Adjusting to Life in Spain: Using the Spanish Healthcare System

Click here to read the previous post, Adjusting to Life in Spain: My First Visitors to Madrid (Part 2)!

Before I dive in, let me just say for any friends and family reading this: I’m okay! Nothing serious happened. Having said that, let me tell you how I wound up in Urgencias, the Spanish equivalent of the Emergency Room. Okay, okay, even that, although true, sounds a bit dramatic. It’s not, but I just wanted to mention my experience with the Spanish healthcare system as compared to the U.S. healthcare system (i.e. the U.S. health-for-profit system).

*A very realistic portrait of my red, swollen eye.*

So, late in the week I was aware of feeling like there was sand or an eyelash caught beneath the lower eyelid of my right eye, and upon further inspection discovered a red bump hiding down there. The rest of the inner, lower eyelid was red, too. Being a lone woman in a new country whose language I was not fluent in nor whose healthcare system I was familiar with, I promptly ignored it.

Surprise, surprise, by Friday late afternoon the eye was swollen, a little purple and tender to the touch. I knew I had to see the doctor – for the very first time. But as a introvert prone to anxiety, making an appointment on the phone is harder than running a marathon across the Sahara Desert. So I went online to my new doctor’s clinic to see if I could make an appointment via their website. Hallelujah, I could! But the first available appointment was a week ahead. Crap. I was going to have to call them to see if I could get in earlier.

*This is* exactly what the health clinic looks like.

In my journey to improve my Spanish to the point of fluency, there has been one consistent speed bump: speaking, or rather understanding, Spanish over the telephone. I will do almost anything to avoid having to make or take a phone call in Spain. It’s not that I read lips or anything, but when talking to someone in Spanish whom I can’t see, missing the facial expressions and body language really throws a wrench into my comprehension.

As any introvert worth their weight in avoidance might guess, I worried about this phone call for so long that the clinic was closed by the time I tried to call.

The next morning my eye was even worse. I looked to see where my assigned hospital was and now worked up the courage to go to the Urgencias (ER), check in, and explain to a doctor what my problem was in my broken Spanish.

Applying for the Tarjeta Sanitaria (Health Card)

Let me just back up a sec and say that in a moment of foresight a few weeks ago, I had applied for my Tarjeta Sanitaria (Health Card), which I am entitled to as a tax-paying resident.

I’d learned that to apply for it, you can just walk in to your assigned health clinic without an appointment. Normally, I’d have said “Well how the hell do I know which is my assigned health clinic??” Luckily, I’d just received a newsletter from Life in the Move explaining this very thing! In it was a link to a health center finder site where you simply look up your address and it tells you which health clinic you must go to (a great way to evenly disperse residents to all the health clinics across the city):

So once I found my health clinic (just 1.2 km or .75 miles from my home), I got to work reaching out to my friends R&E, a super nice married couple who are both bilingual and, did I mention, super nice?? They immediately agreed to accompany me to the health clinic.

The funny thing was, because they were with me, I felt confident enough to converse with the guy behind the counter. He asked me all the relevant questions and typed my answers into the computer.

At one point R said to me, “You’re speaking Spanish so well you don’t even need us here!”

But the truth was, knowing I could turn to them for a translation comforted me to the point where my mind was relaxed enough to understand what the guy was saying. Had I been alone, I’d have been anxious, and in that state would not have understood quite as much Spanish over all the screaming and crying voices in my head.

Back to Urgencias

Another moment of the stars lining up was that as I was getting ready to head out to the hospital, my friend L phoned me (and, yes, I ignored it and texted her back; then she phoned again and I answered it in a panic) and said, “Guess what? I’m on the bus into Madrid. Do you have time to hang out, get some lunch, before I go meet another friend at five?”

“Sure!” I said gratefully. “And I’ve got just the place. Do you know where the Hospital Universitario Fundación Jiménez Díaz (Jimenez Diaz Foundation University Hospital) is?”

Like a truly great friend, she didn’t bat an eyelash, just said “Text me the address.”

