Home Healthcare Healthcare Basics Healthcare in Spain: a guide to the Spanish healthcare system
Last update on November 01, 2019

The healthcare system in Spain is ranked among the best in the world, and this helpful guide provides everything you need to know as an expat.

If you are living and working in Spain, you will likely have access to free state Spanish healthcare. This is paid partly by social security payments which will be deducted from your wage. This helpful guide, provided by Cigna Global, explains how to access the Spanish healthcare system, and includes the following sections:

Cigna Global

Cigna Global provides comprehensive health insurance to over 86 million customers in over 200 countries. They have wide access to trusted hospitals, clinics, and doctors and provide expats with help on tailoring a plan to suit their individual healthcare needs.


Overview of the Spanish healthcare system

The Spanish healthcare system

Spain has a high quality healthcare system, guaranteeing universal coverage for all residents. Healthcare in Spain 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).

Around 90% of Spaniards use the public healthcare system, which is called the National Health System. However, it is very decentralized with service delivery organized at regional level. The system is overseen by the Spanish Ministry of Health, which develops policy and oversees the national health budget.

Spain was ranked 19th on the 2018 Euro Consumer Health Index and is praised for its improving health outcomes. It is, on the other hand, criticized for poor accessibility and over-reliance on the private sector.

Healthcare in Spain

Who can access healthcare in Spain?

State healthcare is free of charge to anyone living and working in Spain. However, on some of the Spanish islands you may have to travel to find a state healthcare provider. As the Spanish healthcare system is decentralized, you will need to check the conditions in your own area for using healthcare services.

As an expat, you can get free state healthcare if you are:

  • a resident in Spain and work in employment or self-employment and pay social security contributions;
  • living in Spain and receiving certain state benefits;
  • a 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 a resident in Spain;
  • under 26 and studying in Spain;
  • a state pensioner;
  • staying temporarily in Spain and have an EHIC card.

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. Check with your local Spanish embassy to see if any agreements are in place between Spain and your home country. If you don’t have the right to state healthcare, you will have to organize private health cover.

Healthcare costs in Spain

Spanish health care spending accounts for around 9% of annual GDP, making Spain the 13th biggest healthcare spender out of EU/EFTA nations. Spending works out at just over €2,000 per person. However, healthcare expenditure has increased in recent years and there has been more of a reliance on private sector provision.

Despite this, most public healthcare in Spain remains free. Residents only need to pay a proportion of prescription charges if they are making regular public health insurance payments. They also have to pay for certain specialist medical procedures and may need additional private insurance coverage.

The Spanish state healthcare system is funded by social security contributions. Each region of Spain takes individual responsibility for a health budget, which is allocated by the central government.

Health insurance in Spain

Health insurance in Spain is covered by Spanish social security payments, which are made by all employees and self-employed workers. Spouses and children of workers are also covered.

Certain other groups such as pensioners and those receiving benefits can also register for healthcare if they are residents. They can do this even if they haven’t paid into the health insurance scheme. There is also a discount state contribution scheme for low earners and those out of work called the convenio especial.

Those not covered by state insurance or the EHIC card will need to take out private medical insurance. See our Guide to health insurance in Spain for more information.

How to register for Spain’s public healthcare

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.

To register for social security, you will need to provide:

Once you have registered with the TGSS you will be given a social security number and a certificate stating that you are entitled to medical help. You can then register for medical treatment and apply for a health card (tarjeta sanitaria individual or TSI). You will receive this in the post, or need to pick it up personally.

Private healthcare in Spain

Private healthcare provision in Spain runs alongside the public system, with some providers offering both public and private provision. Anyone not eligible for state healthcare will need to take out private health insurance or pay the full amount for any medical costs.

Many people also choose to cover themselves for private treatment to give them access to wider and quicker treatment. Around 19% of the Spanish population have some form of private healthcare coverage. Private insurance is also popular among expats.

Private health insurance in Spain usually costs between €50-200 a month, depending on the coverage plan. Some of the largest private health insurance companies in Spain include:

You can compare private health insurance providers in Spain and get free quotes on our special Expatica health insurance page, and with the following tools: Acierto.com (in Spanish) and Rastreator.com in (Spanish).

Doctors and specialists in Spain

Doctors in Spain work out of either private practices or health centers. They offer both private and state healthcare so be clear which type you want. You can choose your own doctor in Spain. They can be found via your local healthcare authority.

If you want to be seen by a medical specialist in Spain, you will need to have a referral from a family doctor. Bear in mind that waiting times can be long for highly prescribed analyses or certain specialist services. If you have private health insurance, you will be able to see a specialist much faster than going through the public system.

You can find out more information in our detailed guides to visiting the doctor in Spain and medical specialists in Spain.

Women’s healthcare in Spain

The standard of women’s healthcare facilities in Spain is generally good. However, it can vary across the regions, with more available in urban environments. Pregnant women in Spain have access to gynecologists and midwives through either public or private provision. Most births take place in a hospital, although home births are becoming popular.

Pregnant woman

Contraception is widely available in all regions. You can buy condoms in pharmacies or supermarkets, but you need a prescription for birth control pills in most areas. You can acquire emergency contraception without a prescription.

