# Can you use both public and private healthcare?



## AllHeart (Nov 22, 2013)

Is a patient allowed to use both public healthcare and private healthcare? Or do you have to choose between one or the other? Also, are there doctors who are both public doctors and private doctors? Or do they also have to choose between one or the other?


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## xabiaxica (Jun 23, 2009)

AllHeart said:


> Is a patient allowed to use both public healthcare and private healthcare? Or do you have to choose between one or the other? Also, are there doctors who are both public doctors and private doctors? Or do they also have to choose between one or the other?


of course you can use both

I don't know if general family doctors work in both the public & private system at the same time - I suspect surgeons do though


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## kalohi (May 6, 2012)

AllHeart said:


> Is a patient allowed to use both public healthcare and private healthcare? Or do you have to choose between one or the other? Also, are there doctors who are both public doctors and private doctors? Or do they also have to choose between one or the other?


Yes you can use both, and yes there are doctors who work in both systems. 

I use both private and public healthcare all the time. No problem, except that the public healthcare doctors won't usually accept diagnoses or test results from private doctors or clinics. 

Many of the doctors who work privately are also working in the public system. Only if they take on an administrative role in the public system (eg Head of Oncology at XXX Hospital) do they have to agree not to work privately.


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## AllHeart (Nov 22, 2013)

Thanks for your answers, Kalohi & Xabiachica. We don't have private healthcare here, so I'm new to the idea of both public and private healthcare.

So inasmuch as patients and physicians can use both systems, since public doctors don't accept diagnoses or test results from private doctors, you're really limited to either public or private healthcare, right? Put another way - why would you use both public and private, if they won't share information?


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## kalohi (May 6, 2012)

AllHeart said:


> So inasmuch as patients and physicians can use both systems, since public doctors don't accept diagnoses or test results from private doctors, you're really limited to either public or private healthcare, right? Put another way - why would you use both public and private, if they won't share information?


I find that the public system is better for primary care. I can be seen by my Social Security GP the same day if it's urgent and within a few days if it's not. However I might have to wait a few weeks to be seen by a private GP, even if it's urgent. Also, prescriptions are partially subsized in the public system but not at all in the private system, so I see my Social Security GP for prescriptions for medications that I have to take regularly.

I find the private system is often better for specialists. Here in our area there are long waiting lists (up to 6 months sometimes) to get in to see a specialist, but in the private system I can be seen in a few weeks. I also get to choose my specialist in the private system, so if I don't like one specialist I can decide to see a different one. In the public system you get who you get, and you have no recourse for a second opinion.


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## Alcalaina (Aug 6, 2010)

kalohi said:


> I use both private and public healthcare all the time. No problem, except that the public healthcare doctors won't usually accept diagnoses or test results from private doctors or clinics.


Mine does.


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## baldilocks (Mar 7, 2010)

AllHeart said:


> Thanks for your answers, Kalohi & Xabiachica. We don't have private healthcare here, so I'm new to the idea of both public and private healthcare.
> 
> So inasmuch as patients and physicians can use both systems, since public doctors don't accept diagnoses or test results from private doctors, you're really limited to either public or private healthcare, right? Put another way - why would you use both public and private, if they won't share information?


I was under ophthalmology in the public sector at Granada and went to see the specialist privately in Alcalá la Real. He changed my medication and it was accepted in the public sector.


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## Alcalaina (Aug 6, 2010)

Forgive me AllHeart, I'm sure you've told us before but how are you going to be eligible to register for State healthcare? Do you have a job?


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## Alcalaina (Aug 6, 2010)

AllHeart said:


> Thanks for your answers, Kalohi & Xabiachica. We don't have private healthcare here, so I'm new to the idea of both public and private healthcare.


Yes you do!


Healthcare in Canada - Private Sector


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## AllHeart (Nov 22, 2013)

Thanks for your replies. Seeing that your replies differ, since healthcare is regional, perhaps the rules of sharing between public and private healthcare are different between regions. Perhaps it varies also between doctors.




Alcalaina said:


> Forgive me AllHeart, I'm sure you've told us before but how are you going to be eligible to register for State healthcare? Do you have a job?


Yes.



Alcalaina said:


> Yes you do!
> 
> 
> Healthcare in Canada - Private Sector


I've lived in Canada for 49 of my 50 years. I suggest you do better research than quoting Wikipedia before challenging me.  I've already discussed on the forum what is public healthcare in Canada, and have no desire to readdress that. And, yes, I'm in a pissy mood today.


