dealt with it very fast whilst also assuring me that I would not be going home until I was out of the woods.

I guess in the UK there are good and bad hospitals, and probable the same here but all in all I think they are worlds apart on the things that matter!


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## xicoalc (Apr 20, 2010)

DunWorkin said:


> Steve, sorry to hear you have been unwell but glad to hear you are ok.
> 
> I agree with all that has been said about the health system here in Spain.
> 
> ...


Agree totally. I had surgery done at Levante hospital and actually I can´t really fault them for their surgical care. The surgeon was excellent although the nursing care was far worse than state healthcare. 

As for fees, I experienced similar to you... they did every test known to man before the operation as "pre op" tests... which at the time I wasn´t worried about because insurance was paying BUT clearly when it´s a business they milk it for every penny. I had a dog bite which I went to Levante for and it needed stitching...they dealt with it very well and faultlessly but they really dragged out the aftercare, and even wanted me to see trauma doctors all because the insurance was paying the mounting bilL!

All in all, would I go back to private... NO! State care dealt with me quickly, they were much more than I could ask for... even though A&E was heaving nobody was waiting hours.. they somehow were seeing people very quickly after arrival and getting the job done. They "process you" more than the UK... ship you into one room, then another, then back to waiting room etc instead of leaving you in a cubicle BUT it means people get seen faster. There were no people on trolleys in corridors either!

Also, which I thought was very good was that despite the hospital I attended not being in an area with many brits... when they knew I was english they were running round trying to get an english speaking doctor... despite the fact that my Spanish is not too bad and my Spanish OH was with me to help out... in the end I got a Spanish doctor who spoke no english apart from "have you made piss" because I told them I was happy with this but they showed consideration to the potential language barrier without even being asked!

Anyway I woffle again!.. Must do some work!


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## Pesky Wesky (May 10, 2009)

I haven't got any experience of British hospitals thank goodness, but people's comments about Spanish hospitals ring true. The treatment received has always been good and professional, but with a dry, even cold approach. This always comes as a surprise to me as the Spanish are so "tender" in other aspects, in their dealings with children for example. However, when my daughter was in hospital at three years of age there was none of that to be seen, just straight down to business. Still, as I said, professional treatment which is after all the most important.

Keep taking the tablets Steve , and take care of yourself! :kiss:


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## xicoalc (Apr 20, 2010)

Pesky Wesky said:


> I haven't got any experience of British hospitals thank goodness, but people's comments about Spanish hospitals ring true. The treatment received has always been good and professional, but with a dry, even cold approach. This always comes as a surprise to me as the Spanish are so "tender" in other aspects, in their dealings with children for example. However, when my daughter was in hospital at three years of age there was none of that to be seen, just straight down to business. Still, as I said, professional treatment which is after all the most important.
> 
> Keep taking the tablets Steve , and take care of yourself! :kiss:


Absolutely! If I had to choose between being molly coddled in a filthy hospital by doctors and nurses that a) don´t care and b) don´t know what they are doing OR have a doctor that is a little cold in his approach but knows his stuff and makes me better then I know what I would choose! The only complaint was when the nurse appeared with a syringe and was abotu to inject me... without saying what it was! But when I asked she explained everything and was lovely so all was good.

I will indeed take the pills... that was my warning so have to be a good boy now... pills and follow my HUGE list of things I can´t eat!


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## Alcalaina (Aug 6, 2010)

I was talking to a Spanish guy last night who was complaining there was no hospital in our town (population 5,600). The nearest one is half an hour away, but we have an excellent state Consultorio with 24 hour emergency care and three full-time doctors.

He thought England must be far better than Spain because he'd heard about the wonderful NHS. When I told him that hundreds of small local hospitals had been closed down to save money, and a town the size of ours would be lucky to have a district nurse, he was incredulous!


