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The quality of healthcare in Spain
Spain has an excellent quality of healthcare. It’s routinely ranked amongst the world’s best.
The WHO Healthcare Index put Spain 7th of 191 countries ranked.
Of course, if you live in a small town a long way from a major city, the range of care available to you will be less than if you choose to live in, say, Marbella or Barcelona.
Spain’s life expectancy from birth is 83 years (three years higher than the OECD average of 80. The OECD also pointed out that 72% of people in Spain reported themselves to be in good health, in comparison to the 68% OECD average.
Spain spends around 9% of its GDP on healthcare and has four doctors for every 1,000 people (6th best in the EU).
The structure of healthcare in Spain
The scope of the services offered by the Spanish national health system (Sistema Nacional de Salud or “SNS“) is laid down by law and applies (at least in theory) throughout Spain. Management of these services has been progressively transferred to the various autonomous communities of Spain but some continue to be operated by the National Institute of Health Management (Instituto Nacional de Gestión Sanitaria “INGESA”), part of the Ministry of Health.
It aims to provide comprehensive health care, including the promotion of good health, the prevention of disease, most kinds of treatment and rehabilitation.
Healthcare is provided via a network of public and private facilities. The private facilities are contracted to the state to provide various services. not all private facilities – hospitals, clinics, doctors etc – are contracted to provide services under the SNS. If they are not contracted, you will have to pay the full price of your treatment. however, the network is comprehensive, so you should always be able to find SNS treatment.
Financing healthcare in Spain
The financing of the SNS is the responsibility of the autonomous communities. Inclusion of a new service in the list of services to be provided by the National Health System creates the obligation to pay for it.
Of course, public finances in Spain (as in most of the rest of the world) have been tight over the last few years and so the SNS has been under financial pressure.
Individual treatments are paid for in part by reimbursement of the doctor, pharmacy or hospital from public funds and in part by fees charged directly to the patient.
The rights of foreigners to use the healthcare system in Spain
Organic Law 4/2000 (Ley Orgánica 4/2000) establishes the rights of foreigners resident in Spain. Article 12 states: “Foreigners who are registered in Spain in the municipality in which they are habitually resident have the right to health services on the same conditions as the Spanish. Foreigners who are in Spain have the right to urgent health services in the event of contracting severe illness or having an accident, whatever may be the cause, and the continuity of this care until the time of discharge. Foreign minors of less than 18 years who are in Spain have the right to health care on the same conditions as the Spanish. Pregnant foreigners who are in Spain have the right to health care during the pregnancy, while giving birth, and post partum.”
However, some of foreigners will be required to have health insurance before they can obtain the right to be resident in Spain. See our guides to immigration. In addition, a law introduced in 2012 limits the rights of unregistered foreigners to use the system.
Foreigners working in Spain and contributing to the social security system will have the same rights as a local person contributing to that system. These include healthcare for themselves and their immediate family.
Citizens of EU member-states who have registered for the (free) European Health Insurance Cards (EHIC) in their own country will be entitled to any medically necessary treatment in Spain during trips of up to 28 days. This will not necessarily be free. They will have to pay the same as ans Spanish person would pay. See below. Of course, it isn’t really free at all. Spain can claim back health costs from other EU countries if their citizens use medical services in Spain.
Who is eligible for state healthcare in Spain?
You can take advantage of the public healthcare system in Spain if:
- You have an EHIC card and are staying only temporarily (see below)
- You are a resident in Spain paying social security (through employment or self employment)
- You are a resident in Spain not paying social security but are recently separated or divorced from somebody who is
- You are a resident in Spain and on state benefits/social security
- You are a resident in Spain and pregnant
- You are a student in Spain (and under 26 years old)
- You are a resident in Spain under 18
- You are a state pensioner
How can I register for public healthcare in Spain?
You’ll have to register with the Dirección General de la Tesorería General de la Seguridad Social (TGSS) to get a social security number. See this website.
When you go to the office, you’ll need to bring:
- Your passport or ID card
- Your residency certificate
- A completed Modelo TA1 application form.
Once you’ve registered, you’ll get a certificate. You can use this certificate to apply for a health card at your local health centre. You’ll need to present your card whenever you use a clinic, hospital or pharmacy.
How to access healthcare in Spain
Healthcare in Spain is mainly accessed through health centres or public hospitals. You’ll find one of these in almost every town or village in Spain. Before seeing a doctor you’ll need to register with the health centre nearest to where you live. Bring with you a utility bill or other proof of address (such as a rental agreement).
A healthcare centre is likely to have around five doctors – you may not see the same one every time.
Healthcare centres may offer both public and private healthcare – be sure to specify the type of healthcare you want.
