The healthcare system in Spain
The Spanish healthcare system is ranked among the best in the world. Here’s how to sign up to free state healthcare in Spain, or apply for health insurance.
If you're living and working in Spain you'll likely have access to Spain's free state healthcare, paid partly by social security payments, which will be deducted from your wage.
The Spanish healthcare service is regularly rated among the world’s best, guaranteeing universal coverage and no upfront expenditure from patients apart from paying a proportion of prescription charges. Spain spends about 10 percent of its GDP on healthcare, and is ranked 6th in the EU for the number of doctors with around four doctors per 1,000 people. A 2012 World Health Organisation survey showed that Spanish women outlive all other nationalities (living to 85.1 years) apart from the Japanese, so they must be doing something right.
Public and private healthcare in Spain
Spanish healthcare consists of both private and public healthcare, with some hospitals (hospitales) and healthcare centres (centros de salud) offering both private (privado) and state healthcare services (asistencia sanitaria pública). You don’t need to have private health insurance to get medical treatment in Spain but it usually allows you to get faster treatment for non-emergency procedures.
The state health system in Spain
State healthcare is free of charge to anyone living and working in Spain, although in some of the Spanish islands you may have to travel to find a state healthcare provider.
As an expat, you are entitled to free state healthcare if you are:
- resident in Spain and work in employment or self-employment and pay social security contributions,
- resident in Spain and receiving certain state benefits,
- resident in Spain and recently divorced or separated from a partner registered with social security,
- a child resident in Spain,
- a pregnant woman who is resident in Spain,
- under 26 and studying in Spain,
- a state pensioner, or
- staying temporarily in Spain and have an EHIC card (see below).
If you don’t have the right to state healthcare you have to organise private health cover. If you have been registered on the padrón at your town hall for a year, the Spanish government has a state insurance scheme (convenio especial) with a basic monthly fee. This is administered by the authorities in each autonomous region.
The state system is funded by social security contributions, with each region of Spain taking individual responsibility for a health budget allocated by central government.
As the healthcare system is decentralised, you will need to check the conditions in your own area for using healthcare services. There’s a directory of the regional health authorities within the different regions of Spain on the Spanish health ministry’s website (mainly in Spanish). Click on your region on the map for contact details of your local health authority and links to specific information about the health services it provides.
Private healthcare in Spain
If you are not paying social security contributions, then you can choose to take out private health insurance or pay the full amount of any medical costs.
You can find information about Spain's public and private health insurance systems in Expatica's guide to health insurance in Spain. Read more about choosing between public and private health insurance as an expat.
How to register for Spain's public health care
First of all, you must register with social security (Dirección General de la Tesorería General de la Seguridad Social or TGSS), which has offices throughout Spain, to get a social security number. You’ll need to show your passport or ID card, residency certificate and a completed application form. You’ll also need to have registered your details (address etc.) at your town hall.
Once you have registered with the TGSS you’ll be given a social security number and a certificate stating that you’re entitled to medical help. You then take the certificate, passport and NIE number (foreigner’s identity number) along to your local health centre. Click on this map to find the closest one to you. You can then register with a doctor and apply for a health card (tarjeta sanitaria individual or TSI). This will be sent to you in the post, or you will be asked to pick it up personally. The health centre will also be able to arrange for you to get a Sistema de Informacion Poblacional or SIP card. You’ll need to show it every time you visit a clinic, hospital or collect a prescription from a pharmacy.
European Health Insurance Card (EHIC)
If you have an EHIC card issued by an EU-member state and you are in Spain on a holiday or other temporary visit – that is, you are not yet a resident in Spain – you can use your EHIC to access state healthcare in Spain. You can also use it if you are studying in Spain as part of a course based in your home country.
You can use the EHIC to get any medically necessary treatment (as determined by the doctor you see) through the state system either at a reduced cost or free. This could be routine or specialist treatment – for a new or an ongoing condition – which cannot wait until you return home. It does not give access to private healthcare.
You cannot use the EHIC if you are coming to Spain specifically to get medical treatment or to give birth. If this is the case, you should seek advice from the health authorities in your home country before coming to Spain.
It is advisable not to totally rely on the EHIC and to take out medical insurance. There have been cases where an EHIC has been refused in some parts of Spain. This is being investigated by the European Commission but if it happens to you, try to get proof that you presented it at the time as it may persuade an insurer to waive their excess.
Bi-lateral health agreements
Spain has bi-lateral agreements with some countries, such as Andorra, Brazil, Chile, Ecuador and Peru, that allow citizens from these countries visiting Spain for short periods of time to obtain free emergency medical treatment. Everyone else needs to take out private health insurance.
