From 84 euros for a consultation to 177,735 for a transplant: the invisible bill of public healthcare

PalmaGoing to the doctor, getting a test, going to the Emergency Room, or spending a night admitted to the hospital does not mean you have to take out your wallet when you are entitled to public healthcare. But just because the patient doesn't pay at the time of receiving care doesn't mean it's free. Every consultation, every test, every treatment, and every admission has a cost that the public system assumes and that, ultimately, is paid for with everyone's resources. The official IB-Salut rates allow us to put figures on this invisible bill and better understand the value of the healthcare services available to everyone.

The regulations set the public prices for health services in certain cases, mainly when there are third parties obliged to pay and when users are not entitled to healthcare covered by Social Security. These are not the prices paid by a person entitled to public assistance when they go to a health center and hospital, but rather the rates at which the system values services. These amounts allow us to see what lies behind healthcare.

A first Primary Care consultation is valued at 84 euros and a subsequent consultation at 43 euros. If complementary tests are necessary, the amounts rise to 107 and 53 euros, respectively. A nursing consultation has a fee of 30 euros and reaches 54 if it includes tests. In the case of a medical visit at home, the price can reach 158 euros when nursing care and complementary tests are also necessary. These are the most common attentions, but they show that even an apparently simple visit mobilizes professionals, facilities, materials, and public resources.

349 for non-hospital emergencies

The fee is more important when the patient arrives at the hospital. A first specialized care consultation is valued at 154 euros and a subsequent one at 92. Hospital emergency care that does not end in admission has a fee of 349 euros, while certain day hospital services or emergency box care reach 723 euros. An outpatient surgical intervention costs 1,085 euros and the use of the operating room can reach 2,202 euros when an operation lasts up to four hours.

Hospitalization further increases the bill. One day of admission is valued at 1,092 euros and a surgical hospitalization stay at 1,394. If the patient requires an intensive care unit, a special unit, or a critical care unit, the rate reaches 2,094 euros. These amounts include a large part of the resources needed to care for the patient, such as medical assistance, nursing care, medication, certain tests, food, and accommodation.

There are more complex situations. The IB-Salut places hospital processes related to migraines and other headaches between 3,370 and 7,812 euros, while an intracranial hemorrhage can reach 15,076 euros and a stroke with infarction, 13,389, among other treatments. A cranial trauma that leads to deep coma can reach 80,531 euros. In the most complex cases, the amounts far exceed 100,000 euros: a liver or intestinal transplant can reach 138,297 euros and a heart or lung transplant, 177,735 euros. A bone marrow transplant can exceed 133,000 euros.

These figures do not mean that a citizen has to pay these amounts when they need healthcare: in Spain it is universal and free. Precisely one of the functions of public healthcare is to guarantee that a person can receive an operation, a treatment or emergency care without having to bear the cost directly. The bill, however, does exist. It is paid for by public budgets and, therefore, by the citizenry as a whole.

Knowing the cost of healthcare services can help raise awareness of the importance of using them responsibly. However, this responsibility cannot fall solely on the user. It makes no sense to ask a patient to avoid going to the Emergency Room if, when they need a Primary Care consultation, they find centers where appointments can be given with a delay of up to two weeks, even though the regulations state that they should be offered within a maximum of 48 hours. In these situations, the patient may end up going to the Emergency Room because it is the only way they have to receive care within a timeframe they consider reasonable.

The user's responsibility also exists, even in situations where it is not always easy to assign blame. For example, a patient requests an appointment with their GP for an illness and it is scheduled for ten days later. Five days later, they are already feeling better and, simply because the appointment is far in the future, they do not think to cancel it. When the day arrives, they do not go, and the center records an absence that has prevented that time slot from being used by another patient. Using the healthcare system responsibly therefore implies a shared responsibility: that citizens use resources wisely and that the Administration guarantees that the resources and capacity are available to attend to patients when they need them.