If children are involved this is even more the case.  Can you safely and confidently leave the health care you have in your own country to take up a new life in Spain?  The answer is both yes and no and depending upon where you wish to live.  Where and when it is good, the quality of Spanish health care and facilities available to patients probably equals anywhere in Europe and betters most.  However, standards across the country vary considerably, with public medicine being scant in some inland areas.

The Spanish are among the world's healthiest people and have an average life expectancy of 80 for women and 74 for men, the highest in the EU.  The incidence of heart disease in Spain is among the lowest in the world, a fact attributed to the Spanish diet which includes considerable quantities of garlic, olive oil and red wine.  Recently, this figure has started to rise and is believed to be as a result of the increasing popularity of "foods to go" such as hamburgers and other foods with high fat content.  On the other hand it could be the increasing use of diesel fuels since smoking doesn't seem to have made as great a contribution as some would have us believe...

Health Care % GDP Health care cost per head in Spain are average for the EU and Spain currently spend about 8 per cent of its GDP on the Nation's health.  When it comes to hospital nursing care, and post-hospital treatment and follow up, the figure is below that which would be expected by Northern Europeans or Americans.  It's not unusual for people to praise the care they receive in Spanish hospitals but criticize the after care, which often is claimed to be very poor. 

As with the UK, Spain has a public health system which provides free or low cost health care for those contributing to Spanish social security system and their families.  The system also caters for retirees and includes those from other EU countries.  The country has an excellent system of private medicine and this exists easily alongside the State system with both operated so as to compliment each other. 

Expatriate Problems

There are medical reasons both for and against a permanent move to Spain. Expatriates problems which are well documented include sunburn, which can often be quite serious, stomach and bowel problems which can some times be attributed to the change of diet and/or water but all too often simply because of poor hygiene and careless food preparation. Summer in Spain is not the place to let your cat walk over kitchen work surfaces or leave food out of the fridge for any longer than is necessary. Hands must be scrupulously clean.

There is a high incidence of alcoholism among expatriates. This exists for several reasons but the primary ones are simply the relatively low cost of alcohol and the fact that socializing, of which there can be a lot, seems to start, continue and end with an alcoholic drink. It can soon become a habit, then a need!

Alergies

Those who suffer from hay fever or asthma may find the high levels of airborne pollen during spring difficult to cope with although this is likely to be less of a problem if you live within a mile or two of the sea.  Sun Damage In the United States of America, the epicenters of plastic surgery are Los Angeles, Miami and Houston, where plastic surgeons carry out numerous face-lifts, the requirements for which have been brought on by sun damage.  The effects of gravity on the soft tissues of the face are to constantly pull them down, adding to the ageing appearance.  Ultra violet helps break down the collagen in the skin and create the formation of wrinkles.  In Spain, the sun will do exactly the same. Your copper tan will not be without cost.  You can help by using a high factor sun blocker or if premature ageing really does leave you cold, by staying out of direct sunlight.

Skin Cancer

The incidence of skin cancer is far higher in Spain than that experienced in the United Kingdom or other Northern European countries and people from these latitudes suffer a greater risk of contracting the disease.  If it is detected early enough it can be treated most effectively but you will need to avoid direct sunlight for ever more.  Again, effective barrier creams will help enormously.  People with fair hair, blue eyes and pale skin are the most at risk.  Redheads, who do not tan at all, are also at risk but little point exists in these people spending hours in the sun if they do not tan.  Skin cancer is something to be aware of rather than feared and you should not worry that moving to Spain will leave you and your family as walking time bombs, waiting for a beam of sunshine to set you ticking. 

There are tremendous medical benefits to the Spanish sunshine that more than outweigh the slight risks associated with it. An example is the benefit to sufferers of rheumatism and arthritis and those prone to bronchitis, cold and pneumonia.  If you are a person prone to stress, then again Spain can come to the rescue with its slower (if stopped for most of the time can be described as slow) pace, siestas and laid back attitude to most things.

Climate and Lifestyle

Beyond doubt is the fact that the climate and lifestyle in any country has a marked effect on mental health.  People who live in warm, sunny climates are generally happier, more content and much more relaxed than those who live in cold, wet climates such as those which can be found in northern Europe.  As you are reading this, you probably are more than aware of this fact  The Costa Blanca and Costa Del Sol have the highest percentage of retired persons in the world.  Even higher than Miami, which specialises in retirement and has an industry set up to deal with it. 

