Understanding the Spanish Healthcare System
Spain boasts one of the world’s top healthcare systems. In 2009, it was ranked as the 7th best overall by the World Health Organization.
It is also ranked sixth in the EU for the number of doctors, with an average of about 4 per 1,000 people. The Spanish government spends approximately 9.2% of its GDP on healthcare. The result is an excellent standard of living.
For instance, a 2015 World Health Organization survey showed that Spanish women outlive women from all other nationalities, except for those from Japan.
Despite high unemployment and high rates of smoking, people are healthier than nearly everyone else in the world. If you’re moving there or simply traveling to Spain, here’s what you should know about the healthcare system in Spain.
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Overview of the Sistema Nacional de Salud
Spain has a universal healthcare system known as the SNS or Sistema Nacional de Salud. Since 2002, health responsibilities have been decentralized to the regional level, resulting in the establishment of 17 regional health ministries.
However, the Ministry of Health, Social Services, and Equality remains responsible for policy and for monitoring performance at the national level.
Through the SNS, all basic medical services are provided free of charge. However, if you undergo surgery, require an overnight hospital stay, or have certain diagnostic tests, a small fee may be applicable.
While Spain has a long history of supporting and advancing medicine dating back to the Middle Ages, the SNS has only existed since 1986, thanks to the General Health Law (Ley General de Sanidad).
This law fulfilled a mandate in the Spanish Constitution of 1978. This mandate states that the protection of health is a right.
Before the General Health Law, a system of obligatory health insurance was linked to employment taxation.
Private Care Options for Expats Living in Spain
Many people opt for private international medical insurance while residing in Spain. For those who choose this route, a higher level of service and convenience is available at hospitals and clinics.
Private insurance is also associated with shorter wait times and greater privacy. Finally, a small percentage of people opt for a combination of public and private systems.
They enroll in the public system, much like the majority of their friends and neighbors, and then purchase additional supplemental private coverage.
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How Expats Can Qualify for Spain’s Local Healthcare
For those in the process of relocating to Spain but who aren’t yet eligible for public health insurance coverage, you have to organize your own private health coverage in the meantime.
If you have been registered at your local town hall for at least a year but still haven’t met your region’s standards for permanent residency, there’s another option.
The Spanish government has a private state insurance program (known as convenio especial) with a modest monthly fee. This is administered by the authorities in each autonomous region.
You can also maintain your own private global health insurance, which you can set up before leaving your home country.
Expatriates who are permanent residents are eligible to participate in the public healthcare system. That includes people who have an employer or who are self-employed and contribute to Social Security.
It also includes individuals under 26 years old who are in school. Additionally, EU and UK senior citizens are automatically eligible for SNS coverage when they reside permanently in Spain.
The Application Process
Your first step is to register with your local social security office (Dirección General de la Tesorería General de la Seguridad Social or TGSS).
You need to do this to get a Social Security number and a certificate stating that you’re entitled to medical care. You’ll also need to register your address and details at your local town hall.
With your medical care certificate, social insurance number, passport, and foreigner’s identification number (also known as an NIE number) on hand, visit your local health center.
There, you’ll be issued a health card (Tarjeta Sanitaria Individual or TSI), which is usually sent to you by mail.
The health center will also assist you in obtaining a Sistema de Información Poblacional (SIP) card, which you’ll need to present every time you visit a clinic, hospital, or fill a prescription.
Healthcare Costs for Visitors to Spain
If you are traveling to Spain for a short period, a good travel insurance plan is recommended to cover your medical costs in case of an emergency.
Travel medical insurance is a short-term solution for travelers who are traveling anywhere between 5 days and one year.
Even if you have health insurance at home, the chances are this will not cover you when traveling outside of your home country, or if it does, the level of coverage will be very minimal.
Prescription Costs
In Spain, prescription costs vary depending on your income and age. If you’re of working age, you pay a certain percentage of the prescription cost based on your income.
At the lowest income level, €18,000 or less, you pay 40% of the cost. At the highest income level, more than €100,000, you pay 60% of the price, with varying levels in between.
However, if you are a senior, you pay a much smaller percentage – as low as 10% – if your income is €18,000 or less. Additionally, the monthly payment is capped at as little as €8.
In short, if you are working and require several medications, your prescription costs could be very high, which is a strong argument for holding private insurance to help offset the costs.
However, Spain does an excellent job of providing for the medication needs of its seniors, especially those with limited income.
How Routine Doctor Visits Work
In Spain, primary healthcare is provided through a health center (Centro de Salud or Centro de Asistencia Primaria or CAP), or a general practitioner’s office (médico de cabecera).
The majority of practitioners, both at clinics and in solo offices, see patients through pre-booked appointments.
The wait to see your doctor will vary depending on your location and the urgency of your visit, but the average wait is approximately 2 weeks. 4-8 doctors generally staff health centers.
On the plus side, the number of practitioners means that you can likely get an appointment that accommodates your schedule. On the downside, you might not always see the same doctor at each visit.
For visits to specialists outside the emergency room, you’ll need a referral from your primary care physician. Specialist visits, general practitioner visits, and emergency room treatments are free for those covered by the SNS.
However, private hospitals will charge a fee if you aren’t covered by private insurance or if they don’t accept your insurance provider.
Finding a Family Physician in Spain
Once you’ve registered for public health insurance, the next step is to register with a general practitioner to get an appointment. Generally, this is relatively straightforward.
You can find a list of doctors through the SNS catalog of primary care providers or through the list provided by your insurer. Friends and colleagues can help you narrow down your choices.
Brexit’s Effect on the Healthcare System
According to the BBC, the British expat community in Spain is worried about what their healthcare will look like in a post-Brexit Europe.
Spain is home to a massive community of British expats, most of whom are senior citizens. UK pensioners are automatically eligible for public SNS coverage once they have been permanently living in Spain.
As seniors, their access to healthcare is structured differently from the rest of the population, but they are unsure what the future holds.
According to the Financial Times, the country will guarantee healthcare services to this community, regardless of what Brexit brings, but there remains a high level of uncertainty and confusion.
Travelers visiting Spain and considering relocation will likely hear a great deal of discussion about this topic.
Find the Best International Medical Insurance
- Compare multiple quotes from top insurers
- Get expert advice at no additional cost
- Find the right plan for your needs and budget
Joe Cronin, President of ICI, is a leading expert in international health, life, and travel insurance. An MBA and founder of multiple global businesses, he helps expatriates and travelers access trusted, comprehensive insurance solutions worldwide.
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