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## kalohi (May 6, 2012)

AllHeart said:


> Thanks for your replies. Seeing that your replies differ, since healthcare is regional, perhaps the rules of sharing between public and private healthcare are different between regions. Perhaps it varies also between doctors.


This could be. All I know is that at my Social Security health center there are signs all over the place saying that they will not write Social Security prescriptions for medications prescribed by private doctors. And my own doctor has refused to look at tests and xrays that I've brought him from private clinics.


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## Alcalaina (Aug 6, 2010)

AllHeart said:


> I've lived in Canada for 49 of my 50 years. I suggest you do better research than quoting Wikipedia before challenging me.  I've already discussed on the forum what is public healthcare in Canada, and have no desire to readdress that. And, yes, I'm in a pissy mood today.


The Canadian system is admirable compared to the USA, but it's misleading for you to say "there is no private healthcare in Canada" when 27% of the population have private health insurance. If you don't trust Wikipedia, try Canadian Business News:

Private health-care services growing in Canada


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## xabiaxica (Jun 23, 2009)

kalohi said:


> This could be. All I know is that at my Social Security health center there are signs all over the place saying that they will not write Social Security prescriptions for medications prescribed by private doctors. And my own doctor has refused to look at tests and xrays that I've brought him from private clinics.


our doctors in the state salud here will always run their own tests as well - they'll look at something you might have had done privately, wrinkle their nose, turn down their mouth - & tell you to pass by the mostrador to have an appt made to have them done all over again!


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## AllHeart (Nov 22, 2013)

Alcalaina, there is nothing wrong with the Wikipedia article, and I never said there was. The problem was your introduction to that article as evidence of private healthcare. The Wikipedia article is an excellent summary of public healthcare in Canada and what is not covered under public healthcare. It's also an excellent summary of the debate in Canada in the right for private healthcare that has gone all the way to the Supreme Court of Canada. You should read the articles you quote before you summarize them in a sentence. It's very odd that you would think that I don't know the healthcare system I've been living in for 49 years. Similarly, I don't know the healthcare system in Spain, and don't presume to be in a position to instruct people living in Spain as to what their healthcare system is - I ask questions.

Kalohi & Xabiachica, thanks for your replies. It's not what I wanted to hear, but there it is. I'm worried about this division between the two healthcare systems in Spain, because I have to use private healthcare until my ID comes in for public healthcare. Oh well. I guess I'll just have to suck it up and hope it isn't too complicated.


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## larryzx (Jul 2, 2014)

Some years ago I was going to pay for breast reconstruction for a Spanish friend. She had had a cancer operations several years previously and was naturally very aware of her loss. It was just as a kindness that I was going to pay. When we spoke to the specialist he said there would be no problem with me paying for the operation but he pointed out that if anything went wrong with the operation (at the time or in the future) then my friend could not get follow up assistance on the National Health.

I decided not to proceed with what might have been a life long commitment.

The good news was that very soon after, my friend was contacted by the National Health Service and offered the reconstruction. I suspect the specialist understood the situation and 'inspired' the follow up. 

So whilst one can have private or state funded treatment, they are not ‘interchangeable’.


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## AllHeart (Nov 22, 2013)

Larryzx, I don't know the details behind the reasoning for not allowing followup in the public system of a procedure done in the private system, but perhaps it has to do with some of the logic I've heard in Canada behind the debate of a private system. One of the things I've heard is that the public healthcare system would be burdened with having to clean up the messes in the private healthcare system. So say the plastic surgeon botched up the reconstructive surgery, then the public healthcare system would have to absorb the cost of cleaning up the mess. 

I was thinking about another point in the debate in disallowing tests between the two systems. It may be that there are different testing techniques between the public and private systems in Spain. I see this even amongst the healthcare workers that I use. So an ultrasound, blood work, x-ray, etc from one hospital/clinic sometimes use different testing techniques. So typically I have to go to the specified diagnostic centre that the doctor orders the test from.

I'm really worried right now about moving to Spain. One of the biggest reasons I have to leave Canada is because I'm very sick and I'm getting sicker because I'm not getting proper healthcare here. I don't know how good the healthcare is in Spain, but I know for sure I will not get better here. Like Spain, healthcare is divided in sections, specifically provinces. I live in the Province of Ontario, and the government has a monopoly on healthcare here, i.e. there is no private healthcare for me to turn to for help. Four years ago I started getting really sick and kept going to the doctors telling them my many symptoms. My symptoms were repeatedly misdiagnosed and/or dismissed. I got so sick to the point of almost dying when they finally diagnosed Graves' disease and thyrotoxicosis. Graves' disease is an autoimmune disorder that, left untreated, basically shuts the whole body down. So at the point of near death, I was finally treated. 