In Spain, the presence of so many retired people places a great strain on local health services.  In part, this is due to the fact that none of us have experienced old age and as such, we are not prepared for what it can and often does bring with it.  Health is an important issue if you intend moving to Spain.  If you have good health, your stay will be infinitely more enjoyable.  If your health fails, you may be forced to return to the UK.  In Spain, there are nowhere near the numbers of facilities for looking after the elderly that exist in most northern European countries.  State Registered Nursing Homes Spain has few state registered nursing homes and recently, some of those in the private sector have been involved in serious scandal because of the dreadful living conditions of the residents.  If you bring an elderly person with you to Spain, intent on putting them into a Spanish nursing home when the needs arise, you should check very carefully in regard to what it offers by way of care and facilities.

Health Risks

When it comes to health in Spain, there are no particular diseases or risks and you don't require a series of vaccinations and inoculations before you take up residency.  If you are partial to a "wee dram" you may need to exercise some form of self-control as a litre of whisky only costs about £5 - 6 sterling.  The water in Spain is safe to drink and chlorinated one part per million.  In some places, whilst safe, the taste is awful, when you may like to buy bottled water, some of which is slightly more expensive than beer in the same quantity. 

Social Security

There are several ways in which you may be entitled to benefits from Spain's Social Security Service.  The first and indisputable is if you contribute to the country's system of social security.  To be able to do this you need to be working either as an employee or on a self-employed basis.  If you are an EU national, retired and in receipt of a state pension you are fully covered for all aspects of health care in Spain including totally free drugs and medications.  If you are not entitled to benefits from the Spanish social security system you must have private insurance and will have to present proof of this when applying for a residency card.  An E111 or insurance cover note will not suffice.

Contributions & Benefits

If you have made regular payments by way of social security contributions in your own country for the two years prior to moving to Spain, then you will be entitled to public health cover for a limited period from the date of your last contribution.  In the UK, full information can be obtained from the DHSS in Newcastle, who have always proved most helpful in regard to this matter.  Public health benefits include general and specialist medical care, hospitalisation, subsidized drugs, dressings and medicines, basic dental care but excluding cosmetic dentistry, maternity care, appliances and transportation.  Whilst both general and specialist medical treatment is free, patients must pay a percentage of the cost of certain items such as drugs and medicines, if you are retired however these are free of charge.  Contributions are considerably less than those required in the UK.  In resort areas and major cities, Spain's social security health system is on a par with that of the UK but without the lengthy waiting lists.  This does not mean that there are no waiting lists just that they seem to be nowhere near as long.  Where an operation may be life saving, there is usually little waiting if any.

Complaints

When complaint does arise in regard to the state health system, it is usually concerned not with treatment received but more likely some aspect of the crippling bureaucracy or the typically bad management and time wasting so prevalent throughout much of Spain's civil service. Contrary to popular belief, there is no entitlement to state medicine for foreigners apart from that shown above. It is unlikely that this will remain the case as the EU seems bent on providing a health service throughout the European Union. However, until such time as this happens, if you are not entitled to Spanish State medicine, you would be well advised to keep yourselves insured.

Medical Insurance

If you do not have insurance and become ill, unlike the United States, in Spain you will receive medical treatment regardless of whether or not you can afford to pay.  This is the law, Spanish doctors agree with it and it is a sign of a caring civilized country.  However, when you are well, the authorities will make arrangements with you for repayment at whatever rate you can demonstrate you can afford. 

Doctors

One of the most often asked questions by people new to Spain, concerns the standard of the country's doctors.  Here, the news is very good.  In Spain there are excellent doctors although you may have difficulty in finding one who speaks English.  This is particularly true in rural areas and is something for those to consider who may be set on moving inland.  In the larger cities and major resort areas doctors, from a variety of countries can be found practicing among whom can be found British, German, Scandinavian and the occasional American.  Both the United Kingdom and Republic of Ireland Embassies and Consulates keep a list of English speaking doctors for most areas of Spain. Other EU states and countries probably have the same information available for their own nationals.   All Embassies and Consulates are listed in both the Spanish white and yellow pages. 

