First, an anecdote.

When I moved from the United States to Spain and created Jazztel in 1998, I opted to offer health insurance to my employees—a very North American concept. I asked them if they would prefer that Jazztel pay for a private health insurance plan, or instead, that I give them that money directly. It wasn’t substantial, something like 60 euros (75 dollars) a month. It surprised me to learn that hardly anyone chose the private health insurance plan, that few were interested in private health care, that they were remarkably content with the public health system and that they preferred to earn 60 euros more a month.

Later, I was given the chance to check out the Spanish public health care system for myself, partly due to my mountain biking injuries and also because of my children’s various accidents. I saw firsthand that it was really very good and very free. Especially coming from the US where health care costs some 600 euros (750 dollars) per month and, you have to pay for additional things that are included as insured here in Spain.

Now, let’s “fast forward” to 2012.

We have a bankrupt Spain being bailed out by the EU day-to-day. A bankrupt health care system and with massive defaults, but still with good quality medicine and full of new hospitals freshly equipped with the latest “bubble” models from when we still had credit. All this accompanied by a great debate over the topic of copays and the plan to charge 710 euros (890 dollars) a year to illegal immigrants. Seeing the situation and being an entrepreneur, it occurred to me to make a business out of this tragedy.

Or let’s just say: make the tragedy less tragic by constructing a business to help it.

Spain is the fourth largest tourist destination in the world. We receive almost 60 million tourists per year and almost all of them come from countries where medicine is more expensive. Why don’t we sell our medical services—that are so good and so cheap—to our tourists? Why don’t we launch medical tourism to a larger scale? Why don’t we transform public health care into an export-oriented industry?

How do you do this? The government could launch a big publicity campaign in which they offer medical insurance to foreigners and allow them access to public health care for 100 euros per month. And for those foreigners who travel here without an insurance plan, they would be charged 40 euros (50 dollars) each time they wanted medical attention and not be seen for free as they are now. North American friends that had health problems in Menorca, for example, couldn’t believe it when after receiving medical treatment, were released without being charged. They were willing to pay 100 euros for a consultation; 40 euros would seem like a bargain. Foreigners don’t expect it, but they receive free medical treatment in Spain.

From here we can start to promote medical tourism. Come get yourself treated with the Spanish national health system! We are the longest-living of all big countries in the world!

If the government ensured that one million of the 60 million tourists pay this medical tourism insurance, it could obtain 1.2 billion euros (1.5 billion dollars) a year. To North Americans, being able to come to Spain and while here, go to the doctor for free, all for an insurance premium of 1,200 euros annually, would be very beneficial. The Germans pay 300 euros a month for insurance. And we won’t even speak of the uninsured people in many countries who have money but not enough to afford insurance in their country. In Argentina, for example, insurance that provides the same quality of service as Spanish health care costs about 300 euros per month. I know that getting a million customers isn’t easy, but the market has 60 million. Later we will have to determine the costs of treating these patients, but I find it possible to make a profit. Especially when there is so much infrastructure already in place.

I think the Spanish government has a possibility to finance a part of the health of its people with medical tourism, and that this opportunity should at least be studied. I know many Spanish people think that health care should be free for everyone, but it isn’t—we pay for it ourselves and we can find more customers overseas. It’s time to be creative and sell medical insurance to foreigners with the Spanish national health system.

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Pat Phelan on August 30, 2012  · 

A very interesting concept Martin
I already buy all my medicine in Spain, am just back from a week in Cambrils where I picked up 12 of each inhaler I use.
Becotide and Ventolin cost me almost 60 euro per month in Ireland, in Spain its sub 7 euro, an incredible difference over a year as you can imagine with the exact same manufacturer.
I must agree on the quality of the health service also after using it a few years ago I found it to be excellent
Here is also a recent piece on medical travel in the USA

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Kerry Ritz on August 30, 2012  · 

Mexico has already started to promote itself as a medical destination to Americans. A lot of Mexican doctors have been trained in the US, many private hospitals have first class facilities and prices are a fraction of the US. Costa Rica has been promoting itself to Canadians as well, despite Canada having a high quality, public system– the queues are now too long. Hungary has long provided high quality dental care to Brits.