Also, for 20 years, I've been suffering from neurological and muscular symptoms that have become progressively worse. Again, my symptoms have been repeatedly misdiagnosed and/or dismissed. Starting in January of this year, I finally got tests done that are showing a lot of pathology in my spine. A few weeks ago, EMG and nerve conduction tests showed nerve damage in my feet. At this point, I'm in agony from head to toe and I can't walk much because of the cramping and numbness in my feet. 

For both of these sets of problems, it has been absolutely, unequivocally hell to get any tests done because the doctors have dug their heels in the ground for their misdiagnoses. So they have refused testing. I have had to fight tooth and claw to finally find doctors who would listen to me and who believed me. For a doctor to go against the opinion of another doctor is like getting water from a stone. It is safer for a doctor to hang the patient out to dry than it is to compromise their career by challenging a colleague.

At this point, I have been on provincial disability for three years trying to get to the bottom of my health problems. I'm at the point where I can work 10-12 hours a week, which is just enough money to survive on in Spain. I've managed to save up some money because I'm very good at budgeting, which is enough to give me a couple of months off work in Spain to settle in.

Yesterday I learned that in 2013 the World Health Organisation rated Canada's healthcare system as 30th in the world, and Spain as 7th. This offers me hope. However, from what you've said here in this thread, I just hope to God that I'm not relegated to the same politics and ineptitude in the public healthcare system. I'm really concerned about what you say in this thread that, even if I have the money to do a test or appointment here and there in the private system if I need to challenge the doctors in the public system, the public doctors may not listen anyway. In other words, a person is relegated to either the public system or the private system. If that's the case, I may be in the same situation in Spain as I'm in here in Canada. My only hope is that the public system in Spain is a good one. This is part of the debate, which is called a 'two-tiered' system - a system for the rich and a system for the poor.

So that's a little more of my story. Alcalaina, perhaps you can understand now why I ripped your head off. I hope you accept my apology for being so harsh with you.


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## Alcalaina (Aug 6, 2010)

Well, I think you are right to be worried. Although the state system in Spain is very good it has suffered a lot over the past five years of spending cuts. In my region (Andalucia) this has manifested itself in fewer staff and longer waiting times. So although the quality of care may not have declined, access to it has become more difficult. 

For example, the consultorio in my town used to have two full-time family doctors; now it has one a day on a rota system. So if I want to see the doctor I am registered with, I have to make an appointment on a Thursday, and hope that he's not called out on an emergency.

That's why we are also registered with a private medical centre where we can get instant access. My husband, who is Type 2 diabetic, had a crisis with his blood sugar recently and would have had to wait nine weeks for a consultation with a specialist in the state system; at the private clinic he got one the same week and had all the tests done straight away. 

Our doctor in the state system accepted those diagnoses and test results, and was able to prescribe the medicines recommended by the private consultant. So my husband is able to get them for €4 a month on prescription instead of €65 which is the full price.


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## larryzx (Jul 2, 2014)

Alcalaina said:


> Our doctor in the state system accepted those diagnoses and test results, and was able to prescribe the medicines recommended by the private consultant. So my husband is able to get them for €4 a month on prescription instead of €65 which is the full price.


I have always lived in Andalusia. In each of the medical centres I have used there have always been (25 years plus) notices informing that the health service doctoprs are prohibited from re-writing private prescriptions so that patients can get the medications on the health service. However, there has always been a certain 'elasticity' with this !


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## brocher (Mar 21, 2011)

Allheart, if you haven't already done so, find the recent thread about nursing care, or lack of it, in Spain. It seems that family/ friends have to provide almost all care should you be hospitalised in Spain. You might want to consider how you would deal with such a situation should it arise.


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## larryzx (Jul 2, 2014)

brocher said:


> Allheart, if you haven't already done so, find the recent thread about nursing care, or lack of it, in Spain. It seems that family/ friends have to provide almost all care should you be hospitalised in Spain. You might want to consider how you would deal with such a situation should it arise.


In my experience of 4 private hospitals the need to have someone providing the non medical care is important.

On one occasion in a private hospital, I was lying on my back after an operation in a private room. I was alone. I had a drain in one arm and a drip in the other. I needed a pee. The nurse brought the bottle, put it on the table (over the bed) and left. I had to sort out how to have the pee.

