Locals speak on Spanish healthcare system

Seeing how universal healthcare functions when implemented and revised over time

Pamphlets in San Francisco Hospital in León advertising some of its services, one that provides tips on minimizing occupational hazards and the other a chiropractor clinic that works specifically with feet.

Universal healthcare. This is the dream of the Affordable Care Act, passed seven years ago under the Obama administration.

Spain may have only been a democracy for less than 50 years, but its constitution made living a healthy life a right for its citizens. The National Health System established in 1986 gave the logistical responsibility to its autonomous communities, while serving more as an overseer.

With a republican-controlled Congress trying to break this system before it begins, I wonder what is it like to live in this kind of system when it has been in place for decades? I talked to several residents and here is what they had to say.

If you feel sick is it easy to figure out what is wrong?

Ana Cabello, age 50, León, elementary school cafeteria worker: “I just go to a doctor. I tell them how I am feeling and they usually figure out what is wrong. Then they give me a solution to try, whether it is more rest or buying pills. Don’t really worry about how much it will cost unless it is more serious and requires an operation.”

María Medel, age 29, Valencia, Home Youth Hostel staff: “Here in Spain we have this public service that works pretty well. It used to work better but after the crisis they cut a lot of resources for healthcare. Now it is pretty slow. But if you are sick one day, you can go to the doctor, but you need a card to be in the system.”

María Medel from Valencia

Are there private insurance companies and do people use them?

Mele Garrido, age 42, Valencia, baker: “I actually only use public insurance, but I still own private insurance. The public system works very well.”

Medel: “In Spain, we don’t have that many private insurance groups. Some people do and they have certain doctors covered, you can choose [which ones]. I usually only use the public system, but in case I have bigger problems or want the best care, I go to private. For example, I had never gone to the gynecologist through the public system because I want to choose my own doctor.”

Álvaro Fernández Costero, age 46, León, Generali insurance manager: “You can’t use private insurance to pay for doctors and care in the public system. It does provide more options outside the bigger hospitals by connecting you to private practices. In the end, you will get care you need, it depends on how quickly you want or need your problems taken care of. It is not as though the doctors who do not have private practices are worse than those who do.”

There are separate prescription forms that private practices like Dr. Jesús Gonzalez’s fill out, different from the ones from larger public hospitals. Public insurance does not cover prescriptions authorized by private practitioners.
Author’s note: The public plans do not cover visits to the dentist or opticians, but most people still see the former at least one or two times a year. In a previous article, an optician said the consultation is free, the only cost is if they buy glasses or other products.

Have you or others have had any problems paying for healthcare?

María Jesús González, age 54, León, private practitioner specializing in addictions: “Sometimes. I usually try to be flexible and make it easier when people are having trouble paying me up front. Maybe they are having trouble making the payments every month. I usually extend the amount of time they pay.”

Medel: “Through the social insurance, I don’t need to pay anything. But for private care I do sometimes have problems. I usually only pay a percentage up front. It depends on what insurance I have for that doctor.”

Garrido: “My daughter has a chronic illness, she has Type I diabetes and she needs glucose supplements. In some provinces in Spain, these kinds of operations aren’t covered but luckily for us most of these are so I don’t have any problems with the cost.”

Mele Garrido inside her bakery at Valencia’s Central Market.

What is the biggest problem with the public healthcare system?

Cabello: “You need to wait. Before an operation, you need to take tests and let the doctors run some analysis. Then they need to evaluate whether you are ready to have the operation. So it takes a lot of time.”

Fernández Costero: “For one hospital, you have all these people coming in. You read articles in the newspapers all the time talking about how long people had to wait. The public services are not allowed to reject anyone, it doesn’t matter where they are from or how much money they make. This is why people would pay for private insurance. This way they can get doctors that will prioritize them.”

What are people’s attitudes toward their tax money paying healthcare for those who may not be able to afford it?

Garrido: “I think it is really good. I am totally in favor for doing this.”

Jesús Gonzalez: “People understand the need and realize there are people who are unable to pay for the care they need. There are some politicians there that think that it is unnecessary but most normal people think this is important.”

Cabello: “We need to help people who cannot pay. We may need to fix how much we are helping them, maybe not pay so much. I didn’t have a job for a while, but I still had a card and was still in the system, so if I had an emergency, I could be taken care of.”

Ana Cabello from León

Last thoughts on the current system?

Fernández Costero: “The system works fine, except when it comes to the waiting time, the waiting time is horrible. My final conclusion is that patients who will end up needing operations immediately, should have private insurance.”

Medel: “When I didn’t have a job, my healthcare was covered because my parents were working. And now I am married, and my husband is from the States, and because I have lived here he is in the system. I had to do a lot of paperwork, but that is how it works in Spain.”

Jesús Gonzalez: “The Red Cross has a public center for people with addictions that cannot pay for private services. So they can go there. People who have more money can afford private practices and get more personal attention, better care, and see their doctor more. But there are still options for more specialized care out there.”