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keefieboy on August 30, 2012  · 

As an autonomo living in Spain, I have to pay €275 a month for Social Security. This entitles me to two things only: healthcare and a tiny little pension if I ever retire. I find this incredibly expensive, and sometimes it’s a burden that I cannot meet. My experience of primary health care is that the doctors can be incredibly rude and unhelpful, especially as I am a guiri whose Spanish is not great (and if you’re talking about health tourism in Madrid, doctors who can speak English are about as common as hen’s teeth). However, I did have an experience a few months ago involving a sharp blade, two fingertips and a trip to the hospital: the care and treatment I got there was superb, although the follow-up visits showed me the Spanish health service has an awful lot to learn about the management of appointments and queues.

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Balta Biosca (@BaltaBiosca) on August 30, 2012  · 

Actually Im health professinal on spain, pharmacist. This looks like a good idea, really profitable for Spain, But you know what? This is a political thing, if somebody proposes that, soon all the politycs not on the power gonna start saying that is non ethical, make pay “poor” people who need treatment from other countrys. Sounds crazy for people from other countries I know it, cuz I had this conversation overseas. But its how it is.
Right now health system on spain is really into make pay taxes to just people “who got money” using a sofisticated software that connects with national taxation database to check that.
Its a beginning, but make pay tourists more for healthcare? never in Spain, non ethical

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d on August 30, 2012  · 

I’m not agree with that idea. It is not only about money but resources. People with right to use Spanish tax-payed health services (oversimplifying it: Spanish people) willfind a more oversaturated hospital or primary health centre because it is full of foreigners that are here for a cheap medical care.

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Adan on August 31, 2012  · 

Are you proposing that people fly to Spain for a flu shot? I like the idea, but the benefits have to outweigh the costs…

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Pablo on September 1, 2012  · 

Buena idea

No estoy muy seguro, pero creo recordar que a mis amigos extranjeros (de Chile) se les obliga a tener un seguro médico. Y creo que es una de las preguntas para dejarte entrar como turista en España.

Si aplicáramos tu idea aquí Martin, las agencias de viajes podrían ofrecer la cobertura en el origen. Y en vez de elegir el típico seguro privado escojan el “seguro para turistas publico”.

Esto está bien para el que viaja solo dentro de España. En mi caso la mayoría de amigos que vienen a España después continúan por Europa, y el seguro no les serviría, a no ser que España extendiera la cobertura a toda Europa como lo hace con la tarjeta sanitaria europea.

Saludos y buena idea Martin!

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Maria marques on September 1, 2012  · 

Siempre resulta positivo oír la opinión de gente con perspectiva , y quien ha vivido en otros países con otros sistemas sanitarios lo es. Sin embargo hay algo que no contempla y es el pudor cerval de los políticos españoles para sacar beneficio monetario de un bien publico como la sanidad. Oír “privatización”y echarse a temblar es lo mismo.
Lastima no tener políticos con “perspectiva”

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Joan Carles on September 2, 2012  · 

Spain’s different (a slogan used since many years ago). Indeed it is. We can charge 30 – 50 euros for a paella (presumably frozen) and a sangria (from the supermarket but poured into a nice jar) but give free medical services…

Martin, why are you still here (if you are)?

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eva on September 3, 2012  · 

This is hardly a breakthrough initiative (Malaysia for example and Kuala Lumpur in particular has a very healthy medical tourism industry, pun intended) nevertheless one worth setting up. Good climate + state of the art medical equipment + lots of doctors must surely be all that’s needed. Spain has them all.

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Ed on September 5, 2012  · 

I would buy it!!!
Everytime I go to Spain I am terrified of having any health issue, this service would guarantee me peace of mind.
Any chance of making it official?

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Stacy on September 5, 2012  · 

When we go to Spain we sometimes get medicals supplies. I think you have a fairly good idea but eventually the money is going to catch up. I think someone somewhere pays the same? As an American I’m somewhat optimistic that I’m not being over charged and these prices are what it costs everyone. When you get you business off the ground I’d be interested.

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GR on September 5, 2012  · 

Of course what you propose is an untapped valuable opportunity, as many many others for the Government.