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## gerrit (Jul 15, 2008)

The one complaint I have is that dental care and mental healthcare are either not covered by the public system or have long waiting lists. For the dental care I don't mind the waiting list that much, but for the mental health I am forced to go private (AND state ... because my private psychologist cannot write prescriptions and thus communication between different people, sometimes with different opinions, is needed and not always smoothly) and it is very expensive (although not as expensive as in the UK where I paid about 50 GBP per hour, here I pay about the same numbers but in EUR which means it's at least a bit lower if we take conversion rates into account )

One of the action points of my political movement (well, "my", the one I joined I mean) is a more efficient healthcare by the state. Being in the far left it's a given we support state-supplied healthcare.

That said: my experiences with Urgencia were excellent, and the cost of medication is amazingly low. I pay 1.50 € for one box of Xanax while the same amount cost me about 20 € in my native Belgium  IMO Spanish healthcare is good to very good.

PS: mental health care is lacking in the entire Europe, in all countries I've been the system shows shortcomings, both public and private. So let's just say Spain should not be blamed when the rest of Europe also shows serious shortcomings. I heard Sweden and Denmark are the exceptions but cannot speak from experience there. And it's not worse in Spain than it was in the other countries I've lived in (in fact, my psychologist here is excellent, but she unfortunately is limited in movements because as a private consultant she cannot sign notes or prescriptions)


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## bob_bob (Jan 5, 2011)

I can't believe you've had such a bad time in UK hospitals, you must be the unluckiest patient going.

I've worked all over and there were one or two I'd not rush back to but on the whole they are very good in the UK. The worst was a Central London teaching hospital, it was filthy, no regular staff, all agency workers (me included); I'll admit that I only stuck working the five night shifts in A&E because it was bank holiday and I was on £50 and hour. Worked in some s**t holes in the States, many are not what the movies would have you believe.

Nursing is not an easy role these days, I'm glad to be out of it truth be told, so many patients and families are right pricks and wear you down in the end; you smile and do the best you possibly can but its not easy.

Hope you all keep well and have no need for the apparent awful NHS, I'm off in the morning so TTFN and I hope it all works out for Jojo, she's one of the nice guys and gals, give her my best wishes.

I'm so glad I did not move to Spain.


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## gerrit (Jul 15, 2008)

I lived in Belfast for 2 years, granted that calling this UK is a politically risky term but in healthcare terms you're in the UK system up there.

The only night I ever had to spend in the hospital in my life, was in Belfast. No rooms available so had to lay in a bed in a corridor with only curtains for some privacy. Upon arrival, even in emergency, I had to wait for 3 hours before being helped. The dentists were rude to say the least. The GP was a friendly guy and my therapist was an amazingly great woman, but the costs of the meds were about 12 or 13 times what I'm paying here in Spain for the same meds (what am I saying?? My dosage went up in the years between so I pay much less here for a higher dosage of medication)

I can only speak for Belfast, but the public system here in Spain is good to say the least. In Belfast I had quite a few bad experiences with healthcare. Gimme Spain anytime over NHS Northern Ireland! Maybe things are better in mainland UK than in N.Ireland, I won't comment on that.


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## Caz.I (Mar 21, 2009)

Well there is good and bad everywhere, and as with everything it varies where you are, and who your doctor is or who you see, and what the ailment is.

There are a lot of positives about the Spanish healthcare system, and it seems to be quicker when you have to see a GP or a specialist (apart from for smear tests - cos apparently there is a lack of gynaecologists (!)). And I think waiting times for referrals only got quicker here a couple of years ago when they built a small, local outpatients hospital. And when the GP does make a referral, you do get put through a series of tests and checks quite quickly.

But the thing I am most impressed with is being able to book a GP appointment over the internet or by text message with only a few days waiting time (once I even did it on the same day.). However, before this system (a few years ago) it was a question of going to the health centre and joining a massive queue just to ask for an appointment. And there was no point phoning because no one ever answered the phone! And in some of the hospitals in Malaga that still is the case so when you get a letter for your appointment as an outpatient and you want to change it, it is almost impossible.

The state mental health service down here doesnt seem be so up to date though, they seem to provide psychiatrists but not psychologists, so there is a gap there. Although the schools seem to have some kind of access to psychologists.