Spanish doctors are permitted to advertise the services they offer and many do.  Examples of this can be found in the Costa Blanca News and other expatriate newspapers but advertisement appear in television programme guides and a host of other publications.  It is quite common for expatriate doctors and dentists to promote their practices in this way - if you want a doctor of your own nationality simply look in the local British press.  When you first arrive in Spain it's worth obtaining a copy of the English language newspaper in your area as most routinely list on a continual basis, telephone numbers for emergencies.  The numbers included are usually those for doctors, ambulances, hospitals and dental practices plus many more.  Most, if not all, have their own web site.

Doctor Patient Ratio

The ratio of doctors to inhabitants in Spain is higher than in many other western European countries but this does vary from town to town and region to region.  In some rural areas they are quite thin on the ground and are overworked to a degree where they often have to deal with more than 30 patients in an hour.  Whilst these workloads mainly affect doctors working within State medicine, they may also apply to some doctors working for Spanish insurance companies.  When it comes to finding a doctor with whom you are happy and confident, there are no hard and fast rules. It simply is a matter of trying them until you find the one with whom you feel comfortable.  One person’s experience of a doctor may not be matched by that of another and for this reason recommendations are often of little use.  However, if one doctor comes in for criticism from several sources, it may be worth avoiding him or at least putting him to the end of your list. 

Before leaving For Spain

If you are currently taking regular medication or undergoing a course of ongoing treatment, you should ask your current doctor to provide "notes from file" which will consist of your condensed medical history.  You can give this, or better still, a copy to the doctor you select following your arrival in Spain.  If you have it translated into Spanish so much the better but if you can't arrange this, he certainly will be able to.  In any event, if you don't speak Spanish you will probably find a doctor who speaks English so the need will probably not arise.  If you elect private health insurance you can select any doctor and be seen at most times convenient to yourself.  This obviates the necessity to register with any particular doctor, leaving you free to visit whoever you want and importantly, obtain a second opinion easily should you feel it necessary. Doctors are normally paid for their efforts immediately following a consultation.  Although it does happen, few invoice at the end of a course of treatment or on a monthly basis.  A consultation at the doctors practice will cost somewhere between 30 - 45 Euros, depending upon which part of the country you may be and which doctor you consult.  If you ask him to make a home visit during the day you will be charged between 40 - 60 Euros and at night, between 40 - 90 Euros. You should ensure that you only become ill during the day!!

Surgery hours of doctors vary between public and private sector doctors and between themselves.  Public sector doctors may work from 8 in the morning until 8 at night, often without a break.  A doctor in the private sector may choose to work 4 or 5 hours in a day, which hours have been selected to best suit the requirements of his patients. Practice hours are prominently displayed in advertisements, surgeries and other places.

Remote Areas

Of particular importance if you are considering moving into the "Bush or Spanish Outback" is the fact that if you are unable to attend a doctor’s surgery or clinic, you may have trouble finding a doctor to call on you, unless you can convince him that you, or perhaps your child, are an urgent case.  If you opt for care with the public service, make a note in your diary not to get sick during the month of August, when Spain "shuts" for the annual holidays of its professionals, including most of its doctors!!  To illustrate how important this is you need only understand that during this month a number of medical disasters occur.  The system in Spain regarding doctors is probably quite different from anything you may have experienced before, unless you are a seasoned international traveller.  Don't worry, because for all its trials and tribulations, medical standards are quite high and you should not feel concerned in regard to available healthcare.

Healthcare Entitlements

There is considerable misunderstanding among foreigners, but particularly the British, in regard to what entitlements there are to health care in Spain.  With many from Britain, the belief is that it is simply a matter of arriving and signing on with a local doctor.  Unfortunately this is not the case.  It may well be in a few years time, as the European Union strives for a society in which medicine is without charge.  If you enter Spain as a tourist, and stay for less than six months, you can obtain emergency medical cover simply by collecting and completing form E111 from your nearest post office or from the DHSS in Newcastle Upon Tyne before your departure

Form E121 

If you intend to move to Spain permanently, it may well be that you will be entitled to Free State Medicine.  This will be determined by the amount of contributions you have made in the past and again the DHSS in Newcastle will be able to advise you.  If your contributions are not sufficient for ongoing state medicine it may well be that they will provide cover for a year or two when the question of health care will have to be resolved finally.  You will need form E121 for claiming state medicine permanently.  If you work in Spain officially, you and your family are automatically granted benefits under the Spanish Social Security System.  You should be aware that these benefits do not cover most dentistry, being restricted to emergency extractions. 