There are clinics located across the country, which offer free STD tests and sexual health information and advice. Cancer screening programs are administered by the regional autonomous communities for breast cancer and cervical cancer.

Abortion has been legal in Spain, during the first three months of pregnancy, since 2010. Terminations are only permitted after this under specific circumstances, such as if there is a serious risk to the life or health of the mother.

For comprehensive information about women’s health in Spain, see our guides to women’s healthcare and to having a baby in Spain.

Children’s healthcare in Spain

Children in Spain have free healthcare coverage under their parent or guardian’s insurance. This includes free dental care and access to pediatric services until the age of 15.

There are many specialist services across the country, which cater specifically for children’s needs. This includes mental healthcare through child psychologists and psychiatrists. Public services are good, although private healthcare is an option for those in regions where specific facilities may be lacking.

There is a national vaccinations program for children in Spain. Vaccinations are available against a number of conditions including:

  • Hepatitis B;
  • Polio;
  • Tetanus;
  • Measles, mumps, and rubella (MMR);
  • Diphtheria

More information can be found in our detailed guides to children’s healthcare in Spain and vaccinations in Spain.

Visiting the dentist in Spain

The Spanish healthcare system does not cover dental care in Spain, unless you are aged under 15 or require emergency treatment. You will need to pay for dental treatment unless you have private health insurance. Dentists in Spain will typically require payment upfront. Read more in our Guide to dentists in Spain.

Dentists in Spain

Hospitals in Spain

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 will need a referral from a doctor. There are public and private hospitals in Spain. 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 a Spanish hospital you will need to show your social security card or proof of private insurance. You can find out more information and see a list of hospitals in our Guide to hospitals in Spain.

Health centers and health clinics in Spain

Primary healthcare in Spain is delivered through GP surgeries a (médico de cabecera) and health centers (centro de salud or centro de asistencia primaria or CAP). Health centers are located in every region and are staffed by multidisciplinary teams comprising of GPs, pediatricians, nurses, gynecologists, and physiotherapists.

Health centers in Spain tend to have around six GPs. You may not see the same doctor each time you visit, although in some centers you can book to see a specific doctor. There are also a number of specialist health centers providing specialist care in Spain.

You can search for a health center in your local area on the Spanish Ministry of Health website.

Pharmacies in Spain

You can take a prescription to any pharmacy (farmacia). Look for a shop with a large green cross sign outside. Pharmacies are usually open on Monday to Friday from 9.30am-2pm and 5pm-9.30pm, and Saturdays from 9.30am-2pm. There is 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.

Pharmacies in Spain

Spain operates on a co-payment system for prescription medicines. Residents have to pay a non-refundable percentage of medicine costs. How much you pay depends on your personal situation, and the guidelines are as follows:

  • If you are of working age, you pay between 40-60% of costs depending on your annual income;
  • Pensioners with an annual income of less than €100,000 pay 10% of costs;
  • Sufferers of chronic or serious illnesses pay 10% of costs, with a cap on each medication.

Registered pharmacists can also provide health consultations and guidance on health matters.

Mental healthcare in Spain

Mental healthcare provision in Spain falls short of what is available in terms of physical healthcare services. According to EU figures, there are 8.1 psychiatrists, 5.7 psychologists, 9.7 mental health nurses, and 32.2 psychiatric hospital beds per 100,000 inhabitants. This is below the EU average.

These figures are reflective of the general gap in mental health services in southern Europe, compared with other parts of the continent. That said, Spain has implemented a Mental Health Strategy which aims to improve service delivery and coordination. The Confederation of Mental Health in Spain works closely with the Ministry of Health to improve service quality and integrate the Autonomous Communities.

If you need mental health treatment in Spain, you will typically receive care through your GP or at a health center in the first instance. Those with serious or ongoing illnesses will be referred for specialist treatment, most of which is provided at community mental health centers. They can also access private treatment such as psychotherapy. However, state health insurance will not cover this, so you will need private coverage if you don’t want to pay the full costs.

Other forms of healthcare in Spain

Alternative and complementary therapies, including homeopathy, acupuncture, reflexology, and chiropractic treatment, are currently available in Spain. According to Spanish law, alternative medicine should be practiced only by those with full medical qualifications. Some treatments are available in health centers. However, the Spanish government recently announced plans to eradicate alternative treatments from public centers.

Although some treatments such as homeopathy are widely available in Spain, public health insurance does not cover complementary therapies. Some private insurance companies will cover it, but you will usually have to select this as an add-on and pay a higher rate.

In an emergency

In a serious, life-threatening emergency, call the pan-European number 112; this is free of charge from any mobile/cell phone or landline. The Spanish word for A&E or ER is urgencias.

Other emergency numbers include:

  • 061 – for an ambulance (ambulancia)
  • 1003 – for an emergency doctor
  • 961 496 199 – emergency dentists
  • 963 600 313 – on duty pharmacy

Save this complete list of important emergency numbers in Spain.

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

Save this Spanish medical dictionary.

Spanish healthcare contacts