I have had some bad experiences though, with both GPs and emergency doctors, not because of their inefficiency or lack of bedside manner just their arrogance but that seems to be a common trait with doctors everywhere (and one here was English but was bilingual and he was horrible!). I had one bad experience when I was pregnant and a very bad one when I had an allergic reaction and was given medicine which made me worse (so I had to return to A&E in the middle of the night, face and lips swollen.) and although A&E was okay then (and there was _no_ other patients waiting!), when I saw the daytime emergency doctors (about 4 different ones in one day at one point, they ignored everything I was telling them and one forcefed me a tablet. I was getting more and more ill and the only thing that made me better was ignoring their advice, stop taking the tablets and listening to my own body.

Some people have great GPs, others not. And mine depends on her mood, which seems to vary quite a lot. I would go to another one but I dont know who is worse or better - because it so subjective. I have had many discussions about healthcare in my English classes with Spanish students and most joke that if you have anything wrong which your GP cant identify, they send you away with Ibuprofen or paracetemol - and that has been true for me on many occasions with my GP. Another Spanish student of mine, whose mother is a doctor (but not a GP) told me that GPs lose their bonus payments if they make too many referrals, so they are discouraged from doing so!

So it is good, but not perfect!


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## lynn (Sep 25, 2008)

Out of interest, how does this booking an appointment online work? I haven't got a green card, as we have only got the reciprocal health cover which only sends you a piece of paper?? I've never had to make an appointment to see the doctor, we have only ever gone to the emergency department for a couple of things... I wouldn't actually know how to make an appointment to see the doctor for a routine thing!??


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## TheHendersons (Feb 22, 2011)

I have been wondering the same Lynn.. I would be interested to hear!


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## Pesky Wesky (May 10, 2009)

TheHendersons said:


> I have been wondering the same Lynn.. I would be interested to hear!


If you're in Andalucia you go to this page and click on cita medica.
Portal de Salud
I can't go any further because it keeps saying "Esta conexión no está verificáda", but I think that's my computer maore than anything
For Madrid it's here
https://www.citaprevia.sanidadmadrid.org/mobile/(S(wr4bcqimrndkisi1fq24212x))/Forms/Login.aspx

Not all health centres are on this yet though...


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## xicoalc (Apr 20, 2010)

For us its the valencian givornment website. They have it in many languages. There is also a number on the back of my SIP card that I can call for an appointment 24/7 and its one of those automitic voice recognition things, but its in english and very accurate... in the last week I have seen the doctor a couple of times, and even when trying at midnight you always get an appointment for the very next morning which is far better than the UK where at my old practice the receptionist seemed to take on the role of deciding who needs urgent appoinemtns and who doesnt and often you could wait a week!

To book online or on the phone you do need a SIP number in this area, so if you don´t have one I don´t know how it would work... when you say you are on recipricol care, do you mean EHIC? If so then you won´t get a GP If you have ongoing recipricol care document from england then I would take this to your local centro salud who should issue with a Tarjeta Provisional meaning you can see a GP.


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## DunWorkin (Sep 2, 2010)

Here in Comunidad Valenciana, you need to be registered with a doctor and have a SIP health card and number to make an appointment online.

On the Conselleria de Sanitat web page you go to "Solicitud de cita en Atención Primaria - Cita por Internet". You type in your SIP number and select a day and time from the available ones listed.

There is a page to print out to take with you when you go to the appointment to show you have booked.

This is a very good system and is escpecially useful to anyone whose telephone Spanish is not so good (like me ).

Edit : Steve obviously types quicker than me LOL


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## Alcalaina (Aug 6, 2010)

Pesky Wesky said:


> If you're in Andalucia you go to this page and click on cita medica.
> Portal de Salud
> I can't go any further because it keeps saying "Esta conexión no está verificáda", but I think that's my computer maore than anything
> For Madrid it's here
> ...


We are in Andalucia too - the online booking system didn't work until we got our cards, but the telephone booking did. You need your NIE and the SS number you get when you register at the health centre.


