This is the third of four installments on Spain which I recently visited with my husband and two other friends. You never know when you are going to need health care. In this episode, an unlucky event turned into a fortuitous experience, Spanish style. An accident required a trip to the emergency room. That visit pleasantly surprised me and made me envious of Spanish health care. As we work to solve our very deep health care crisis here in this country, it helps to look at how others, in other places, do it, even if that happens after a fall.
Madinat al-Zahra, the city of the caliph, Abd al-Rahman 111, lies 7 km outside of the city of Córdoba on the southern slopes of Jebel al-Arus, the Bride’s Mountain. Founded in the early 11th century and destroyed by civil war a mere 65 years later, it was long-forgotten and only recently rediscovered in the early twentieth century. Today it makes a pleasant excursion with marked paths through the excavations and immense vistas of the Andalusian plains below.
Even though we arrive in the evening when the sun is low and the shadows long, it is still very hot; only a hint of a breeze moves the heavy air as we start our descent into the ruins. Suddenly, just behind us, we hear a cry. It is our friend; she has fallen on the stairs. Helping her up, we think that perhaps all is right, but it isn’t. Even though she can walk, she is in pain. Insisting that we continue, she returns, with her husband, to the car to rest. But now, our leisurely stroll has turned into a race to see the sights as quickly as possible and return to our ailing friend.
That evening, the ankle swells up. Propping it up on a pillow, we give the patient ibuprofen, and apply anti-inflamatory cream and ice to the offending body part. The next morning, however, it is clear that our friend requires something stronger than a home remedy. The clerk at the hotel’s front desk gives us the address of the nearest hospital. Luckily, it is just around the corner, but too far for our friend to walk. Hopping in a taxi we are at the emergency entrance in three minutes. Inside, the receptionist asks our friend a few questions and then says, “I’m sorry, here we take only internal medicine emergencies. You need to go to the hospital for trauma emergencies.” Dismayed, we look at each other. “Don’t worry, the man continues,” I’ll call a taxi. You’ll be there in ten minutes.” And we are. That’s when our eyes are opened to the marvels of personal yet efficient and cost-effective health care.
On checking in at the trauma emergency, the receptionist insists, “I’m sorry but this is a private hospital; because of that the emergency service will cost you 90 euros.” Sorry? I wondered. 90 euros? 90 euros (about $129) is nothing. There must be a trick; surely there will be additional charges. We pay and as instructed take a seat. We expect a long wait, especially since it is Saturday morning, but within five minutes someone calls our friend’s name.
An attendant ushers us into a room where a doctor greets us. Competent and pleasant, she asks questions and examines the ankle. “I don’t think it is broken,” she says happily, “But we’ll need an x-ray.” The attendant leads us down the corridor to x-ray where a technician, after greeting us, whisks the patient inside. Shortly, our friend emerges. “Done,” she says, “Now, we just have to wait for the results.”
We wait; other patients come and go. No one sits for long, but, surely, I tell myself, this will take quite a bit of time. But, no, it doesn’t. After only fifteen minutes, we hear our friend’s name being called again. The doctor has the results and a diagnosis. “It’s badly torn; since you are traveling, we’ll bandage it tightly; continue to take anti-inflamatory medication and keep the ankle elevated and iced for a week; then change the bandage,” she explains. We thank her as, once again, the attendant shepards the patient out and into another room. Very soon, however, our friend is back with the bandage intact. So fast. It’s only been about hour I say to myself “Let’s go,” says the satisfied patient.
As we approach the receptionist’s desk I am ready for the bad news about additional costs. I ask, “Do we need to check out? Do we owe anything in addition to the 90 euros?”
“No and no,” the receptionist says.
“And, a taxi? Where can we find one?” we enquire.
The woman behind the desk smiles. “There will be one waiting at the taxi stand just around the corner.” And there is.
I am curious to discover how much a visit to an emergency room in the U.S. for the same ailment would cost but put the question out of my head. After all, we are on vacation.
Later when I get home, I do some web research. It is difficult, to say the least, to get information about the price of various medical treatments here in the States. This, I decide, is emblematic of one of our problems: Lack of transparency. It is never clear what you get for what price. Only after the fact and with much exertion can you sometimes understand what is the real price of your treatment. However, I am in luck because, in 2005, the State of Minnesota surveyed both public and private providers to get a handle on the 2003 price of some typical medical treatments.
In the list I find “broken ankle.” The price includes the trip to the emergency room, x-ray of the ankle, and application of a short leg cast. This is fairly close to the case of our friend. Perhaps the trip to the ER was by ambulance (It doesn’t say.) and I would expect the application of a cast costs more than that of a bandage (although it actually looked like a cast). The price of the treatment in the U.S.? $1,386.00. The price in Spain? About $129.00. Amazing, the price here is 10 times more than in Spain and I’m not even adjusting the 2003 price of the U.S. treatment for inflation. Let’s be generous and say with the added expense of an ambulance ride and cast (instead of bandage) the price is only five times as much, that’s still too expensive. We need to expect more from our health care system.
All original content copyright 2009 Mary E Slocum