Introduction to the Spanish Healthcare System
Here’s the good news – the healthcare in Spain is ranked among the best in the world. According to The Global Competitiveness Report by the World Economic Forum, Spain is the country with the best healthcare in the world, along with Hong Kong, Japan and Singapore.
This is not the first time that Spain has been classified as a world leader in terms of health. Last year Bloomberg published its 2019 Healthiest Country Index where Spain was ranked as the healthiest country in the world. The report, which analysed 169 countries, took into account various factors that influence quality of life.
Not only the characteristics of the healthcare system, but also eating habits, life expectancy, smoking and obesity rates and environmental factors, among others. Spain obtained an overall score of 92.8 out of 100 and moved up six positions to displace Italy from first place.
In this helpful guide to the Spanish healthcare system, we will answer all of your most or frequently asked questions about healthcare in Spain. This guide can also be printed off (with link) or bookmarked (control D) for later use. Too make things easier, we’ve put the guide into the following sections:
Go ahead and click on the links below to jump to each section…
Quick Facts & Overview of the Spanish Healthcare System
Spain maintains a high-quality network of hospitals and medical centres throughout the country.
Whether you’re packing up to move or have already settled in Spain, this guide will walk you through Spain’s healthcare system, including helpful information and tips on how to access medical treatment in your new country. Here are some quick facts about the Spanish Healthcare system:
- Type of healthcare system: Public, with the option for additional private coverage
- Average cost of an emergency room visits: €200 (£184, US$240, AU$160)
- Average cost of a doctor’s visit: Free with European Health Insurance Card, otherwise €100 (£92, US$120, AU$80)
- Number of pharmacies: 21,458
- Number of hospitals: 453
- Population covered by health insurance: 99%
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, and is mainly financed by taxes. As a result, healthcare in Spain is either free or low cost for residents (and their dependents) paying social security. The national healthcare system covers 99.7% of the Spanish population. The remaining 0.3% only has access to private medical care. In addition to this, voluntary private health insurance has been contracted by 13.5% of the population.
Spain maintains a high-quality network of hospitals and medical centres throughout the country. Theoretically, you’re never more than 15 minutes away from one when you’re in Spain. The Spanish constitution requires the state to provide medical care, so the public system is robust. Spain’s medical network caters to a variety of needs, including home visits, surgeries and wellness checks.
There’s more – You are entitled to healthcare in Spain if you are:
- 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
Spain’s Overall Health Chart
|Statistics by The World Health Organisation||Total Population|
|Total population (2016)||46,348,000|
|Gross national income per capita (PPP international $, 2013)||31,850|
|Life expectancy at birth m/f (years, 2016)||80/86|
|Probability of dying under five (per 1 000 live births, 2018)||3|
|Probability of dying between 15- and 60-years m/f (per 1 000 population, 2016)||74/38|
|Total expenditure on health per capita (Intl $, 2014)||2,966|
|Total expenditure on health as % of GDP (2014)||9.0|
The costs involved – How much does healthcare cost in Spain?
The Spanish healthcare system guarantees universal coverage with no upfront spending from patients apart from paying a proportion of prescription charges. In fact, Spain spends about 10% of its GDP on healthcare, and is currently ranked nineteenth in the EU, and number six on the healthcare index.
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.
Each region of Spain takes individual responsibility for their own health budget. Therefore, it is important that you check the conditions in your own area for using the Spanish healthcare system. You can do so on the Spanish Health Ministry’s website (mainly in Spanish). Just click on your region on the interactive map for more details.
Simplified, if you want public healthcare in Spain, you can have it. Just by living and working in Spain, you get access to state-funded Spanish healthcare. If you’re an unemployed non-citizen, you can pay a monthly premium for a private plan, which we discuss in this guide.
In the chart below, you can see how much Spain spends on healthcare for its citizens.
Here are some estimated costs you can expect from living in Spain
|MEDICAL ITEM||COST IN SPAIN|
|Average monthly medical premium for an individual||€50|
|One-day hospital stay||€200|
|Primary Care visit||€100|
|12 months of prescriptions (maximum)||A percentage of the full prescription cost, per drug, depending on your social situation.|
The Spanish State Healthcare System
Spain has both public and private healthcare systems. The public system provides free basic healthcare to those who contribute to the Spanish social security system and their families. The public system also provides free healthcare for retirees, including those from other EU countries.
The UK government pays Spain an annual sum per pensioner to cover their health costs. However, this information may be subject to change with Brexit soon coming into effect. We will however, do our very best to keep you updated with all the latest information and facts.Information may be subject to change with Brexit approaching
Foreign employees working for Spanish companies or self-employed foreigners in Spain usually have to contribute to Spanish social security (seguridad social). This entitles them and their families to receive free or subsidised medical care on the same terms as Spanish residents.
As you are now well aware, the Spanish healthcare system is ranked among the best in the world, but did you know that the Costa del Sol has one of the best hospitals in all of Andalucía?
We’re talking that the hospital is something pretty special, and we are up against stiff competition; from 135 hospitals from 17 autonomous communities. But the Costa del Sol Hospital was declared the overall winner of the ‘Best in Class’ award for the whole of Spain.
This national award was presented in Sevilla and recognises the excellence in the quality of patient care. The Costa del Sol hospital has 400 beds, and some of the best doctors in Spain. It also has a reputation as one of the best hospitals to give birth.