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## Alcalaina (Aug 6, 2010)

lynn said:


> Out of interest, how does this booking an appointment online work? I haven't got a green card, as we have only got the reciprocal health cover which only sends you a piece of paper?? I've never had to make an appointment to see the doctor, we have only ever gone to the emergency department for a couple of things... I wouldn't actually know how to make an appointment to see the doctor for a routine thing!??


Have you actually registered at a clinic?


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## xicoalc (Apr 20, 2010)

DunWorkin said:


> Edit : Steve obviously types quicker than me LOL


faster btu moer msitakse!


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## Pesky Wesky (May 10, 2009)

What is the SIP???????????

(You've told me before but I don't remember.......)


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## lynn (Sep 25, 2008)

Alcalaina said:


> Have you actually registered at a clinic?


Well, no, we haven't this time.. The first years cover was on an E111 form and we took that into the healthcentre and registered (but they only registered us on the system for 6 months, and didn't give us a card). This year was done with an S1 form, and that was sent back stamped, with a covering letter saying:

'Cada vez que necesite Asistencia sanitaria, debera entregar fotocopia de dicho Formulario al Centro de Salud de la Seguridad Social.'

I don't have an SS number as far as I can see....


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## Caz.I (Mar 21, 2009)

lynn said:


> Well, no, we haven't this time.. The first years cover was on an E111 form and we took that into the healthcentre and registered (but they only registered us on the system for 6 months, and didn't give us a card). This year was done with an S1 form, and that was sent back stamped, with a covering letter saying:
> 
> 'Cada vez que necesite Asistencia sanitaria, debera entregar fotocopia de dicho Formulario al Centro de Salud de la Seguridad Social.'
> 
> I don't have an SS number as far as I can see....


If you don't have a SS card then you won't have a SS number, which you need to use the online booking system (as well as your NIE number and DOB). 

It sounds like you are only registered for emergency healthcare, if it is based on the E111/S1( S1? what is that?) European agreement for providing healthcare to a UK citizen. In the health centres here you have to show your card when you make an appointment in person (or give the number over the phone - I think they have improved the phone lines too as they have a separate number especially for making appointments.) Normally you have to have paid into the Spanish social security system to get a social security card.

If that is right then you wouldnt be able to book an appointment online.


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## lynn (Sep 25, 2008)

Caz.I said:


> If you don't have a SS card then you won't have a SS number, which you need to use the online booking system (as well as your NIE number and DOB).
> 
> It sounds like you are only registered for emergency healthcare, if it is based on the E111/S1( S1? what is that?) European agreement for providing healthcare to a UK citizen. In the health centres here you have to show your card when you make an appointment in person (or give the number over the phone - I think they have improved the phone lines too as they have a separate number especially for making appointments.) Normally you have to have paid into the Spanish social security system to get a social security card.
> 
> If that is right then you wouldnt be able to book an appointment online.


Apologies Caz, I quoted the wrong form: we used the E106 not 111 last year, and the S1 has replaced that. This is not just for emergency cover. It is for reciprocal healthcare for up to 2 and a half years based on NI contributions paid in the UK before we moved over here. But we registered with the healthcentre last year, and never got a card. I'm not sure what we do next?


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## Caz.I (Mar 21, 2009)

lynn said:


> Apologies Caz, I quoted the wrong form: we used the E106 not 111 last year, and the S1 has replaced that. This is not just for emergency cover. It is for reciprocal healthcare for up to 2 and a half years based on NI contributions paid in the UK before we moved over here. But we registered with the healthcentre last year, and never got a card. I'm not sure what we do next?


I am not sure about the ins and outs of the E106 etc but I think you need to go to the Social Security office (first thing in the morning - or earlier lol) as they issue the cards. Show them the letter and just ask nicely  when they think you will receive the cards for you and your children?


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## xabiaxica (Jun 23, 2009)

Pesky Wesky said:


> What is the SIP???????????
> 
> (You've told me before but I don't remember.......)


it's what we call the medical card here in Valencia

SIP


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