Elsevier

Health Policy

Volume 105, Issue 1, April 2012, Pages 46-54
Health Policy

The health care experiences of British pensioners migrating to Spain: A qualitative study

https://doi.org/10.1016/j.healthpol.2012.02.002Get rights and content

Abstract

Background

Notwithstanding the importance of cross-border healthcare mobility for Member States very little research has been carried out to understand the experiences of those that move. This paper focuses on a type of patient mobility that has had a significant growth in the past decades. These are pensioners who have moved from Northern European countries to countries in the South.

Objective

To explore the health care experiences of British pensioners who have migrated to Spain.

Design

Qualitative study using in-depth interviews complemented with natural group discussions.

Participants

Fifty-eight British retirees living in Spain and four that had returned to the UK from Spain.

Setting

Spanish Autonomous Communities of Valencia and Baleares and the UK.

Results

British pensioners reported high satisfaction with their experiences of Spanish health care, in contrast to their more negative experiences of other public services in Spain. The perceived high quality (assessed in terms of thoroughness of care and the cleanliness of facilities) and humanity of care provided were the pivotal features of health care encounters, at all levels of the health care system. Exceptions to the overall positive assessments were transport to health care facilities, personal care in hospitals, long term care, and the management of pain relief, which were compared unfavourably with the UK NHS.

Conclusion

In contrast to the existing literature, which suggests widespread problems faced by migrant British pensioners in accessing health care, we identified high levels of satisfaction with services.

Section snippets

Background

The increasing mobility of people within the European Union has stimulated growing interest in how they obtain health care. Although certain rights to care from statutory health systems in another Member State have existed since the earliest days of the European Economic Community, initially covering certain cross border workers, in 1971 all European citizens achieved the right to care should they fall ill while abroad and, where authorised by their funder, to obtain non-urgent care abroad.

Participants

Interviewees were sampled purposively to include a range of older adults who are British, had been living in Spain for at least three months a year, spread across different locations and approximately equal numbers of men and women. We continued to carry out interviews until we reached the point of data saturation, whereby we had enough data to enable an in-depth explanation of the emerging areas of interest. For example, at a late stage of the research it was considered important to explore

Structural factors influencing the health care experience

Pensioners identified a range of ‘structural factors’ that shaped experiences, which broadly related to physical access to staff and services as well as attributes of the settings. Access to services can be considered both a structural and an organisational factor. We discuss access in more detail in this section but we also acknowledge that the way in which services are organised has an influence on access to health care.

Importantly, assessments were frequently made through explicit or

Discussion

These findings concerning the health care experience of British migrants retiring to Spain have extended and modified our understanding of this group in several ways. First, previous research on the health care experience of this group is sparse and most has focussed on its negative impacts [21], [22], [23], apart from limited survey findings which suggest that, when asked directly, pensioners agree that the Spanish health care system is very good [12], [30]. This paper unpacks the reasons for

Funding

The Economic and Social Research Council [PTA-031-2006-00373] funded the work. The views expressed do not necessarily reflect those of the funder.

Contributors

HLQ conducted the interviews. HLQ, JG, EN analysed the data. HLQ drafted the paper; MM, JG, EN and DlP contributed to the subsequent drafts and final version. HLQ is guarantor for the work.

Ethical approval

The research was approved by the Ethics Committee of the London School of Hygiene and Tropical Medicine. All participants were informed about the content of the study and its likely outcomes and were informed of their right to refuse to answer any question which they did not wish to answer. A consent form provided information on the research, including the confidentiality and anonymity of interviewees’ responses. All read the information sheet, signed the consent form and gave written consent

Conflict of interest

We are not aware of any relationships or support which might be perceived as conflict of interest.

Acknowledgements

We thank Rosemary Quigley for her invaluable contributions to the study. We also thank all the interviewees in the study who took time to generously share their experiences.

References (37)

  • M. Calnan et al.

    Ageing and public satisfaction with the health service: an analysis of recent trends

    Social Science & Medicine

    (2003)
  • H. Legido-Quigley et al.

    Cross-border healthcare in Europe: clarifying patients’ rights

    BMJ

    (2011)
  • INE. Padrón Municipal; 2010. Available from: www.ine.es [cited 2011 31st...
  • D. Sriskandarajah et al.

    Brits Abroad: mapping the scale and nature of British emigration

    (2006)
  • Foreign and Commonwealth Office. Accessing health care in Spain; 2011. Available from:...
  • X. Paunero

    Els estrangers residents a la Costa Brava

    Revista de Gerona

    (1988)
  • A.M. Solana et al.