Many doctors and nurses will speak English, but this is in no way guaranteed. It’s a very good idea to brush up on some useful Spanish phrases!
Your SNS Card
Each card includes a standardised form of basic identification data for the holder, and indicates in which autonomic health service the person is enrolled. Health facilities throughout Spain have the equipment to read the digital information from the cards. A cardholder should, therefore, be able to access all the services of all relevant health professionals throughout the country.
The system works well.
Your clinical history
Your Clinical History – the records created by the people you deal with in the SNS – is stored centrally by the SNS. It is intended to allow health professionals access to whatever clinical information is relevant for a particular patient. This history should be available at all authorised locations, but nowhere else. Except when needed for treatment, the information is considered confidential and access is severely restricted.
Don’t wait until you have an accident or fall ill before you register for healthcare. It will end up much more expensive and stressful. Moreover, don’t wait until an emergency before scoping out your local hospital: which is the closest to you (you need to go to a hospital registered in your district) and does it take both public and private patients?
It’s also a really good idea to have your medical history and a list of the drugs you take translated into Spanish. Give a copy to your doctor and keep a copy to take whenever you interact with the Spanish system.
European Health Insurance Card (EHIC)
You can get an EHIC if you’re an EU citizen. Apply through your country’s government website.
You can use this card whilst on holiday or during a temporary visit to Spain. Take it with you to a health centre or public hospital if you need treatment. If a Spanish national would have to pay a fee for the treatment you receive, so will you. The health centre or hospital treating you will decide whether your treatment can wait until you return to your home country.
The card is only recognised in state hospitals and health centres.
An EHIC is not a substitute for medical and travel insurance when travelling abroad. Use an EHIC in conjunction with proper travel insurance.
See here for more information about the EHIC, how to get one and how to use it.
Treatment in Spain under the EU Cross Border Directive
This directive allows patients who are citizens of an EU member-state to seek treatment abroad, pay the costs up front, and then seek reimbursement from their country of residence upon their return.
You would be entitled to apply for treatment under the Cross-Border Directive as long as the treatment is considered medically necessary and would be made available to you under the state system in Spain.
It covers both treatment given in state-run hospitals and by private service providers. Please note that you will only be reimbursed up to the amount the operation would have cost if you were to have been treated in your own country.
Treatment may need to be prearranged and authorised by both your own country’s health authorities and the Spanish health authorities in advance.
Private healthcare in Spain
If you don’t qualify for public healthcare – or if, indeed, you just prefer to go private – you’ll want to purchase health insurance.
There are plenty of private healthcare facilities in most parts of Spain. Indeed, many doctors and hospitals provide both public and private care.
Pharmacies in Spain
You’ll need to pick up any prescriptions through a pharmacy. You’ll find pharmacies in almost every town: look for a large, green cross outside a shop. Check out this list to find your nearest pharmacy.
Most pharmacies are open from 9:30 to 14:00 and then 17:00 to 21:30. Some pharmacies are open 24 hours.
Unless you are an EU-resident pensioner, you will have to pay for prescriptions in Spain. People registered with the Spanish health system or carrying an EHIC (see below) will have to pay 40% of the cost of medication. People not registered will have to pay the full cost. Each item is priced individually. If you need expensive medicines this can prove costly.
Dental care in Spain
Dental care in Spain is not covered by social security but the prices are generally reasonable (a filling may cost €50, a tooth extraction €30), so it’s accessible to most.
Use the Yellow Pages (Páginas Amarillas) to find a dentist near you. If the pricing is not indicated on the website, most will give you an estimate on the phone.
Cultural differences in Spanish healthcare
One thing to be aware of in Spain is the fact that, if you’re staying in hospital for an extended period, you will be expected to have a friend or family member help out with general care.
In Spain, public hospitals have nursing staff whose job it is to administer drugs, change dressings, and are present when the doctors do their rounds. The rest (fetching drinks, providing and laundering bed-clothes, helping with toileting etc) is usually left to the patient’s family members. This is looked upon as normal and keeps the running costs of hospitals down.
I did join the private health insurance out here – it’s a fraction of the cost of back home. Back in Ireland I was paying €1,100 a year. I now pay €55 a month. I’m 60 now but when I’m 70 it will still be a third cheaper than what I was paying as a 55-year-old in Ireland.
My Irish health insurance company was very honest with me and said, ‘If you intend to live in Spain you’re actually better off going to the private system.’ They said to me that private hospital care in Spain is just as good as in Northern Europe.
Gerry O Brien, Dublin, Ireland
You’re unlikely to have any problems with the quality of healthcare in Spain. Just be sure to be prepared and, if at all possible, learn at least some rudimentary Spanish.