The Spanish Private Healthcare System
Spain also offers private insurance without any citizenship restrictions. Less than 20% of Spaniards pay for private insurance, and most do so for additional prescription or specialty coverage. 10% of people in Spain pay extra to be treated at private clinics, with wealthier Spaniards more likely to go. Sanitas is the largest health insurer in the country.
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.
Good points to know – Going to the doctor in Spain
- You get primary healthcare through a health centre or centro de salud or centro de asistencia primaria or CAP
- Doctors in Spain offer both private and state healthcare
- There are likely to be separate surgery times for private and state patients
- Upon registering, you will be provided with a leaflet called Carta de Derechos y Deberes (Charter of Rights and Obligations) that sets out your rights as a patient.
- You must make an appointment to see your doctor at a health centre
- You have the right to be accompanied by a friend or relative during consultations
- You can change doctors at any time by re-registering
If you require additional healthcare services, you can opt for private health insurance. Spanish private health insurance companies offer a range of packages that cater specifically to your circumstances.
As ever, it’s important to thoroughly research your options and seek as much advice as possible before committing to a specific plan. Foreigners should check if their package provides the same protection in Spain as it does back home.
EU nationals who travel frequently outside of the EU may also consider private health insurance, as the EHIC card only covers travel within the EU.
The advantages of getting private health insurance coverage in Spain
While the quality of public healthcare is high, some residents opt for private coverage. This helps patients avoid the lengthy waiting times often found in the state system.
This is an important factor to consider when weighing up the private care avenue, and is particularly important if you will require regular treatment.
A private health insurance plan enables you to select a doctor with a strong grasp of English. Lists of English-speaking doctors are also available from tourist offices and embassies.
How to register for Spanish Healthcare – Public Healthcare in Spain
If you are a resident in Spain, you need to register your address on the padron at your local town hall. Once you have done this, you will get an empadronamiento (certificate of registration). You’ll need this to apply for a healthcare card.
Please note that you will absolutely need a social security number, as well as an NIE – residencia card. If you haven’t received one, you can sort this out through your local social security office, called the Tesoreria General de la Seguridad Social (TGSS).
In order to apply for the Spanish Healthcare Public system, you must first 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.
Important links for above information
To register for social security, you will need to provide:
- a valid passport or ID card
- your residency certificate
- proof that you have registered your address at your local town hall
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.
About the EHIC in Spain
The EHIC is called a Tarjeta Sanitaria Europea (TSE) in Spain. It allows legal residents of Spain to benefit from emergency medical treatment and care when temporarily in a member country.
Anyone covered by the Spanish social security system or a system is entitled to a TSE.
Residents of Spain can apply to the local Social Security Service and Information Centre (CAISS) for the card. No online application is available.
Note: The TSE cannot be used in Spain to make medical claims. The EHIC (TSE) is for use when visiting a member state other than the country of residence where the card has been issued. That means a resident of Spain with a TSE may use it while travelling in other EU/EEA countries.
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.
Doctors & Specialists in Spain
You will find Doctors in Spain that work in both the private sector or public health centres, so be clear in which type you want. You can choose your own doctor in Spain. They can be found via your local healthcare authority.
In order to see a medical specialist in Spain, you will need to get a referral from a family doctor. Keep in mind that for the public sector, wait times can be long for a highly prescribed analyses or specific specialised medical areas. However, if you have private health insurance, you will be able to see a specialist much faster than going through the public sector.
About Women’s healthcare in Spain
You will find the standard of women’s healthcare facilities in Spain as generally very good. Pregnant women in Spain have access to gynaecologists and midwives through either public or private sectors. Most births take place in a hospital, although home births are becoming popular.
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.
About 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 paediatric 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
- Measles, mumps, and rubella (MMR)
How about 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.
About the 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.
Mental Health in Spain
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. Unfortunately, these figures in Spain fall significantly short when it comes to your mental health.
There is a gap in mental health services in southern Europe, when you compare to other parts of Europe. With that said, Spain has implemented a Mental Health Strategy, which aims to improve the services and the coordination between medical staff and general mental health doctors or therapists.
If you need mental health treatment in Spain, you will typically receive the initial care from your GP. Those with serious or ongoing illnesses will be referred for specialist treatment, most of which is provided at community mental health centres. 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.
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.
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
Prescription costs will vary depending on your economic status. You’re expected to contribute a certain percentage based on your standing.
Here is a table of the breakdown of what you can expect to pay:
|Annual Income||Social Situation||Percentage of Contribution||Contribution Cap|
|€18,000 or less||Of working age||40%||No cap|
|€18,000 or less||State pensioner||10%||€8 per month|
|Between €18,000 and €100,000||Of working age||50%||No cap|
|Between €18,000 and €100,000||State pensioner||10%||€18 per month|
|More than €100,000||Of working age||60%||No cap|
|More than €100,000||State pensioner||60%||€60 per month|
Good to know in Spain – Emergencies, numbers, useful Spanish Phrases, etc.
Important Telephone Numbers in Spain
For serious, life-threatening emergencies, call the pan-European number 112 free.
Dial 060 for an ambulance
Spanish phrases to remember in case of an emergency:
I need an ambulance: Necesito una ambulancia
I need a doctor: Necesito un medico
Heart attack: Ataque cardiaco/Infarto
Stroke: El accidente vascular cerebral