Healthcare in Spain: All You Need to Know in 2024

Whether you are a resident, citizen, or tourist, you need to know how to access the healthcare system in Spain.

Tourists are less likely to require a doctor’s visit, but if you live in the country permanently, making use of the public health system can potentially save your life. Therefore, it is crucial that you know what your options are and how to access primary healthcare services.

In this article, we’ll explain how to register with the local family doctor, what you need to access the Spanish national health service, and what your options are for both public health insurance and private health insurance providers.

Overview of Spain's Healthcare System

Spain’s healthcare system is known for its effectiveness and accessibility, providing universal healthcare to residents. It is primarily funded through taxation, which ensures that the vast majority of healthcare services are free at the point of use for Spanish nationals, residents, and even those from other EU countries under certain conditions.

The healthcare system in Spain is a combination of public and private sectors. The public sector (Sistema Nacional de Salud) is the system’s backbone, providing comprehensive coverage that includes preventive, primary, specialized, and hospital care. Each of Spain’s 17 autonomous communities manages its healthcare services, allowing for regional adaptations to the national health policy framework.

Private insurance also plays an important role, offering an alternative for those seeking shorter waiting times and more provider choices. Approximately a quarter of the population opts for private health insurance to complement public services.

High-level comparison with other countries

Spain’s healthcare system is internationally recognized for its high standards of care, robust public health initiatives, and excellent patient outcomes. It frequently ranks highly in global healthcare system comparisons, reflecting its commitment to ensuring health services are both high-quality and universally accessible.

However, the healthcare systems of different EU countries can vary in terms of the services provided, degree of privatization, patient contribution levels, and the efficiency of service delivery.

Like Spain, many EU countries finance their healthcare systems through taxation, providing a wide range of public healthcare services at little or no cost to the patient. However, the balance between public and private healthcare services, waiting times for certain treatments, and patient satisfaction can differ significantly.

Countries such as France and Germany also prioritize high-quality healthcare, with both systems offering a combination of public and private options. France is recognized for its extensive coverage and patient choice, while Germany’s healthcare system is known for its efficiency and quality of care. The Nordic countries, including Sweden and Denmark, emphasize equal access and comprehensive coverage, often resulting in high levels of public satisfaction.

In comparison, Spain offers similar care quality and accessibility, making it competitive with other European countries. However, differences often arise due to the specific healthcare policies and funding mechanisms employed by each country, which can impact the user experience and overall system efficiency.

How Healthcare Works in Spain

Spanish nationals and residents have a choice between public healthcare system or paying monthly for a private provider. While the outcome is generally the same, there are several significant differences between the national health systems.

The public healthcare system in Spain provides comprehensive coverage to all residents, funded by the state, with potentially longer waiting times for certain services. Private insurance, on the other hand, offers an alternative route, with faster access and more choice at a cost, either through insurance premiums or direct payments.

Public healthcare in Spain

Funding and Accessibility: Public healthcare is primarily funded by the government through taxes. It is available to all Spanish residents, providing comprehensive coverage including primary care, hospital services, and some pharmaceuticals at little to no out-of-pocket cost.

• Coverage: It offers a broad range of medical services to patients free of charge or at a subsidized rate, including preventive, diagnostic, and hospital treatment services.
• Waiting Times: Patients may experience longer waiting times for certain treatments and specialist services due to the high demand within the public system.
• Choice of Doctors: There is less flexibility in choosing specific doctors or specialists in the national health system compared to the private system.

Private healthcare in Spain

• Funding: Private healthcare is primarily funded through private health insurance plans or out-of-pocket payments by patients.
• Accessibility: It serves as a complement or alternative to the public system, offering faster access to specialists and elective procedures.
• Services: Private healthcare often provides additional comfort and convenience, such as shorter waiting times, more choice of providers, and access to private facilities.
• Cost: While offering quicker access and more personalized care, private healthcare requires individuals to either pay for services out-of-pocket or carry private health insurance.

