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Health insurance for Spain

The health care system in Spain is often considered as amongst the best in the world. On the whole, Spain has more doctors and hospital beds (per 1000 people) when compared with the US and UK.

When moving to a new country, it’s important to consider how you'll stay safe and well. Medical insurance should be a serious consideration when relocating, to avoid substantial medical bills should you fall ill.

If you have something in place already, make sure you understand what medical treatment you are already covered for in your new country. If you don’t already have anything in place, here at Aetna International, we can help arrange full health insurance plans suited to your individual needs, so that you and your family get the best quality treatment, no matter how far you are away from home.

The health care system

Health care in Spain consists of both public and private facilities. In fact, some of the nation’s hospitals (hospitales) and health centres (centros de salud) offer both private (privado) and public (asistencia sanitaria pública) services. National health care is decentralised in Spain - it is the responsibility of the local authority in each region - and therefore health services can vary dependent on region.

Spain’s national health care system (el Sistema Nacional de Salud) is funded by social security (income tax) contributions known as Tesorería General de la Seguridad Social (TGSS ). Therefore, state health care is free at the point of use for anyone living and working in Spain. As an expat, you will be entitled to state health care if you are a resident of the country and are making social security contributions (through either employment or self-employment).

Once you are registered with the social security system in Spain, you are then able to apply for a health card (known as Tarjata Sanitaria Individual or TSI). The TSI should be presented when receiving medical treatment in a public facility and entitles you to free doctor and hospital treatment, as well as subsidised fees for prescription medication.

If you are not eligible for state health care then you should consider a private health insurance policy, to avoid costly medical fees if you do need to seek medical treatment.

Private medical cover is not a necessity for expats relocating to Spain, however, you may wish to choose it for the purposes of quicker treatment in private facilities.

Whilst el Sistema Nacional de Salud is generally rated as world class, like any national health service across the globe, it is not without its issues. Decentralisation of the health care system means there is a disparity in the quality of facilities available in individual regions of Spain. There can also lengthy waiting times and staff shortages for those using the public system.

Whilst many Spaniards do still rely on their national health service, most who are in a financial position to do so are now opting for private medical care. Dental care is not covered by el Sistema Nacional de Salud and the vast majority of dental and eye care is carried out in the private sector.

Help with health care costs in Spain

Pensioners from certain countries which have reciprocal agreements with the Spanish government, such as the UK, may be entitled to state care. For additional information on how to receive access to Spanish health care as a retiree, you can contact the social security department in your country of origin.

There is one other possibility for gaining assistance with health care costs in Spain: a pay-in scheme called the Convenio Especial. This scheme is designed to be low-cost public health insurance for those who otherwise do not meet the criteria to access the state health care system.

The scheme has not been launched in all areas of Spain, however, as of 2017 it is available in several provinces including Andalusia, Murcia, and the capital Madrid, as well as both the Balearic Islands and the Canary Islands.

To apply, you must have been registered at the local town hall on the Certificado de Empadronamiento for at least one year.

In an emergency

The number for most emergency situations in Spain is 112 and most operators speak both Spanish and English.

Health risks

Very few health risks are associated with travel to Spain. Indeed, risk from the sun — sunburn, prickly heat or heat stroke — are the most common visitors will face. These can be easily managed and prevented with adequate sun protection, keeping hydrated and staying in the shade during the peak sunshine hours (11am – 3pm).

It is also worth being aware that the UK Health Protection Agency deems Spain to be an ‘intermediate risk’ zone area for contaminated water, no doubt in large part due to the tourist industry and the many swimming pools in the country. Inadequately treated swimming pools can be hotbeds for the transmission of pathogens which can cause diarrhoea, vomiting, or infection of the ears, eyes, skin, or the respiratory system.

Measles outbreaks are reported fairly frequently in Spain and therefore MMR immunisation is strongly recommended. Other illnesses which are associated with Spain and the Mediterranean in general are: Tickborne Encephalitis (TBE) — usually associated with forested areas only — and Leishmaniasis, which is spread via insect bites. Precautions against insect bites are therefore wise, as is the case in any warm country.

In Catalonia, an outbreak of Enterovirus occurred in April 2016. Seventy-three children have been affected but most cases have resolved favourably and, as at May 2016, the virus has been confined to Catalonia.

Other risks

Spain is by and large a safe and trouble-free destination for foreigners but Spanish roads are some of Europe's most dangerous. Drunk driving and a lax attitude to road rules in general mean that average fatality numbers on the roads are the second highest in Europe. Be extra vigilant while driving in Spain, and when crossing the roads in major cities such as Madrid, which has a particularly bad traffic problem.

Theft from parked cars in larger cities is also sometimes an issue, so be sure to hide valuables and park in secure parking lots, rather than on the street. There are reports of various confidence tricks being played on tourists in major holiday destinations. Be wary of lottery ticket and timeshare scams being operated in holiday resort areas, particularly the Canary Islands and the Costa del Sol.

Political concerns

Spain is a peaceful democratic country and there are few major political concerns or problems that tourists or expatriates are likely to encounter. There have been isolated bomb attacks by the Basque separatist group ETA in tourist areas within the last decade, leaving a handful of people dead, but the risk to expatriates and tourists from their activities is minimal. In 2011, the group announced a permanent ceasefire. Large-scale demonstrations occur occasionally in big cities and should be avoided, although the risk of serious violence is minimal.

That being said, Spain along with many other countries in the world also faces threats from terrorist activities in the current global political climate, the threat being deemed highest in large cities, especially the capital of Madrid.

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