Dentists In Spain

Dentistry can be and usually is quite expensive. A simple extraction can cost up to £120 and an enquiry for a couple of crowns will have you firmly convinced that following your treatment, your dentist intents to retire to an expensive part of the world.  Even though you may have cover under the Spanish social security system, obtaining dentistry can be quite difficult. Many of those you deal with simply don't know that dentistry is a health benefit and will inform you that you need to consult a dentist privately.  The system is that you first see a doctor and he gives you the necessary paperwork for the dentistry.  Both surgery and dentistry in Spain are to very high standards but unfortunately the administration of both leaves everything to be desired.  If you arrive in Spain intending to stay permanently and are of retirement age or over, medicine is provided free of charge, together with any drugs and dressings you may require from time to time.  As an aside, you can of course draw your UK pension in Spain which will be subject to Spanish income tax.  The one exception is if you are a civil servant, in which case taxation and the collection of it, will always be the responsibility of the country paying the pension.

Private Medical Insurance

If you are not eligible for Spanish state health care, you will need to review your options for private insurance.  You really do need to be very careful as prices vary enormously.  In many cases price does not reflect additional benefits and in fact the opposite may apply. BUPA and some of the other UK companies offer policies in Spain but these, whilst offering good cover, are 100 per cent more expensive than some of the other companies in the market.  As an indicator of price, a 55 year old man should expect to pay in the region of £500 - 1200 sterling depending upon the company he chooses.  Benefits under the policies as stated can be more or less the same.  Very few, if any private medical insurances cover you for the cost of drugs apart from those necessary during a period of hospitalisation.  This is not quite the bad news that it may sound because Spain is one of the cheapest countries in Europe when it comes to the cost of drugs.  Most drugs you are likely to require can be purchased privately, often far cheaper than the cost of an NHS prescription in the UK.  Knight Insurance brokers have offices up and down the coast and have a good range of Health plans to choose from, you can phone them on 96 583 4000. or 902 28 28 20 (reduced tariff quote line)

Think About Location

Anyone contemplating a permanent move to Spain should consider carefully the area in which they intend to live. Check carefully on the medical facilities available, particularly if you have retired when the possibility of illness becomes a lot more likely.  The same applies if you are receiving long term treatment for an illness such as diabetes etc. Very young children have special needs when it comes to medicine and often need it at the most unexpected times.  Ensure that your medical policy covers all their requirements.  Mentioned elsewhere in this section is emergency recovery by helicopter which costs approximately £140 per annum and may well be justified if you want to live far inland.  Regardless of whether your medical cover is from the Spanish state or obtained privately by way of an insurance policy, as previously mentioned medical standards in Spain are generally quite high and in most large cities and resort areas, waiting times are relatively short.  In Spain, all cities and large towns have at least one hospital or clinic.  In most resort areas these are modern and equipped to international standards.  Staff are highly trained and abundant to such a degree that two years ago the UK Health Service concluded a deal with the Spanish authorities for the supply of trained nurses for British Hospitals.

If your interest lies in inland Spain, you should be aware that hospital facilities in some rural areas may be poor.  In these areas, although the situation is slowly changing, there can still be long waiting lists and equipping of some hospitals which leaves a little to be desired.  The building of more hospitals and reduction of waiting lists - wherever they are, remains a priority for the Spanish Government.  However, if you want all singing all dancing health care, then this is available through any of the private medical insurers.  Medical insurance in Spain is remarkably cheap when compared to the UK and even more so if you shop carefully and tailor a policy to your own particular needs. 

Types of Hospitals

There are numerous categories of hospitals and clinics in Spain which include both public and private hospitals.  These include general hospitals, district hospitals, regional hospital provincial hospitals, local hospitals, military hospitals, nursing homes, private clinics, emergency clinics and day case hospitals.  Many Spanish public hospitals are run by the Red Cross and funded by private donations but some towns make contributions from their public funds. There are a considerable amount of private hospitals and clinics in the cities and resort areas, with many of these foreign owned and controlled.