Going to the doctor in Spain
In Spain, you get primary heath care through a health centre (centro de salud or centro de asistencia primaria or CAP), or a general doctor (médico de cabecera). Before you can see a doctor, you’ll need to register (see above).
Click on this map to find your local health centre. The health centre will probably have around six doctors and you may not see the same one each time you visit, although in some centres you can book to see the same doctor, particuarly if you are in ongoing treatment. Find a doctor with his or her own practice through the phone book or by personal recommendation.
Doctors may offer both private and state healthcare; make sure you are clear which type of healthcare you want. There may be separate surgery times for private and state patients. You should be given a leaflet called Carta de Derechos y Deberes (Charter of Rights and Obligations) that sets out your rights as a patient. You usually make an appointment to see a doctor at a health centre although doctors with individual practice may offer a first-come-first-served basis. You have the right to be accompanied by a friend or relative during consultations. You can change doctors easily, just by re-registering.
Going to see a specialist
If you want to be seen by a medical specialist in Spain you’ll need to be referred by a family doctor. If you have private health insurance, you’ll be able to see a specialist much faster than going through the public system.
In an emergency you can go straight to a hospital A&E or ER (Urgencias).
If you want to get any other type of hospital treatment, you’ll need a referral from a doctor. There are public and private hospitals. Only the public hospitals provide free treatment. Some hospitals offer both private (privado) and state healthcare services (asistencia sanitaria pública), so make sure the staff knows which service you want.
When you go to hospital you’ll need to show your social security card or proof of private insurance.
If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don’t issue prescriptions.
Pharmacies in Spain
You can take a prescription to any pharmacy (farmacia). Look for a shop with a large green cross sign outside.
Pharmacy opening hours
Pharmacies are usually open Monday to Friday from 9.30am to 2pm and 5pm to 9.30pm, and Saturdays 9.30am to 2pm. There’s usually a notice on the pharmacy window or door with details of the nearest 24-hour pharmacy (farmacia de guardia) – or you can find a list of pharmacies online.
Prescription charges in Spain
You have to pay a percentage of the cost of prescription medicines, and the cost is non-refundable. How much you pay depends on your income and whether you are of working age or a state pensioner. For example, if you are of working age and your annual income is less than EUR 18,000 you have to pay 40 percent of the cost of the medication. If your income is between EUR 18,000 and 100,000 you pay 50 percent, and if it’s over EUR 100,000 then you pay 60 percent. State pensioners pay 10 percent unless their income is over EUR 100,000, in which case they also pay 60 percent. You can find out more about this co-payment system, in Spanish, here.
Registered pharmacists can also provide health consultations and guidance on health matters.
Visiting the dentist in Spain
Dental treatment is not covered by the state healthcare system unless in an emergency. You must either pay for dental treatment unless you have private health insurance. Find a dentist by looking in the phone book or by personal recommendation. Just call up and make an appointment.
Pregnancy and birth in Spain
The standard of care for pregnant women in Spain is highly regarded in both the private and public sectors. The degree of medical contact is reasonably high, with an initial appointment with a doctor or midwife (comadrona/llevadora) to confirm the pregnancy, antenatal appointments and hospital scans. Most births take place in a hospital although home births are becoming increasingly popular. A word of warning: if you wish to give birth at a private clinic, it’s advisable to take out medical insurance well ahead of getting pregnant otherwise it might be hard to find an insurer.
For comprehensive information about maternity care in Spain, see Expatica’s article on having a baby in Spain.
In an emergency
In a serious, life-threatening emergency, call the pan-European number 112 free of charge from any mobile/cell phone or landline. The Spanish word for A&E or ER is urgencias.
Other emergency numbers include:
- 060 for an ambulance (ambulancia)
- 961 496 199 – emergency dentists
- 963 600 313 – on duty pharmacy
Useful Spanish phrases in an emergency
- Accident: Accidente
- Emergency: Emergencia/Urgencia
- I need an ambulance: Necesito una ambulancia
- I need a doctor: Necesito un medico
- Heart attack: Ataque cardiaco/Infarto
- Stroke: El accidente vascular cerebral
- I need a dentist: Necesito un dentista
For more information
- Seguridad Social, the Spanish social security office, where you can find information on all social benefits including registering for national insurance. Some of the information is in English.
- Ministerio de Sanidad, Servicios Sociales e Igualdad, the website of the Ministry of Health, Social Services and Equality has more information about the Spanish healthcare system
Need advice? Post your question on Expatica's free Ask the Expert service to see if we can help.
Updated from 2009.
Bupa Global offers a variety of health insurance packages to expats in more than 190 countries around the world.