Salut

Gary’s comments

Unlike my usual newsletters about wine and other adventures of living as expats in Spain, this one about one of those our not-so-fun our adventures of managing health care in a foreign country.  Thus the title, Salut (Health in Catalan).  There has been much discussion in social media about differences between US and EU medical systems recently, so my comments will be only about Carol and my experiences.

Spanish health systems

There are two medical systems in Spain: Public and Private, and Carol and I have had experiences in both. My first experience was in Valencia when I tripped over a curb and did a face plant on the street.  Before I could get up four people had me by the arms, insisted I go to the clinic, and walked me there despite my objections. I had a minor cut sewn up and bandaged for no charge.  

Carol had a more serious issue and had to be hospitalized.  She spent a night in a public hospital and, since we had private insurance was transferred to a private one.  At the public hospital she was put in an open ward in urgent care then transferred to a two-person room.  In the private hospital she had a single room with a day bed by the window for family to sleep.  The stay at the public hospital was free, the ambulance ride to the public hospital was about 50€. The cost of the private hospital was about 1,000€ and was covered by our insurance.  Treatment at both hospitals was very professional, but the private hospital with a private room and place for family to stay was a much nicer experience.

Spanish small town health care

Our move from Valencia to Falset was only about 250k (155mi) but the experience was more like moving to a new country.  Valencia is a city of about 800,000 people in the autonomous community of Valencia, and Falset is a city of about 3,000 people in the autonomous community of Catalonia.  We had to first register with the city to establish our residency and then with the local health clinic to get a new medical ID card. We were helped in effort by a couple of lawyers who specialize in this stuff, and there is no way we could have done this without their help.

The public health care facility in Falset is small and about a 15 minute walk from our house.  This facility has family physicians that treat minor issues and assign specialist doctors to more serious ones.  It also has medical techs that do vaccinations, and emergency aid.  The closest major facility is a hospital in Reus, a city in Tarragona, about a half hour drive away.

Hospital Sant Joan

The best description I can give for St. Joan hospital is huge and efficient.  Images of the structure and main floor are below. The doctors offices are on the main floor, pharmacy is in the basement, and the upper floors are wards and other facilities that I didn’t see.

I had a short stay at the hospital and took picture of the ward and my room.  All the cubicles are private and are open to the ward.  There is also a large chair that folds down to a semi-bed for family to stay.  I don’t think there were visiting hours, and family seemed to be able to stay overnight if they wanted to.  There was no charge for the hospital stay or for the prescribed meds.

Meds

There are two classes of prescribed medications: Prescribed meds that that can be bought at a pharmacy and prescribed meds that are available only at hospitals. We spend about 180€ a month on prescription meds at pharmacies. I take two meds, Retacrit and Brunkinsa zanubrutinib, that are available only at the hospital. Retacrit was prescribed while I was in the private system and cost about 150€ a month in the private hospital, and is now free through the public system.  Brunkinsa zanubrutinib was prescribed when I was in the public system and is also free. 

I did a bit of research on the cost of these two meds in the U.S. and was stunned at the cost.

   Retacrit

   Dosage: One 10,000 unit dose every two weeks.

  Cost:  $469.4/month and $5,632.8/year

  Brukinsa zanubrutinib 

   Dosage: One 80 mg capsule twice daily   

Cost: $67.98/capsule. $4,073.40 / monthly and $48,880.80/year.

This is 1/2 the normal dosage. I started with the full dose of two 

capsules twice daily and had a bad reaction, so the dosage was cut in 

half.

In conclusion

So, that’s our experience with the Spanish medical system so far.  Wading through the healthcare bureaucracy was a pain, But well worth the effort.  We have both dropped our medical insurance because, 1. At our age most everything is a pre-existing condition and that the insurance won’t cover, 2. 

The public system works well for us, and 3. The private system is cheap enough that we can afford it if we need it.

One might ask, how much in taxes do you have to pay for this type of medical care?  We do pay a lot of taxes, but I don’t understand enough about the U.S. and Spain taxes to comment on the differences.  I think this may be my next project.

References: 

   Brukinsa zanubrutinib: https://www.drugs.com/price-guide/brukinsa

https://www.webmdrx.com/drug-prices/retacrit

   Retacrit:  https://www.singlecare.com/prescription/retacrit

Catalunia healthcare system: https://catsalut.gencat.cat/web/.content/minisite/catsalut/publicacions/docs/sistema-atencio-salut-catalunya-angles.pdf 

Hospital Sant Joanhttps://www.salutsantjoan.cat/ca/ciutadania/