Accident & Emergency Units

As with the UK, not all hospitals have an emergency department, relying instead on special hospitals with trauma teams being located in strategic areas to supply this service.  The cost of an accident and emergency unit is such as to cause few, if any of the private hospitals to operate one.  Again as with the UK, private hospitals tend to opt for cold surgery or surgery which whilst important, is not needed to be carried out is not classed as an emergency. 

Language

In resort areas, up to 15 per cent of patients treated by public hospitals may be foreigners, many of whom have retired to Spain.  Despite this fact, apart from hospital receptionists and one or two others, the vast majority of staff will not speak English.  In recognising this problem, in many areas expatriates have organised volunteers to interpret for their countrymen.  Ask around in order that you get to know who and where they are.  In Spanish hospitals, whilst treatment seems to be excellent, administration and information are typically Spanish and probably cause patients more distress than their illnesses or subsequent medical treatments.  If you are unable to speak Spanish, it is unlikely that any attempt will be made to supply you with information of any sort, including meal times, visiting hours and a host of other things which would make life a little more pleasant.  This being the case, perhaps you would like to consider being treated privately.

The cost of a bed in a Spanish hospital is in the region of about £80,00 per day or half or even less than that of the UK. Include Consultants fees and you can reckon on spending about £160.00 per day for the duration of your stay. More if you are involved in some lengthy surgery which requires a long time in postoperative recovery.  The advantages of private treatment are universal but generally concern only convenience and not quality of medical or surgical treatment.  Privately treated you will have your own room with telephone, television and radio and visiting hours to suit yourself and visitors. You can also decide when and where you will be treated and by whom.

Public Hospitals

Conversely, facilities provided in public hospitals may not be quite as grand although you can usually rent a radio, television or telephone for a small daily fee.  However, if your room mates are all Spanish it’s unlikely that you will have much input as to viewing content or volume levels. Torrevieja market and Malaga airport and the average Plaza de Toros are probably quieter than the average Spanish hospital.  Although the standard of nursing is high in Spanish hospitals, many claim that it is cold and impersonal.  Nonetheless, as stated, it is of a high standard and you should not be concerned.  When it comes to liberating hospital beds, the Spanish medical authorities are more than competent in that your postoperative recovery is designed to be at home.  That there may be no one at home to care for you has little or no bearing on the matter - you're done - out you go!  In many areas, expatriates have formed support groups to deal with this problem and if you have to go into hospital it may well be worth contacting them wherever they may be.  As mentioned above, asking around is a good idea.

Hospital food. 

One final thing on Spanish Public Hospitals - food, the quality of which is varies considerably.  Some say it varies between inedible and disgusting but others are kinder, choosing merely to say that it leaves a little to be desired and besides which they needed to lose 30 lb in any event!   Spanish hospitals may not find their way into the Michelin good food guide but it is quite common, in fact, almost normal for both the Spanish and expatriate press to carry "thank you" notices, from former patients, all grateful for the care and treatment they have received whilst in hospital.

Pharmacies

In the UK or ROI, drugs and medication are dispensed via a pharmacy.  In Spain the situation is the same other than in most cases, a doctor’s prescription is not required.  If you wake up one morning with the flu, often all that is necessary is to visit your local pharmacist who invariably will prescribe an antibiotic and other medication, which in no time at all will have you feeling much better.  The cost of most medication in Spain, even when purchased privately, is often less than the contribution payable to obtain an NHS prescription in the UK.  Pharmacies in Spain are denoted by a green cross which is often prominently displayed not only on the building but in several areas close by. Pharmacy hours are usually from about 0930 - 1330 and again from 1630 - 2000 hrs. Pharmacists take turns in supplying 24 hour coverage and most have a list of participating pharmacies and their roster coverage.  Recently, legislation has been enacted allowing pharmacies to open for as long as they deem necessary or perhaps more accurately, as long as they want to.  If you have a requirement for pharmacy services after normal hours, you usually have to ring the "night bell" and speak to the pharmacist through a security door.  Your prescription will be delivered through a small serving hatch offering similar security to that of a bank.  You cannot obtain any other service from a roster pharmacist other than the supply of a prescription written by a doctor for which there may be a surcharge.  In large towns and cities where crime is rife, it may even be necessary for you to be accompanied by a policeman.

