Overview
The health care system in Spain is based on a Social Security system and provides universal and free medical assistance to 99% of the population. The system is financed through the contribution paid by citizens through compulsory taxes. To get access to the public system it is necessary to obtain a Health Insurance Card after getting a certification of residence. Foreign inhabitants without certification of residence may access only the emergency assistance and will have no right to the Health Insurance Card.
What happens if you need to see a doctor?
An appointment with the specialist must be scheduled from the Primary Care Center through the General Physician or the General Pediatrician. In this case, you are transferred to the referent hospital (the closest to your place of residence) and you are not allowed to choose the hospital or the doctor you see. With the Health Insurance Card no payment is attached to this service. Regarding insulin, people must pay 10% of the total price although this percentage may be higher in case of higher salary incomes.
Who decides what medicines a doctor can prescribe?
The European Medicines Agency is responsible for the scientific evaluation of medicines developed by pharmaceutical companies for use in the European Union. An authorization of the Spanish Agency of Medicines and Medical Devices (AEMPS) is also required for all products to be potentially prescribed.
What is it like to live with type 1 diabetes in Spain?
In Spain type 1 diabetes is managed primarily in tertiary hospitals. People with diabetes are usually followed-up in a specialized Diabetes Unit with regular visits every 3-6 months. Although the number of physicians seems to be adequate for the number of patients, the ratio of nurses seem to be very tight (especially in small hospitals) and thus the access to comprehensive and well structured diabetes educational programs may be difficult. In addition, most diabetes units do not have access to dieticians and psychologists.
Rapid insulin analogues and basal analogues, as well as NPH, are reimbursed under medical prescription and people with diabetes have unlimited and universal access to insulin (only a small percentage of the total price must be paid by the patient). Glucometers are usually provided by the industry for free at medical centers. Test strips are also generally provided at primary health centers under a prescription of the physician. The number of provided strips depends on every center but people with type 1 diabetes usually have access to 4-8 strips per day. Insulin pumps are reimbursed, however a prescription from a physician specialized in endocrinology or pediatric endocrinology is needed. Continuous Glucose Monitoring is not reimbursed at all and thus people with diabetes must pay for themselves if they want to use it.
What about getting admitted to hospital?
Attention at emergency rooms is free and hospitals must take care of every person who demands attention. In case of hospitalization, it is free for Health Insurance Card holders, EU Health Card holders and for people living in countries with a health agreement with Spain. Otherwise, the person will be charged the cost of hospitalization which goes from 140€ up to 500€ per day.
How does diabetes care vary throughout the country?
The rules on which the health care system is based are exactly the same throughout the whole country in terms of patients benefits and medicine prices. However the health budget is different for every Autonomic Region and some inequalities are observed, including different use of insulin pumps, number of patients followed-up by the same doctor, time to get an appointment, etc. The density of doctors, nurse educators and specialists in smaller areas is not as big as in big cities.
We are grateful to Dr. Roque Cardona Hernandez for supporting our map and offering this information.
Last updated 2016