Sunday, September 2, 2018

Baby in Barcelona - The "all you wanted to know about Spanish healthcare" post

Image credit via Unsplash

As promised in my previous article, I want to share some "insider" details about what it's like to be expecting a baby in Barcelona.

We're entering the final stretch of the pregnancy. I want to share our experiences (so far) with Spanish healthcare. Read on to see what we've learned.

A quick note on healthcare systems 

Before diving into this subject further, it's important to clear up a few misconceptions about healthcare in Europe.  I know many fellow Americans read this blog and the misconceptions around insurance, doctor's appointments, and hospitalizations are rife in the US.

Europe!= Europe 

First, many people have a habit of conflating Europe as one giant, unified system. That isn't the case.  Each country and sometimes even regions within a country have their own, different healthcare systems.

For example, Belgium's system is a mostly private one where residents must purchase health insurance (unless the person is below the poverty line, in which case the government covers the cost).  If you're from the United States, this system should sound familiar to you.

However, unlike in the US, the Belgian government uses a board of medical professionals, politicians, and industry representatives to set prices for medicines and procedures.  This control keeps prices in check and in turn, healthcare costs under control.

As all doctors and hospitals -- both public and private (more on that below) -- work within the same system, patients are free to choose their doctors and care facilities.

Here in Spain (and like in the UK with the NHS), public healthcare is free.  As in you don't pay a cent for the care outside of what you contribute to social security.  While the central government plays a role, each region runs their own system meaning Catalonia sets the rules for our public care here in Barcelona, which is called CatSalut.

In this system, each resident gets assigned a doctor and a primary care facility by default (ours is right around the corner). You can ask to change, but your request isn't automatically granted. Additionally, if you have a non-life-threatening emergency, you might have to go to your primary care facility.

A (widely-used) private option.

So at this point, you might be thinking "sounds socialist" and well, it kind of is (although you'd be hard-pressed to find any political party campaigning to get rid of it). But Spain, like almost every other country on the continent, has a free market alternative.

Those wanting more variety can turn to a private health insurer. This parallel structure provides patients with choice and, in some cases, better care than the freely-available public option. In the private system, patients choose their doctor and their hospital.

Our hospital  (via their website)
Often, private insurance will cover treatments not available in public care.  The facilities are usually more modern.  Private rooms are almost always guaranteed in the private system wherein the public one it's a matter of availability.

Supplemental private insurance isn't limited to single-payer systems like Spain's.  In Belgium, for example, many residents buy additional insurance to go with their primary one.  Often, employers offer this additional coverage as a perk.  The benefits usually include covering whatever difference between government-mandated prices and the final bill, as well as private rooms for treatment and recovery.

Importantly, though in both systems, the government sets the prices for drugs in the market. This control means that regardless of which system you use, you can go to any pharmacy in the country (they are all private) to fill a prescription, with the price being the same for reimbursable medications.

In any case, it's important to remember that there are many different approaches to building and maintaining a healthcare system.  I can only speak for Spain and Belgium where I'm most familiar with the system, at least as a user.   One size doesn't fit all, and most countries recognize that they have to create a system that works for their culture and economy.

Right...on to the good stuff.

Pregnant in Barcelona

Nathalie and I decided when we moved here two years ago to take the additional private insurance offered by my then-employer.  Our reasons for doing so were to both cover other costs (such as teeth cleanings) and to be able to choose our doctors for specialist needs. This choice was particularly valuable for us because, in the private sector, there are doctors who speak English, French, and well, many other languages.

We wanted to find one we could comfortably communicate with discussing medical issues. Nathalie found an OBGYN she was comfortable with and began consulting her about family planning.

Shortly before Christmas, though, I lost my job. Fortunately, we were able to switch to Nathalie's employer's private plan.  However, since it was with a different provider, we had to find new doctors.  While annoying, we were able to get another OBGYN who speaks English and French, in addition to Spanish, Catalan, and Russian.

Around this time, Nathalie became pregnant (hey, even if my birthday is on December 25th, our daughter is the real Christmas baby in the family) and our first-hand experience in the system began.

So what's the benefit of using private health insurance for a pregnancy?

Great question, other Elliott! There are a few reasons.  First, we're able to choose a doctor who we feel comfortable with.  Considering that we live in a country where we haven't yet mastered the language and never grew up in culture, being able to control our choice of doctors reduces our stress level immensely.

Second, unlike public care, our private option had no real limits on visits or scans. Where CatSalut will only pay for a few ultrasounds per normal pregnancy, our private one did a scan at every visit.  Since the first trimester was particularly rough, the extra checks and visual confirmation that the baby and Nathalie were doing okay helped keep our minds at ease.

Finally, we were able to select our hospital, which comes with a private room.  Even though neither of us has experience with public in-patient facilities here, we are glad to have the one we picked available.  We're also happy with the private room since this is our first time having a baby and I think we'll benefit from being able to retreat to ourselves when in need of a recharge.

Also (and most importantly), the hospital has a 24-hour cafe with sandwiches. That's pretty much what sold me on the facility.

This is the sandwich that sold me.

So there you have it! We're still waiting for the big show to begin (our daughter can take her time; I've been enjoying my sleep lately) and, assuming everything goes well, I'll be writing about that too.

I am by no means an expert in healthcare so if there's something that you see missing or incorrect; please let me know. After all, my blog serves to inform. Until then, I hope you found the article informative. I'm going to grab a sandwich now.


As we're prepping everything for the arrival of our daughter, we've put together a list of stuff that we think will help us give our daughter the best. 

We've been able to get many of these items, but if you'd like to help us, we've posted our baby list here: 

Our baby list

If you would prefer to give cash (and buy me a sandwich!), we have a TransferWise account in my name  -- Elliott Saunders Locke -- that lets us accept payments, from all over the world. Here are the details:  

See something you think we're missing? Know an amazing baby product? Let us know! Either write a comment or send us an email!

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