Expatriates in Spain may be able to use the local health service. But because the system is highly regionalised, with each region exercising its own autonomy, complications may arise.
Permanent and semi-permanent expatriates should register with the authorities and obtain a residence card which gives access to state-run healthcare. But this is not a guarantee.
UK residents on "short-term" visits to Spain are covered for emergency treatment if they produce the European Health Insurance Card (Ehic). Dental care, other than emergencies, is not covered.
Private hospitals will not accept Ehic and may demand cash in advance.
Long-term residents in Spain who are not pensioners, employed persons or officially resident do not qualify for Spanish state healthcare or NHS treatment in England.
This means that people who have recently moved to Spain to retire but are below pensionable age are not necessarily given access to the Spanish state system. Each region is different. To have any chance of access, it is essential to register and obtain a residence card.
UK nationals working in Spain should be affiliated to the Spanish social security system, for which the employer deducts a contribution from the employee's pay. This should give access to the health care system, with the aid of a monthly payslip as evidence.
The self-employed should obtain an NIE (foreign identification number) and a residence card and an Alta Fiscal from the Head Tax Office. They should take these to the nearest social security office, where they will receive a social security number card, entitling them to a health card and full medical cover.
Anyone who works in Spain for up to a year is entitled to form E128, if the DSS (or the Social Security Agency in Northern Ireland), confirm that they and their employer continue to pay UK national insurance contributions. Those employed on a temporary posting, and any dependants who accompany them, are entitled to treatment for any condition during the posting, using an E128.
However, if they leave Spain to visit anywhere in the EU, even if travelling to or from the UK, they are only entitled to emergency treatment and will need a UK-issued E111. If the job unexpectedly lasts longer than 12 months, and the appropriate insurance authorities in Spain agree, employees may remain under the UK scheme for a further period of not more than 12 months.
People of independent means are not normally entitled to state healthcare in Spain, though there are differences between regions.
UK pensioners should get form E121 from the DSS in the UK and register this with their local social security office in Spain. As well as the E121 they should have an application for a residence card and passport. They must apply for a residence card before they can register the E121. A UK State pensioner is someone who receives long-term Incapacity Benefit, Severe Disablement Allowance, Retirement Pension, widow’s benefits or bereavement benefits. As such, UK State pensioners and members of the family who depend on them and who live with them are usually eligible for health care cover from the UK to cover costs in Spain. To be eligible for health care entitlements as a UK State pensioner living in Spain, you must have been issued with form E121 for yourself and any members of your family and had the form registered with the authorities that run the sickness insurance scheme in Spain.
In Spain it is customary for a family member to provide basic nursing care (feeding and personal hygiene) unlike the system in the UK where it would be provided by nursing staff. In most areas where British expatriates live, there are privately run nursing agencies which charge commercial rates for services similar to those you would find in the UK. These charges are not covered by private medical insurance.
If the theory sounds complicated, the reality is worse. Not for nothing did the Spanish become famous for the word 'mañana'. Dealing with Spanish officialdom requires the patience of a saint. Nothing is quick, and just because you think you have the right paperwork, the official may disagree. The man or woman in uniform or in an official office is right, even when they are totally wrong.
As a general rule, medical facilities in Spain are excellent. Many doctors and nurses speak English and most hospitals and clinics in tourist areas provide interpreters. Availability of services varies from locality to locality. If facilities are not available to meet your specific needs, you may have to travel to another area for treatment. But in poorer regions, facilities are not so good.
Getting treatment when and where you want it is not easy either. The Spanish health service has the same sort of delays and lack of cash, as has the NHS, but with the additional problem of local customs, slow speed to reflect the heat, and often total confusion.
If your Spanish is not fluent, you may have trouble getting people to understand you, and, at the risk of upsetting politically correct readers, the biggest disadvantage of all is that you are British - and as such, not Spanish.
All things considered, it is advisable to take private international health insurance which will cover medical and dental treatment and even repatriation to the UK.
International health insurance: Hot topic: July 2007
