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 in Spain. They also have to pay for certain specialist medical procedures and may need additional private insurance coverage.
Social security contributions fund the Spanish state healthcare system. Each region of Spain takes individual responsibility for a health budget, which is ultimately 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 also receive coverage.
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 Spanish social security (Dirección General de la TesorerÃa 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:
- 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 Spanish 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.
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
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.
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 through the Spanish Ministry of Health.
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.
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.
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 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.