Later when the food came, Again it was put on the table and I was left to tear at the meat with my hands and teeth, as I was unable to use the knife and fork.

I brought the problem to the attention of senior management at the hospital and was assured 'they would take it on board'. A year or so later I was due to have another operation in the same hospital. I checked and was told that the help I needed would be available. It was not !


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## Madliz (Feb 4, 2011)

There's an informative discussion about personal care in Spanish hospitals in this thread:

http://www.expatforum.com/expats/spain-expat-forum-expats-living-spain/268129-word-warning-all-i-want-move-spain-ers.html

It should be required reading for everyone considering the move as it is not covered in the guide books and perhaps comes under the heading of 'things one doesn't talk about' or 'it won't happen to me' but unfortunately it sometimes does.


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## Alcalaina (Aug 6, 2010)

larryzx said:


> I have always lived in Andalusia. In each of the medical centres I have used there have always been (25 years plus) notices informing that the health service doctoprs are prohibited from re-writing private prescriptions so that patients can get the medications on the health service. However, there has always been a certain 'elasticity' with this !


He didn't exactly rewrite a private prescription. The specialist wrote him a note recommending what he should prescribe, given the test results. I know a couple of other people where the same thing has happened. I don't if it's just our consultorio bending the rules, or whether it's discretionary and each one has its own policy.


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## larryzx (Jul 2, 2014)

Alcalaina said:


> He didn't exactly rewrite a private prescription. The specialist wrote him a note recommending what he should prescribe, given the test results. I know a couple of other people where the same thing has happened. I don't if it's just our consultorio bending the rules, or whether it's discretionary and each one has its own policy.


I am just about 100% certain it's bending the rules.

. At one time I used to consult my NHS doctor privately. When he gave me a prescription in a private consultation I used to take it to him at the Ambulatoria and ask him what medication (as my NHS doctor) he would suggest. He always gave the prescription but with bad grace !


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## Alcalaina (Aug 6, 2010)

larryzx said:


> I am just about 100% certain it's bending the rules.
> 
> . At one time I used to consult my NHS doctor privately. When he gave me a prescription in a private consultation I used to take it to him at the Ambulatoria and ask him what medication (as my NHS doctor) he would suggest. He always gave the prescription but with bad grace !


Ah well, a lot of rules do get bent in Alcalá, it's an elastic sort of place. :thumb:


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## AllHeart (Nov 22, 2013)

Thanks so much for all your replies and stories. You're most helpful, as always. 

I'll have to hope for that elasticity is the healthcare providers I use. Or that my healthcare won't rely on it.

Yes, I read and participated in that thread cautioning about the lack of nurses in healthcare in Spain, and that family help is relied upon. That thread was back when I first started this forum. I was (and am) very surprised to hear that, and that is just another reason that I'm hoping to find my family in Spain. The first couple of months of settling in includes making attempts to find my family there. 

Government cutbacks in healthcare are a problem in Canada too. Cutbacks directly translate into less healthcare provided. At the same time, healthcare costs rise as treatments and tests become more sophisticated and expensive, especially with aging populations (which is seen in many developed countries). So increased costs and decreased budgets cause a real downward spiral of healthcare. So, like in Canada, people become appalled by the public healthcare and demand the right to private healthcare. The provinces of Quebec and British Columbia have fought hard to be allowed to have private healthcare and they're starting to provide this, but it's still in its infancy. How can the private sector compete with the government, when it is the government who has bottomless pockets into taxpayers' money and when it's the government who makes and regulates the laws? That's some pretty stiff competition. So, like others, I predict it will be a long, long way off before we see any substantial private healthcare system in Canada. 

I've been under intense rehab for several months now, and some of my symptoms are getting better. But according to the neurologist who I saw few weeks ago, we're just treating the symptoms, not the cause, meaning there is something else very wrong going on, but we don't know what yet. So at this point there are three scenarios that I see. One scenario is that I stay the same and am able to work for another 15 years part time, then qualify for Spanish and Canadian pensions. Another scenario is that I get better and can work even more than just being able to get by. The third scenario is that I get worse and cannot work. If I can't work, fortunately I did work up until three years ago, so I will qualify for Canada Pension Disability. I already checked it out and found out that if I go on Canada Pension Disability, as a Spanish citizen, I will qualify for Spanish public healthcare. So all three scenarios are doable in Spain.