Prescriptions

If you have a prescription from a doctor, you must pay 40 per cent of the cost unless you are handicapped or a pensioner when you pay nothing.  If you have private insurance, depending upon your policy, you may be able to reclaim the cost of your medications.  Prescription medicines in Spain are among the cheapest in the EU .  However, pharmacies, which are run by their owners, have a monopoly on no-prescription drugs which can work out quite expensive compared with many other countries.  Items such as Neurofen and Aspirin which can be purchased in UK supermarkets cost much more in Spain although the choice and quality seem to be far higher.  The cost of most drugs in Spain can be purchased at less, often far less, than the prescription fee which is charged in the UK.

Pharmacists In Spain,

If there is one profession which cannot be criticised, it’s that of pharmacist. They are extremely well trained and provide free medical advice for minor ailments.  Most don't speak English but seem to understand what a problem may be and assist.  Such are their diagnosing skills that in many cases they obviate the need to visit a doctor although they will not hesitate in suggesting you visit one if they deem it in your best interests Brand names of certain drugs as with most other products produced by multinational companies change from country to country.  However, the generic name is the same in all countries.  If you have to take a certain drug permanently, you should ascertain from your doctor its generic name in order that your Spanish doctor and pharmacist can easily identify it.  In Spain, there are no pharmacy groups.  Instead a pharmacist in Spain owns and runs his own pharmacy, the numbers of which are carefully controlled and maintained by government.  Standards as mentioned are very high.  Unlike UK pharmacies, Spanish pharmacies don't tend to stock unrelated items, keeping mainly to the theme of the business. Most pharmacies exhibit a list of local clinics and hospitals where emergency medical treatment can be obtained. Make a note of these and keep them to hand.

Medical Emergencies

Assuming you have overcome all the hurdles and now find yourself in Spain, you should be aware of what the situation and procedure is if you are unfortunate enough to be involved in a medical emergency.  In any emergency, the action to be taken will obviously be determined by the gravity of the situation.  Generally, the Spanish emergency services are up to most occasions, but may tend be thin on the ground in some inland.  The best way for minimizing the effect of any emergency is to be aware of the fact that they do from time to time crop up and be prepared for them.  In Spain, you will need to address several important points in order for you and your family to be adequately and competently prepared.  If you find yourself in a situation where you need to summon help, it may well be that whilst a lot of the world speaks English, those from whom you are trying to summon help may not.  Now you have a very real problem.  The only way to avoid this happening is to either stay fit or more realistically, learn a few key phrases so you can explain to a telephone operator, police office or anyone else on the telephone just what your problem is.  At most, this task will only take you a few minutes or perhaps an hour or two at most.  You need to be able to give your address and ask for the appropriate emergency service.  The average phrase book has everything you need.  When you can remember what to say, find someone who speaks Spanish so you can practice your pronunciation. If you do have an emergency call the appropriate service, stay calm and if it is a medical emergency, make sure that you specify the type or symptoms, so that the ambulance can bring a doctor if deemed necessary.  You don't have to speak Spanish fluently to describe the symptoms of a heart attack.  The word "cardio" will be descriptive enough for the operator.  Numbers for emergency services differ throughout Spain.  Upon your arrival you should quickly ascertain what these are.  The English language press in Spain usually has essential numbers printed in every edition.

 Emergency Transport

In Spain, it is a legal requirement for all taxis to transport medical emergencies to hospital when requested to do so. They may not want you bleeding on their upholstery but should this be the case it can best be described as unfortunate, for both the driver and the patient.  By the way, this does not obviate you from paying the fare.  Private cars can become a priority vehicle when transporting a patient in an emergency simply by switching on the hazard lights and displaying a white piece of material from a window.  Don't employ this method simply as a rule to speed you through holiday traffic.  Abusing this unique privilege attracts attention from those likely to fine you heavily on the spot. 

