Expat Spain: 5 ways to get the best out of the Spanish healthcare system

As many expatriates living in Spain will testify, the level of care provided in Spanish clinics and hospitals is exceptional; perhaps the best in Europe. That said, there are still likely to be differences between the healthcare system in Spain and the system you are used to back home, both in terms of the type of care delivered and in how you go about accessing it. Take a look through the following useful tips to help ensure you are prepared.

1. Take time to learn about the Spanish healthcare system

Don't wait until you need urgent medical treatment to find out about how the healthcare system works. It's important that you find out as much as you can about the system before you get there.

The Spanish health service consists of a two-tier system involving their National Health Service and the private health care sector. The general rule is that if you are making social security contributions then you immediately qualify for the National Health Service. However, there are exceptions around the treatment it covers, as well as further exceptions on who can use it. Again, if you do your research in advance, you won't leave yourself open to any nasty surprises when you least expect or need them.

2. Find out what you are entitled to

If you register with the local authority within a few weeks of your arrival you will be given an atarjeta sanitaria (medical card). This effectively entitles you to the same rights as a Spanish national in the state system when it comes to healthcare.

Do bear in mind that Spain has implemented laws to crack down on expatriates "freeloading" on its National Health Service. Be sure to go through the authorities properly if you wish to receive state health care.

Those eligible for state health care include:

• Retired EU foreigners who follow correct procedures
• The employed and the registered self-employed

Those ineligible are:

• Non-working expatriates below retirement age, unless they register as unemployed through the correct channels
• Pensioners who have not gone through the required procedures

3. Look into purchasing health insurance designed specifically for expatriates

People relocating to Spain are often advised to take out private health insurance cover before they leave their home country. But with such a huge number of insurers vying for your business, how do you decide which one to go with?

It may be best to seek one of the insurers out there who provide policies especially designed to suit the needs of expatriates. These specialist insurers have the knowledge and experience to provide valuable, accurate healthcare advice and will ensure your policy is fully compliant with Spanish legalities.

Whatever policy you decide on, it is vital that you read all the details before you go ahead and purchase it. Unfortunately, many people don't realise that the medical insurance they initially thought was a great deal isn't adequate, until it's too late.

Beware also of taking out Spanish policies aimed at the local market. While premiums for these policies may be lower, hospital choice is often severely restricted. In addition, lot of the small print can be "lost in translation" and become ambiguous or misleading should a dispute arise.

4. Consider how you will overcome the language barrier

Learning the local language for any country in which you intend to live is important for many reasons, but when it comes to healthcare, research has found that for expatriates who lacked language fluency the risk of misdiagnosis can be greatly increased.

If you aren't fluent in your local language, your best bet is to do some research and find contact details for good English-speaking doctors BEFORE you need to make an appointment.

5. Make provisions for treatment aftercare and long term elderly care

Spain places great emphasis on strong family ties, and as such the expectation is that the majority of patient aftercare and care for the elderly will be provided by relatives as opposed to the state.

Outreach services and nursing homes are also limited. Those suffering from age-related conditions, such as stroke, heart attack, Alzheimer's, dementia and cancer are usually cared for by family members. You may find some state support if you need it but it may require a lot of time, effort and potentially money on your part.