Healthcare in Spain: Part 1

Matt checking in for an appointment to register our address (called empadronamiento).

Okay… So writing about bureaucratic systems doesn’t sound (or look) as interesting as food, but bear with us while we nerd out on some facts of life here that we do in fact find just as captivating. Spain has a robust universal healthcare system, and as Americans used to a privatized system, we’ve been quite curious to see how things work here. From casually talking with Spaniards, we’ve gathered that they generally feel positive and grateful for the quality of care they have access to. Although, almost all are quick to complain about long wait times. One major assurance regarding wait times; if you have an urgent health problem, you will skip to the front of the line.

Our visa situation here permits us to use the universal healthcare system, and this month we finally got all of our paperwork in order to register. So, yes!… we’ve both had our initial appointment with our primary care physicians. The experience felt pretty alien compared with the way things work in the US, so we thought we’d share some of our first impressions.

After our visa was approved (which is a whole different blog post), we needed to get 3 specific documents in order to register for healthcare.

1) A TIE card (tarjeta de identidad extranjero). (This is technically not a requirement for using the healthcare system, but it makes it a lot easier.) This is the primary identification card used in Spain. Citizens have something similar, called a DNI card (documento nacional de identidad). To get this, we needed to make an appointment at the local police office to have our fingerprints taken, pay a small fee, submit our ID photos, and show proof of our visa approval. This card also lets us leave and enter Spain freely… woohoo! After our initial appointment, we had to make another appointment for about one month later to actually pick up our printed ID cards. Believe it or not, getting that initial appointment with the police department is notoriously one of the hardest steps of moving to Spain. We hired a lawyer to help us with that step, and it took them a couple months to line one up for us. We’ve heard it’s next to impossible without a lawyer due to high demand and low supply of appointments.

2) Empadronamiento- this step involves registering your home address with the local municipality. As proof, you must bring a signed lease and a copy of your landlord’s ID. It’s also recommended to bring proof of your landlord’s last property tax payment, but that was not actually requested during our appointment. Although appointments for this step aren’t nearly as hard to come by as the TIE appointments, we did have to schedule this one a solid month out. This is the one step where we could have moved faster, but we lost some time here because we incorrectly thought we needed our TIE in-hand first. That is actually the case for all of Spain except for Madrid and Barcelona, where you can bring your passport as a substitute, and schedule another appointment to reregister with your TIE when you do get it.

Registering your address is a crucial step in the healthcare system here, since you can only receive healthcare at the facilities assigned to your neighborhood (except for emergencies). The pro: our doctor’s office is close to home- just 1 block away! (Your average person has to walk a tad more than that.) The con: you do not get to chose where you want to go.

3) Documento acreditativo de derecho a asistencia sanitaria pública. This is a document provided by the Instituto Nacional de la Seguridad Social (INSS) that accredits our right to access the universal healthcare system. Our accountants (remember, from Segovia!?) helped us obtain this document digitally once we started paying into the Social Security system this year. This document is important because, depending on the specific type of visa they are on, not all residents of Spain have access to the universal healthcare system when they first move here.

Exhausted yet?!

With these 3 documents, we walked into our local health center and registered for a “tarjeta sanitaria,” or healthcare card. Like the TIE, it will take a month for these to be physically printed, but we have a document as a stand-in for the meantime. That same day, we were able to schedule initial consults with primary care physicians for later in the week. (That’s not too long of a wait!) Just as you don’t get to choose your health center, it seems you have very little choice in your PCP. We were asked if we preferred a morning shift doctor (9 AM to 2 PM) or an afternoon shift doctor (3 PM to 8 PM). I didn’t know that such a distinction existed!

If there’s one thing we’ve learned from this process, it’s that administrative typos abound. Social Security listed Karen’s birthday is 3 days off, and when Karen went to see her doctor, the first thing the doctor said was “You’re not a man!” Apparently, Karen’s medical chart listed her as male. Both issues were fortunately fixed by some quick phone calls, so it seems the system is somewhat flexible. Karen brought her medical record from the US and her active prescriptions to the appointment, and that was enough documentation to get most of her prescriptions on the spot. Her refrigerated biologics injections are actually administered by hospitals here (versus pharmacies in the US) and will require some follow-up visits with specialists to sort out.

It’s worth noting that all of the appointments we have listed above were managed in a DMV-like fashion. For each one, you make an appointment ahead of time and when you show up, you head to a touchscreen to check-in and enter your appointment information. The machine then prints an alphanumeric code and lists what specific floor or waiting room you should head to, if applicable. While this is not too odd at a police station or a civic center, we did find it odd at the doctor’s office. Essentially, all patients are in a central waiting room, and the doctors’ offices are numbered doors around the perimeter. A TV screen updates and chimes whenever a new patient is called.