Half an hour later, I checked in at the hospital’s Sala de Urgencias (Emergency Room – I probably don’t need to keep translating variations of this anymore, huh?), which involved a very nice man behind a counter doing it for me rather than via the computer screen right next to his counter, which I stared at, unblinking, for five minutes.

I received a ticket like it was the DMV:

Then I went into the sala de espera (waiting room), sat down and watched the TV screen mounted high on the wall that showed the current ticket number being served as well as which consultation room.

L showed up shortly after, and soon my number was up. I’d waited maybe thirty minutes, which wasn’t bad at all, as far as I’m concerned. After confirming my name with the nurse with a confident “Sí!” my comprehension soon took a nose dive and I turned to L each time I was asked a question. Once the nurse got all the basics, L and I returned to the waiting room. About 20-30 minutes after that my ticket number appeared on the screen again, this time with a different consultation room.

This consultation room was equipped for eye exams, and as the doctor led me to the slit lamp to thoroughly examine my eyeballs.

After five minutes or so, I learned (again, through my trusty translator friend!) that I had an orzuelo (stye) in my eye. He gave me a small tube of Terracortril ointment and told me how to treat it at home for a week.

When L and I were leaving Urgencias, I asked if it was normal to just receive the medication for free at the hospital (or at a doctor’s appointment), and she said no, but the doc just happened to have a sample size in the examination room. Normally he would’ve given me a prescription to take to a pharmacy.

The whole process was smooth (except the part where I didn’t speak Spanish fluently enough to know what the fuck was wrong with my eye!) and I walked out of the hospital’s Urgencias without paying a dime.

U.S. Healthcare System vs Spain Healthcare System

In the U.S., I was charged every time I walked into any type of healthcare setting:

PCP (Primary Care Physician) visit: $35
Specialist: $85
ER: $350

And this was on top of the monthly health insurance I was paying, which was $135-$245 over the years, depending on my income. From others I’ve talked to, this is still far below the norm. Even though I am not considered poor, I still qualified for a hefty federal premium tax credit (i.e. discount).

What you pay is based on your age, income, household size, location, and which plan tier you opt for. But taking into account someone getting health insurance through California's Affordable Care Act (ACA) marketplace, known as Covered California, it could be:

Silver Plan (second cheapest out of four tiers): For a 40-year-old individual, the average monthly premium for a Silver plan in California is approximately $600.

In Spain, I contribute to Seguridad Social (Social Security) every month, which is mandatory as it funds several benefits such as healthcare, pensions and unemployment. These contributions are also based on your income, and I pay €86 per month (about $91 USD or $127 CDN). While employees pay contributions to the Régimen General (General Regime), autónomos (freelancers) do so under their own Regime, the Régimen Especial de Trabajadores Autónomos (RETA) or Special Regime for Self-Employed Workers (RETA). This amount is generously discounted during my first year and will increase next year to between €200-500, depending on my income.

So, anyway, my trip to Urgencias got me thinking about the costs and the healthcare system that I’ve just experienced here in Spain versus back in the U.S. Although many Americans’ jaws drop at the lack of bankruptcy cases that occur after a hospital visit in Europe, coming from Canada, I already have experience with universal healthcare.

Personally, I don’t know why people are opposed to it. I suppose some people are against expanding government power no matter what, others believe that everyone should take responsibility for their own healthcare no matter what, and still others think that universal healthcare will lead to higher taxes no matter what. And, of course, insurance companies and the pharmaceutical industry lobby fervently against universal healthcare to protect their profits (profits first, people second).

So call me crazy, but I believe that everyone has a right to basic healthcare. No matter what. Yes everyone should be responsible for themselves, but what about unforeseen circumstances where you suddenly find yourself out of a job or you’re working three jobs to provide for your family and must choose between food and health insurance? You’re telling me that these people, should they suddenly have a heart attack, for example, deserve a surgery bill of $80,000 or more? “First, do no harm” my ass.

Here’s a quick look at the differences between the U.S. healthcare system and the Spain healthcare system:

Applying for the Tarjeta Sanitaria (Health Card)

Back to Urgencias

U.S. Healthcare System vs Spain Healthcare System

Selena Templeton