3 Benefits of Spanish Healthcare

Having primary healthcare in Spain comes with a ton of perks you can use:

1. Primary health care is free or has low cost: The health system is free of charge, as long as you’re using the public one. It’s important to note that healthcare is free for older people, children, and unemployed citizens without paying social security.
2. Primary health care offers different services: Primary health care includes different health services, such as access to a family doctor, pediatrician, physiotherapy, and all other medical needs Spanish citizens might have.
3. A good network of hospitals and health centers: Spanish citizens have access to a wide variety of hospitals, and in case you have to get to an emergency room quickly, you probably won’t have to travel far.

5 Most Popular Private Healthcare Providers

While there are many private healthcare providers to choose from in Spain, several companies consistently rank among the top with citizens. This is either for the number of procedures covered, the monthly installment, or the level of customer care.

1. Sanitas: Part of the Bupa Group, Sanitas is one of Spain’s leading health insurance and private providers, offering a wide range of health services and medical facilities across the country.
2. Adeslas: Known for its extensive network of facilities and healthcare professionals, Adeslas is a prominent health insurance company in Spain providing comprehensive coverage and access to numerous medical services.
3. Asisa: Asisa offers a broad spectrum of health insurance products and services, including access to a large network of private doctors, hospitals, and clinics nationwide.
4. Mapfre: A major insurance company that also offers health insurance products, Mapfre is recognized for its quality services and extensive healthcare network.
5. DKV: Part of the Munich Health Group, DKV Seguros is a key player in the Spanish private market, known for its innovative health insurance solutions and services.

Other private healthcare providers include SegurCaixa Adeslas, Axa, Allianz Worldwide, and Cigna.

Eligibility and Coverage for Public Healthcare in Spain

Although public healthcare is funded by taxation, it doesn’t automatically mean that everybody is covered equally. There are still a few eligibility criteria for accessing a public doctor.

People who are employed or self-employed in Spain and make social security contributions are automatically entitled to public healthcare for themselves and their dependent family members. Expatriates living in Spain who are registered as residents (and not working or making social security contributions) may qualify for public healthcare through other means, such as being a recipient of certain state benefits or by registering with the Spanish social security system.

If you retire in Spain and receive a pension from an EU country, you can access public healthcare by registering your S1 form (previously E121) with Spanish social security. If you are a student in Spain, you can also qualify for public healthcare if you are under the age of 26 and you have a European Health Insurance Card (EHIC).

Public Healthcare Registration

Before you can see a public healthcare practitioner, there are a few steps you must go through to register yourself on the system. Here are the general steps to follow when registering for Sistema Nacional de Salud (SNS), also known as National Health Service.

1. You need to be registered as a legal resident in Spain through a visa program.
2. You must have a Spanish Social Security Number.
3. Register yourself on the census of your local town hall (padrón).
4. Visit the Social Security e-Office website and complete your details on the “Application for recognition of entitlement” page.
5. Once complete, download the certificate.
6. With your passport, residency document, registration on your local census, and certificate of entitlement go to the local primary healthcare center (centre d’atenció primària – CAP) to apply for a Spanish health card.

If everything goes well, your Tarjeta Sanitaria Individual (TSI) will be mailed to you in about two or three weeks. With this Spanish health insurance card, you can register at your local doctor or health center. However, if you need to see a specialist provider, you generally need a referral from your local physician.

Healthcare Facilities and Services

Difference between health centers, clinics, and hospitals

The Spanish healthcare system is structured to provide a range of services from primary care to specialized treatments, distributed across different types of facilities. Just as with other European countries, different doctors and services are accessed by visiting health centers, clinics, and hospitals.

• Health Centers (Centros de Salud): Health centers are the cornerstone of Spain’s public healthcare system, primarily focusing on primary healthcare services. There is usually a health center in every town, servicing the local residents. They provide a wide range of services including general medicine, pediatric care, nursing services, and often family and community care.
• Clinics (Clínicas): Clinics often specialize in a particular field of medicine, such as dental, ophthalmology, dermatology, or outpatient surgical procedures. They can refer to both public and private healthcare facilities and may offer diagnostic services, treatment, and sometimes minor surgeries, usually not requiring an overnight stay.
• Hospitals (Hospitales): Hospitals provide secondary and tertiary care, including emergency services, inpatient treatment, major surgeries, and specialized medical care. They are equipped with more extensive medical facilities compared to health centers or clinics, capable of handling serious and complex health issues. Hospitals service public and private healthcare providers.