    Els residents estrangers a Espanya

    Documents d’Analisi Geogràfica

    (1994)
  • V. Rodríguez et al.

    European retirees on the Costa del Sol: a cross-national comparison

    International Journal of Population Geography

    (1998)
  • M.A. Casado Díaz et al.

    Northern European retired residents in nine southern European areas: characteristics, motivations and adjustment

    Ageing & Society

    (2004)
  • K. Friedrich et al.

    Entornos Socioespaciales y tramas sociales de los emigrantes retirados Alemanes en España. Los ejemplos de Mallorca y la Costa Blanca

  • A. Huber

    Retirados Suizos en la Costa Blanca (Provincia de Alicante)

  • T. Breuer

    Caracterísitcas del Turismo Residencial de Alemanes jubilados: Resultados de una encuesta realizada en las Islas Canarias

  • R. King et al.

    Sunset lives: British retirement migration to the Mediterranean

    (2000)
  • V. Rodríguez

    Retired to life in Spain: conditions, situations, scenarios

  • V. Rodríguez et al.

    Una perspectiva actual de la Migración Internacional de Jubilados a España

  • M.A. Casado Díaz

    Retiring to Spain: an analysis of differences among northern nationals

    Journal of Ethnic and Migration Studies

    (2006)
  • K. O’Reilly

    The British on the Costa del Sol

    (2000)
  • C. Betty et al.

    Consideraciones sociales y sanitarias sobre los inmigrantes británicos mayores en España, en particular en la Costa del Sol

    Migraciones

    (1998)
  • Cited by (26)

    • Pills in paradise: Exploring international lifestyle and retirement migrants’ perceptions of the pharmaceutical sector on Cozumel Island, Mexico

      2017, Health and Place
      Citation Excerpt :

      A few investigations of international lifestyle and retirement migrants’ (ILRMs) access to and use of local health care and residential care options (Hardill et al., 2005; La Parra and Mateo, 2008; Amin and Ingman, 2010) or health as a determinant of migratory ability (Williams et al., 1997; Van Dalen and Henkens, 2007) have been published. Otherwise, health engagements within ILRM literature tend to focus upon desires for health promoting lifestyles and landscapes as part of migration decision making processes (Legido-Quigley et al., 2012; Benson and O'Reilly, 2009; O’Reilly and Benson, 2009). Furthermore, while international lifestyle and retirement migration is a growing phenomenon within the Americas (Dixon et al., 2006), the majority of research into these mobile populations has been geographically focused on the movements of people within Western Europe or to Asian nations.

    • Exploring the experiences of EU qualified doctors working in the United Kingdom: A qualitative study

      2015, Health Policy
      Citation Excerpt :

      These findings are consistent with our earlier research in Spain exploring the healthcare experiences of British pensioners. British pensioners reported being impressed with the cleanliness of Spanish facilities and contrasted the empathy displayed by Spanish health professionals with that experienced in the UK [28,29]. Most of our interviewees, contrary to media reports, were well prepared and their main motivation to move to the UK was to learn new skills and experience a new health care system.

    • European health professionals' experience of cross-border care through the lens of three common conditions

      2015, European Journal of Integrative Medicine
      Citation Excerpt :

      The instrument is reproduced in web appendix. We selected acute myocardial infarction as it is one of the most common diagnoses in Europeans treated outside of their residence country [10]; an acute complication (ketoacidosis) of type 2 diabetes, a condition prevalent in older patients, many of whom choose to retire in another country, such as British expatriates in Spain [11]; and hip arthroplasty, an elective procedure subject to long waiting lists, which might potentially become a more common reason to seek care abroad, following the ruling of the European Court of Justice in the Smits–Peerbooms case which explicitly cites undue delay as a legitimisation for cross-border care within the EU [12]. A case scenario describing each of the three conditions was included in the survey (Box 1), followed by identical questions for all three conditions.

    • Health and social fields in the context of lifestyle migration

      2012, Health and Place
      Citation Excerpt :

      These findings are consistent across all levels of the healthcare system, including primary care, hospital care and pharmacy services. Exceptions to this overall positive assessment were transport to healthcare facilities, personal care in hospitals, and long term care, and the management of pain relief (Legido-Quigley et al., 2012). The limitations of this study are also twofold.

    View all citing articles on Scopus
    View full text