Availability of decent healthcare is a key concern for anybody moving abroad and getting to grips with the new system can sometimes be confusing however well you speak the language. On our country sites MumAbroad has devised a healthcare section which aims to help Mums & Dads familiarize themselves with the system from looking at the way it is structured to interviews with Healthcare Professionals.
Before leaving home, European residents should apply for a European Health Insurance Card (or EHIC) which provides medical treatment cover when visiting the other European countries participating in the scheme. The card is free of charge and is issued by your national health insurance provider. The EHIC has an expiry date and is only to tide you over until you have registered as a resident in your new country and/or set up a private insurance policy. The period of validity depends on the country issuing the card. For more information or to apply for your first EHIC, follow this link: http://ec.europa.eu/social/main.jsp?catId=509&langId=en
Healthcare is Spain has improved greatly in recent years and compares well to other European public health systems. Anybody making social security contributions (seguridad social) is entitled to public healthcare in Spain. Every residential area has its own Doctor's Surgery, known as a Centro de Asistencia Primaria (CAP) or ambulatorio. You must present your Health card, Targeta Sanitaria Individual (TSI) on arrival at the Doctor's Surgery in order to make an appointment. Your TSI card is issued at your local social security office by showing your passport and proof of residence.
Although public healthcare is Spain is generally regarded as good, as with all public systems, waiting lists can be long and the access to certain specialists limited, so some opt for taking out private health insurance.
The large Spanish private health insurance company Sanitas was bought by Bupa back in 1989 and Bupa now provides tailor-made Sanitas health plans for foreign residents in Spain. Mapfre is another popular insurer.
If you are having a baby in Spain, you may find that the amount of medical contact during pregnancy is high. Regular visits to the gynaecologist for check ups, blood tests and scans are programmed throughout the pregnancy. Births in Spain are generally highly clinical, hospital deliveries, although home births and alternative deliveries are becoming more common.
Maternity leave is limited to just 16 weeks in Spain and, as most mothers return to work immediately after, mother and baby groups are less common here and daycare centres (guarderías) take babies as young as 4 months old. The statutory paternity leave is 15 days.
The French healthcare system has earned itself a very good reputation and was ranked as the world's number 1 back in 2000. Residents in France must apply for a social security card (Sécurité Sociale) and pay insurance based on income and this is automatically deducted from your salary if you work for a French company. The availability and range of specialists compares well to other European systems and the French social security reimburses the majority of the payment after treatment. Patients must register with a local GP and take their health card or Carte Vitale to appointments. The French Social Security website will provide you with all the necessary information
Many opt for a top-up insurance policy in France; this is known as a Mutuel. There are many mutuelles available to choose from – Groupama, https://www.mutuelle-existence.fr/ and MAAF to name just to name a few.
The advantage of having private top-up health cover is that they will generally reimburse what the Secú (Social security) will not. Definitely worth looking into, especially if you are likely to need additional healthcare such as dentistry.
An important distinction to make in the French healthcare terminology is the difference between “hópitaux”, which are state run, and “cliniques” which tend to be private. If you opt for public healthcare during your time in France, expect to pay for visits up front and then to be automatically reimbursed by the public health plan provider. Residents in France are assigned a local GP but are completely free to visit which ever doctor they like if they require a second opinion or are not within easy reach of their usual doctor. Having said that, only your local GP has the power to refer you to a specialist.When taking your prescription to the pharmacy in France, expect to pay just the percentage of the cost which is not covered by the state.
If you are having a baby in France you should register the pregnancy with your GP and send a declaration of the pregnancy to your health insurance fund. Your Gynaecologist will program regular check-ups, blood tests and scans which you should always attend and you may wish to register with a nursery early on as the French system only allows 16 weeks paid maternity leave, increasing to 26 weeks for the third child. You will find more detailed information regarding information on maternity rights on the state healthcare web site.
Many of those relocating to Italy may be pleasantly surprised by the high quality of the country's healthcare system that, in the http://www.who.int/countries/ita/en/ last health care ranking in 2000, was ranked as the 2nd best in the world after France.
All citizens are entitled to healthcare via the National Health Service “Servizio Sanitario Nazionale” and will be assigned a GP according to where they live. If you are employed in Italy, your company is responsible for paying your health insurance/NI contributions. You just need to go to your local health authority “Azienda Sanite Locale” to register with a doctor. You will be sent a health card and unique health number by post. The SSN is responsible for providing medical tests, medication, surgery and specialized medicine as well as the administration of medical drugs.
In order to avoid a long wait or if you prefer to choose a private hospital (there are several English/International hospitals in Italy) many Expats choose to pay for private healthcare in addition to the SSN. Italian providers include INA Assistalia, Europ assistance and Filo Dretto
Most of the major international healthcare providers operate in Italy.
It is definitely worth shopping around and comparing deals when taking out private health insurance in Italy as prices and conditions vary greatly. Avoid policies which reserve the right to cancel agreements or have a maximum age, also steer clear of policies that only last one year as all of these may lead to you being left with no cover just when you need it most. Italian health insurance companies are notoriously reluctant to pay claims and many expats opt for a policy with a reputable international company such as Bupa:
Having a baby in Italy may differ to the experience in your home country in that births tend to be rather clinical and alternative birthing methods are still relatively uncommon. Maternity leave is paid at 80% for a period of five months. When a woman discovers she is pregnant she should make an appointment at the Gynaecologist's where her, her partner and the doctor will plan a series of tests and check ups during the pregnancy and where the delivery will take place. Many Expats rave about their experience of child rearing in Italy given that children are cherished and adored members of Italian society and Italy is generally considered a very family-friendly country.
Not surprisingly, Germany is known for its efficient, well-funded healthcare system with high-tech hospitals and efficient primary care and close to non-existent waiting lists. Another feature of the German healthcare system which appeals to many foreigners is its focus on alternative medicines and the range of services and specialists available. There is no law binding medical practitioners to stick to purely conventional treatments, so it is possible to find practitioners who are willing to prescribe complementary medicine where they see fit. The system is based on compulsory public health insurance (Krankenkasse) and optional private cover or a combination of the two. The public health insurance provides a comprehensive health package. For more information on statutory health insurance click here:
Those with a higher income and the self-employed will often opt for private healthcare in Germany which generally means faster access to a wider range of specialists and the possibility of requesting an English-speaking doctor. For further information on private health options in Germany click here (In German):
The Gesetzliche Krankenversicherung (public health insurance) is for those who earn less than 4,575€ per month and is quite simple to set up; you just have to make an appointment at the regional office and take your passport and residence permit - Aufenthaltserlaubnis - with you. The Krankenversicherung (private health insurance) tends to be more complicated to obtain as candidates are subjected to a series of tests and questionaires before they are deemed eligible for care.
Pharmacies in Germany have a large A sign outside them to make them easy to recognise. Those with state health insurance can expect to be fully or partly reimbursed for prescription drugs, depending on the cost. Those with private insurance will also be reimbursed by their private healthcare plan and, furthermore, have access to brand drugs. Carrying a prescription is necessary for reimbursement in both cases.
Having a baby in Germany is generally reported as being a very positive experience by expats - from the range of birthing options and pregnancy support to the financial support and benefits provided to families by the German state after the birth. Women giving birth in Germany can usually choose to do so in a hospital, a birthing house, known as a Geburtshaus and which offers a slightly less clinical atmosphere than a hospital, or at home, subject to prior arrangement. The standard paid maternity leave is set at 14 weeks, although women's work positions are reserved for them for an extended period of time on request and working hours are usually kept flexible for working mothers, which is greatly appreciated for its positive effect on day to day family life. More on parental leave here.