Ambulances

An ambulance will take a patient to the nearest hospital equipped to deal with the emergency.  Private ambulance services provide a 24 hour a day service in most large towns and resorts with many private hospitals and clinics operating their own vehicles. Social security patients pay nothing for ambulances.  This is also the case with private insurance, although you may have to pay first and then claim the money back at a later stage.  When it comes to ambulances, most are fitted with oxygen, portable suction devices and simple ECG equipment but few are to the standards found in the USA or countries of northern Europe.  This is possibly because the idea of a paramedic has yet to really catch on in Spain.  In some parts of Spain, there are services supplied by helicopters.  Unlike the UK you will only be able to avail yourself of these services if you subscribe to them.  If you want to live inland this might be a consideration.  For a family of four, expect to pay an annual fee in the region of about 250€ which will include a home doctor service but not hospital, drugs or specialists fees which are additional. If you are able to, you can go to a hospital emergency or casualty department or a 24 hour public clinic.  ou can find the telephone numbers for these in the front of all telephone directories.  In an emergency, a hospital must and will treat any patient regardless of his or her ability to pay.  You must, upon your arrival in Spain, become aware of the location of those establishments you may need in case of an emergency and learn enough Spanish to be able to summon them should it be required.  Don't do this and all too soon you will find yourself wishing that you had.  Don't leave this to your next door neighbour who happens to have been in Spain for several years.  The day you need him, he just may not be available.  He may even need you.

Mosquitoes & Bugs

When it comes to biting type insects it would appear that there are two types of human.  Those they bite constantly and those they never seem to bother.  If you are the former, Spain can be a problem for you, particularly in the summer months during the evenings and nights.  Needless to say there are a variety of products available.  Many of them are not too effective.  Some are reasonably effective but quite expensive, some are very expensive and completely ineffective and with some, it is infinitely more preferable to be bitten than to use them.  If you are contemplating purchasing any ultrasonic device which you may believe will repel mosquitoes or other types of insects, don't bother.  None of them work and you will waste your money.

Repellent

Repel Plus is a product is produced by Boots and regrettably is not available in Spain.  If you suffer from insect bites, particularly those from mosquitoes, this is an excellent product.  It is also effective against sand flies, who can deliver a very painful bite and many other biting insects as well. Importantly, it can be used safely on any child over six years of age, ensuring that they sleep through the night untroubled.  (Sand flies may also carry a virus which is lethal to dogs).  If you can obtain it, it is definitely worth keeping a moderate supply of this product in your first aid box.  Clean, and simple to use, Repel Plus will allow you to enjoy the summer evenings without having to wear long sleeves or sit under fans.  There must be other products as effective but to the present moment they remain unknown to us.  If you are aware of any particularly effective insect repellent, we would be pleased to hear from you.

Ants

These can be a real problem in summer.  There are many proprietary brands of insect killers but such is their tenacity in looking for food it is almost necessary to stand guard over your kitchen.  There is only one way to keep ants out of your house or apartment and that is to deny them access to food.  A single crumb left on a work surface is all that is required for an army to be summoned to remove it.  Cat or dog food left down will also attract ants in great numbers.  If you wish to leave food down for your pets, place a bowl of their food in a shallow tray of water.  If ants can't get to it they simply go somewhere else where there is food.  It must go without saying that hygiene in the kitchen is of paramount importance if you are to avoid invasion by "creepy crawlies" and more importantly, serious illnesses.  Food spoils very quickly in the Spanish summer and your refrigerator needs to be organised in a way so as to separate uncooked foods, especially meats, from cooked foods.  Mayonnaise, salad creams and similar should be used carefully.

Spiders

Depending upon where you are located, there can be quite a few spiders and whilst some can be quite colourful, none are dangerous.  There seem to be more inland than in the coastal areas and a few may be a little larger than you are used to.  Spiders will go where they can find food.  If your house is full of flies, soon it will be full of spiders.  No food - no insects.  Or nowhere near as many.

Sand Flies

These are nasty flies and deliver quite an unpleasant bite.  Worse, they are so quick, they are difficult to knock down, even with an aerosol spray.  The good news is they don't ordinarily present a problem.  As with mosquitoes, Repel or similar, will keep them away should you find yourself troubled with them.

Cockroaches

As with most places in the world, if you are prepared to share your home with these creatures, they'll be happy to move in.  They are real survivors and capable of going without food and water for months.  Deny them any opportunity to become established by keeping the areas in which they live, absolutely clean.  As a precaution, you can always leave "Roach Motels" or similar devices down which will ensure that should they visit, they will not return.  With a little knowledge, organisation and perseverance, insect problems can be overcome and they should not normally present a problem for the average person.

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