Pharmacy services

Spain boasts a dense network of pharmacies that are widely distributed throughout the country. These pharmacies are marked by their green crosses and are highly accessible, owing to regulations that guarantee the availability of a pharmacy within reasonable proximity for residents in both urban and rural areas.

Although privately owned, pharmacies in Spain form an integral part of public healthcare, catering to the needs of the public by providing prescribed medications, over-the-counter drugs, and health advice.

The number of pharmacies in Spain may fluctuate, but the country is renowned for having one of the highest numbers of pharmacies per inhabitant in Europe, ensuring that all citizens have access to comprehensive pharmaceutical services.

Specialized Healthcare Services

• Dental care: Dental services are not covered by SNS in Spain. This means that individuals have to pay for their dental treatments. However, the fees charged by dentists are usually affordable, and the quality of care provided is consistently high. To reduce these expenses, people can opt for private health insurance, which can include dental coverage for as little as €10-20 per month. If you need specialized dental treatment in a hospital setting, such as after an accident, it will be covered by public healthcare insurance.
• Mental healthcare: Public health insurance provides coverage for seeing a mental health professional when referred by a general practitioner. However, the public mental health system in Spain is significantly underfunded. As of 2022, there are only six clinical psychologists per 100,000 people, which is substantially below the European Union average of 38 per 100,000. It should be highlighted that accessing mental health services is generally more straightforward with private insurance, which tends to offer shorter waiting times and a greater choice of providers.
• Alternative medicines and therapies: Alternative therapies, including holistic medicines, homeopathy, acupuncture, reflexology, and chiropractic services, are not covered under Spain’s public healthcare system. However, coverage for these therapies can be obtained through private health insurance, provided they are chosen as an additional option, which may result in increased premiums.

Dealing with Emergencies

To simplify accessing emergency healthcare services, the European Union has one number for all countries in the territory. The primary emergency number in Spain is 112, which can be dialed for any type of emergency, including medical emergencies, fires, or to contact the police. This number is free of charge and can be dialed from any phone, including mobile phones, without a SIM card.

For medical emergencies where callers directly connect to the emergency healthcare services, the number is 061. More commonly used in rural areas, the Civil Guard (Guardia Civil) is contacted on 062, and the National Police (Policía Nacional) is contacted on 091.

Key Takeaways about Healthcare in Spain

The Spanish healthcare system is well-known for its high quality and accessibility. It operates on a universal healthcare model funded by taxes, offering comprehensive services to all residents. These services include primary care, specialized treatments, and emergency services, and are provided through a network of public and private facilities.

While basic healthcare services are widely available at little to no cost, some aspects, such as dental care and alternative therapies, are not covered. This prompts individuals to opt for private insurance for broader universal coverage and access to private hospitals.

Despite challenges such as resource constraints in certain areas, Spain maintains one of the top health systems globally. They emphasize preventive care and patient accessibility, making healthcare services more accessible to everyone.

Frequently Asked Questions about Healthcare in Spain

Are abortions legal in Spain?

In Spain, abortion is permitted and publicly funded in 70% of instances. Pregnancies can be terminated within the first 14 weeks, extending to 22 weeks if there’s a significant health threat to the mother or fetus. Terminations past this period are allowed solely under circumstances where the fetus cannot survive after birth or if there’s a grave, untreatable condition. For individuals aged 16 or 17, terminating a pregnancy does not require the approval of a parent or guardian.

Are prescriptions funded by SNS?

The SNS covers 40 to 60 percent of prescription drug costs, depending on income. Pensioners and retirees only pay 10 percent.

What is the emergency number in Spain?

In Spain and throughout the European Union, you can access emergency services from anywhere by dialing 112.

How much does private healthcare cost in Spain?

While it depends on which private provider and plan you go for, a general estimate of the monthly cost is between €50 and €200. The cost also depends on the inclusion of specialty care and the number of dependents on the plan.

How good is the Spanish national health system?

The Spanish health system is one of the best in Europe, with a family doctor in even the smallest of towns. While residents might need to travel a short distance to see specialist doctors, it’s usually only one or two towns over.