As in “real” business it is not the idea that make the success but to put it in practice in the right way, same for Spain where the issue is not the lack of opportunities but the burocratic weight and the “no, we can not” political slogan.

Issue is the mindset. And specially the fact that they dont see the issue…

BTW, Spain in value represents even a better position on Tourism ranking

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Ben on September 6, 2012  · 

One more example: Israel provides a lot of medical services, especially for those from the former USSR (I helped to pay the bill to a friend of mine: it was not cheap. She could opt for a free OP in Russia – but it’s better to be poor than dead).

But Israel has not only excellent medicine, but also personal speaking all languages. In Spain, that’s going to be a big problem

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Marc on September 8, 2012  · 

I have a holiday home in Spain and myself and our family members use it frequently (as tourists, we are not residents) and yes, public health care is great in Costa Blanca & Spain. We live in Belgium and we have a fine public health system there too. So whenever I or my family need urgent treatment or an appointment with a doctor while on holiday, grace to the EU regulations and agreements between the member states, we do not have to pay for treatment in Spain (or anywhere else in the EU). Our public insurance pays the bill to the Spanish one. We only pay a small part of the bill once back in Belgium – as we would have to do for treatment in Belgium – (to prevent over-use of health service; there is a yearly maximum cap on this).
Furthermore, being members of an EU country, we have the right to take also non – emergency treatment anywhere in the EU, provided that our (in our case Belgian) public insurance system agrees (which they are inclined to do if the treatment is cheaper abroad; which it mostly is 🙂
That is why we have many Dutch people coming over to Belgium, also to avoid the long waiting lists in Holland. Exactly as many elderly EU citizens come over to stay in the warm winter on the Costa Blanca coast and while here get medical treatment. So your idea for EU residents is already in many cases an existing reality. With a small monthly fee with a private health insurer (we have DKV) even hospital bills are covered.

So I am fond of your proposal, and thus of promoting world-wide multi-lateral agreements between public health service systems (and the private ones), and in doing so also to promote “health holiday tourism”. This could boost the Spanish tourism sector also outside of the summer season.
– it stays to go both ways for “free” or for a minimum charge for people with public health care insurance in EU or any other country with a bilateral agreement with Spain (they already pay for it you see paying taxes in their own country – nothing is “for free” in this world; so why not go bilateral between EU and Canada, the USA, Singapore etc.?)
– people visiting Spain without existing bilateral public health insurance coverage would pay a fee (which is already being done in some of the Comunidades here) and there your idea to pay per visit is very correct
– people using the public health system by coming over to Spain to get free medication for a full year, while not staying here as a resident – and thus pay Spanish taxes which pay for this “free” public medical aid- (that is what you have to do by law if you stay longer than half a year in Spain) should not be allowed to do so: their medication is paid for by Spanish residents and nationals and thus tax payers. It would be fair if they would pay the amount in Spain which they would have to pay in their own country.
– people without public health coverage, in real need for help and not being able to pay for it or for private health insurance, should be treated by doctors on the basis of Hypocrates’ oath ( if possible with payment done by international bodies which are created to support dislocated people. And so, yes, paid for by all of us with our taxes).
For all others, not included in this shortlist, your suggestion for a monthly or yearly insurance fee would be a very sensible project, as long as the bills are fully paid by these insurers and not paid for by the already like lemons squeezed Spanish citizens. (Let us not make the same “mistake” which led to millions of subprime loans in the US, causing our Euro crisis… and the austerity measures that are ruining our EU economies).
Sorry for the long comment but I hope it makes my point clear.
By the way I love FON – and your Bike idea.

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Rafael Valero on September 11, 2012  · 

Very nice post.
I have ridden about Social Security and this stuff, which is not related directly with health insurance in Spain, anyway the name could be fuzzy. Social Security is more linked with pension for retired people.
There are some economics how are propose similar ideas, i.e. We have an efficient health system, let share (provide) this product (with a proper price), but, which the right price is? Because the costs are different even in the same region. I think it is not about ethic is about how to make it runs like a business (the most our politician are public servant and they do not have a clue about business or economics.)

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