Saturday, October 15, 2011

Healthcare Abroad

Rather than making sweeping generalizations about healthcare, I will simply recount my personal experiences in both the public and private healthcare systems in Spain.

There is something about the comfort of home, regardless of where you're from, when it comes to healthcare.  Unless it was necessary, I alwayas tried to avoid making medical appointments in Boston.  This may sound crazy since some of the worlds best hospitals are in Boston, but I just preferred to take care of all that stuff at home.  If I didn't want to make appointments in Boston, then I definitely don't want to try and find new doctors for myself in Madrid.  Similarly, my roommate from Colombia who lives in Spain prefers to go back to Colombia for his appointments, and one of the professors here who has been living in the USA this semester prefers to return to Spain for her appointments.  Home is comfortable.

Public Healthcare: Hospital Universitario de la Princesa

Needing healthcare when you're traveling, or living somewhere outside of your home country, is scary.  I admit that I was terrified when I was sent to the emergency room last Monday.  I went to a public hospital, which in Spain is actually a pretty normal thing to do.  In the USA, I get the feeling that stepping into a public health clinic is like a death sentence with a side of mediocre care.  I went to the ER because I had been hit in the eye with a tree branch while hiking down a mountain, and I thought half my contact lens was still stuck somewhere in my eye.  I had heard horror stories about waiting forever and ever and ever in public hospitals; but to my relief, I waited no more than 20 minutes before being called into the Ophthalmology Department, and only about 25 minutes before being seen by the doctor.  They took very good care of me - you know, answered all my questions, took their time, checked an extra time to make sure the entire contact lens was gone, etc.  They even gave me a prescription on the spot - I didn't have to go to a pharmacy.

For emergencies, the public system is the standard in Spain, as I've been told.  It's pretty quick, and the care is very good.  For non-urgent care, I've been told that it's better to use the private health system here unless you don't mind waiting an eternity or two.  I doubt this will ever be the case in the United States, but we'll see.  As it turned out, I had a lesion in my eye from the tree branch, and that definitely qualifies as an emergency.  A very painful emergency.

To me, the strangest part about my visit to the public emergency room was that the staff told me I had to pay for the visit later, the next week, or whenever I could, and that I had to pay at the bank, Caja Madrid.  That's right, you pay for your hospital visits at the bank, not at the actual hospital.  The hospital sets up a temporary account, and you go to the bank and pay when you get a chance.  You have to pay for the whole bill at once, but it's a public hospital, so it's not hugely expensive.  Oddly, they tell you how much your appointment will cost before you are even seen by a doctor.  I guess that means the cost is all inclusive regardless of what's wrong with you.  The two prescriptions they gave me for my eye were included in that cost.


Pharmacies here do a lot more than pharmacies in the US.  In Madrid, when something is wrong with you, you can usually save time by going directly to the pharmacy, describing your symptoms, and taking what they suggest. If you're really sick, they'll send you to the doctor, but if it's just a cold or the flu, you can save a lot of time.  Pharmacies are not combined with convenience stores here; rather, they are their own stores.  Convenience stores in Spain are blog post of their own - they're special...

Two weeks ago when I had the stomach flu here, I never actually went to the doctor.  I was on the metro, mistakenly thinking I was okay to go to work, and then threw up, almost fainted, and was retrieved by security and brought to an ambulance.  It was an exciting morning.  I vaguely remember being very impressed by how quickly the security people came and found me, and that the ambulance (public ambulance, not private) was waiting for me at the top of the metro stairs by the time I got to the top of the stairs - and all of this was free!  I guess that qualifies as an emergency too since I was retrieved very quickly.

Later, I dragged myself to a pharmacy to buy a thermometer.  Since it was a 24-hr virus, which turned out to be more of a 72-hr virus, they just recommended sleep, bland food, and Aquarius.  Aquarius is the equivalent of Gatorade.  Oddly, they recommended ham as a bland food. (Oh, Spain...) I went with toast and rice instead.  My new purple thermometer informed me that my temperature was slightly above 38 degrees Celsius, which is a fever, but not a high one.  Since this was a virus, I mostly just waited for it to end.  Three days, five liters of aquarius, and about 45 ish hours of sleep later, I got better.  My friends and roommates helped me out a lot - thanks, guys!

Private Healthcare: Hospital Sanitas La Moraleja

I've never been a patient here, but I had an internship in this private hospital last time I was in Madrid.  By comparison, everything in the private hospital is prettier than in the public hospital.  Pretty buildings, nicer waiting rooms - not things that matter, but they were there.  The difference I did notice was that the emergency room was constantly overcrowded with non-emergency patients who came to the private hospital claiming to have an emergency because they thought they would be seen sooner.  In terms of quality, the emergency care I received in the public hospital seemed just as good as what I saw while interning in the private hospital for four months.  Of course, private health insurance is expensive.  That's really no surprise.  The advantage seems to be that you get faster care for things deemed "non-emergencies."

It's lovely that this system works in Spain, and I do really like the public healthcare system here since it took good care of me.  That being said, I would panic if anyone were to take away my private health insurance in the US. For now, I'm just hoping not to have anymore annoying health issues for a while.

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