Before I started getting really sick, I had already made the decision for many other reasons to move to Spain. One of the main reasons was that I was at a time in my life that I had done and seen everything in Canada that I wanted. So Spain offered an exciting alternative for a very different life. Then I got sick four years ago, then really sick three years ago, then almost died two years ago from my Graves' disease. Two years ago, thankfully I came under the care of an amazing endocrinologist who saved my life. As anyone who has had a near-death experience knows, this is a time of real reflection, and my resolve to move to Spain was strengthened. Now that I know that I'm really sick again, my resolve to move to Spain has been strengthened even more. 

I saw my endocrinologist for the last time last month and I said to her, "How can I ever thank you for saving my life?" She said, "Use it well." I said, "I promise." Moving to Spain is a big part of that promise to her.


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## baldilocks (Mar 7, 2010)

From my experience, endocrinologists here are not easy to see, largely because GPs generally (both here and in the UK) lack sufficient knowledge to be able to identify that a problem has its root in the endocrine system. Some are, of course, terrified that a patient has more in-depth knowledge than the GP her/himself. 

Saw a different GP on Monday who thinks patients should take more responsibility for their health and he believes in listening to the patient who will frequently know much more about what is wrong and the potential for treatment. 

Sometimes, even specialists give up too easily like the ophthalmologist I saw 2 years ago who said that the problem with my eyesight was down to the deep scars on my corneæ (caused by the medication he had prescribed) and nothing could be done about them. Based on what I had been taught in school, 60 years ago, I devised a solution and can now see perfectly again.


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## AllHeart (Nov 22, 2013)

baldilocks said:


> From my experience, endocrinologists here are not easy to see, largely because GPs generally (both here and in the UK) lack sufficient knowledge to be able to identify that a problem has its root in the endocrine system. Some are, of course, terrified that a patient has more in-depth knowledge than the GP her/himself.
> 
> Saw a different GP on Monday who thinks patients should take more responsibility for their health and he believes in listening to the patient who will frequently know much more about what is wrong and the potential for treatment.
> 
> Sometimes, even specialists give up too easily like the ophthalmologist I saw 2 years ago who said that the problem with my eyesight was down to the deep scars on my corneæ (caused by the medication he had prescribed) and nothing could be done about them. Based on what I had been taught in school, 60 years ago, I devised a solution and can now see perfectly again.


Hi Baldilocks. Yes, this is exactly what I'm talking about - a loss of voice. This is particularly a problem with budget cuts. Doctors and other healthcare workers have less time to talk and less time to listen. We're both on the clock during a visit, so patients have less time to talk and less time to listen also. 

In the 90s there were huge cutbacks by the government in healthcare. Huge. There were massive lay-offs. There were also forced amalgamations of hospitals in an attempt to save money. Extra-billing by doctors was also made illegal. Hospitals started handing off hospital departments to the private sector - everything from the kitchen, to maintenance, to security. This led to a brain drain of highly qualified healthcare workers from Canada to other countries. The ones who were left had to pick up the slack. 

So healthcare workers get hit twice - as patients and in their careers. I'm in that situation as a healthcare worker myself doing medical transcription. I'm one of the people in the private sector because I'm self-employed but working for hospitals. The pay for my work has plummeted in the 20 years I've been self-employed. I understand that the cost of healthcare workers got too much with unions making it almost impossible to fire healthcare workers, giving fat pensions, long paid holidays, sick leave, disability insurance, etc. But it has swung totally the other way now. As a healthcare worker now, I have no pension, no disability insurance, no job security, no sick pay, no holiday pay - nothing but crap pay. I have no union to speak to. Labour laws don't protect me since I'm self-employed. I know the bulk of the global work force has suffered from the same lowered work standards. That is just the way of the world in a fiercely competitive market. But I don't have to like it. 

When I walk into a hospital here now, it's like walking into a shopping mall with franchises and other large businesses running the show. Healthcare is about dollars and cents now. I'm not naïve to say that money shouldn't be a factor in providing healthcare, but it's swung too much the other way now. A sick person is simply not cost effective. I'm not cost effective since I'm sick.

And I'm scared to death about going to Spain being so sick and not knowing if I can get better there. But I know for sure that I don't have a voice here - either in my healthcare or in my career. So like other healthcare workers who have left Canada, my career is one of the other reasons I want to leave Canada. Even though I speak fluent Canadian English, I'm not being heard. So I might as well go to Spain where I speak a little Spanish and may be heard a little, and where the weather is fabulous, and where the culture is divine. It's scary to move to Spain on the one hand, but it makes a whole lot of sense on the other hand.


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