Healthcare in Spain: How to get the Best Care

Whether you are a resident, citizen, or tourist, you need to know how to access healthcare 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 care services.

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

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 infrastructure 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 healthcare 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 healthcare 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 or paying monthly for a private healthcare provider. While the outcome is generally the same, there are several significant differences between the 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 healthcare, 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

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 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 compared to the private system.

Private Healthcare

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.

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.

Sanitas: Part of the Bupa Group, Sanitas is one of Spain’s leading health insurance and private healthcare providers, offering a wide range of health services and medical facilities across the country.

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.

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.

Mapfre: A major insurance company that also offers health insurance products, Mapfre is recognized for its quality services and extensive healthcare network.

DKV: Part of the Munich Health Group, DKV Seguros is a key player in the Spanish private healthcare 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

Although the public healthcare system 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

Steps to register for healthcare

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).

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 healthcare system in Spain 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 the public healthcare system, 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 the public healthcare system.

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

Emergency services and contacts

To simplify accessing emergency 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 health emergency 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