An introduction to the Spanish healthcare system

7 October 2019

Mediterranean weather, beautiful beaches and a popular cuisine are just a few of the things that bring tourists and expats to Spain each year. By 2040, it’s predicted that Spain will have a life expectancy of 85.8 years1, which would make it the highest in the world – so good things can be said about the lifestyle and healthcare system there. Made up of both public and private hospitals, the healthcare system has a few specific rules which you’ll need to be aware of, as an expat. The SNS (Sistema Nacional de Salud) is the widely used public system, funded mainly by tax contributions. Most people living and working in Spain can sign up to this. You can also choose whether you’d like access to the private health services, and if you’d like to take out private medical insurance.

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Signing up to the Spanish healthcare system

If you’re living and working in Spain, and paying social security tax, you’re likely to be able to sign up to the public health system. This allows you subsidised access to healthcare. You can register at your local health centre as soon as you’ve set up your social security number. You’ll be given a health card which you’ll need to show anytime you visit the doctor or use the health service. Until you become a resident in Spain, you might need to pay the full healthcare fees, which can result in unexpected large bills. Many expats choose to take out private health insurance for extra reassurance when moving to somewhere new.

In an emergency

Anyone visiting or staying in Spain has access to the emergency services, including tourists. It doesn’t matter which level of insurance you have – public, private or none at all, you’ll still be treated. But it could affect how quickly you’re seen, as well as how much you have to pay after your treatment. Spain has an agreement with some countries, including Brazil, Chile and Morocco, that nationals visiting Spain can access free emergency treatment. The emergency departments (Urgencias) often have English-speaking staff, but this isn’t guaranteed – so if you don’t speak Spanish, it could help to have a Spanish-speaker with you. Private hospitals are usually more accommodating, as you’re much more likely to find an English-speaking doctor. 

112 is the general number for all emergency services, but there are some healthcare-specific numbers which will connect you to the service you need straight away:

  • 061 – Ambulance
  • 1003 – Emergency doctor (if you can’t get hold of your own)
  • 961 496 199 – Emergency dentist

Specialist appointments in Spain

If you need to see a specialist, you’ll need to see your main doctor first, through the state system. You’ll then be put on a waiting list. If you have private medical insurance you can often go directly to a specialist, instead of going via a doctor. Some people choose this route to avoid the waiting times, which have recently increased due to cuts in public spending. 

Spanish prescriptions and medicines

In Spain, many medicines are available over-the-counter, so can be bought without a prescription. This includes some antibiotics – which can save a visit to the doctor or hospital first. Normal opening hours for pharmacies are approximately 9.30am-2pm and 5pm-9.30pm, Monday to Friday, with some in larger towns open 24 hours a day. 

There are additional charges for prescriptions and medicines, at either 100% of the cost or 40% of the cost (for EU residents with an EHIC card). The cost can vary significantly, depending on the type of medicine, so it’s good to know that these costs can often be reclaimed through private medical insurance. 

Dentists in Spain

Most adult dental treatment is not available through the public system in Spain, so you’ll need to book in at a private clinic. The quality of service is usually high, as the clinics compete with each other to try and provide the best service at the best price - although clinics in city centres are likely to be more expensive than ones in quieter areas. As a new expat, recommendations are a good place to start, but alternatively you can look for a dentist online, using the Consejo Dentista database. This provides a list of dentists who have a certain level of training, and have met the recommended hygiene standards.

Private health insurance 

Most Spanish residents are covered by the state health system, which requires contributions in the form of the social security and income tax. Not all forms of healthcare are covered, and prescriptions and medicines come at an extra cost. Almost 20% of people in Spain have private health insurance2, either to replace or supplement the state service. This can mean reduced waiting times and better accessibility to care.  

Some key facts about Spain’s healthcare system3

  • Additional, out-of-pocket payments account for 24% of total health spending (this is a lot higher than the EU average of 15%)
  • ‘Amenable mortality’ (deaths that could be prevented by effective healthcare) remains one of the lowest in the EU
  • In recent years, some residents have had to stop taking their prescriptions due to higher prices
  • The average waiting time for surgery is between one and six months, depending on which region you’re in, and the type of surgery you need.

1https://www.euronews.com/2018/10/17/spain-to-have-longest-life-expectancy-in-2040-study

2https://transferwise.com/gb/blog/healthcare-system-in-spain

3http://www.euro.who.int/__data/assets/pdf_file/0011/355997/Health-Profile-Spain-Eng.pdf

https://www.expatica.com/es/

https://www.expatica.com/es/healthcare/specialists/dental-care-in-spain-582615/

https://www.angloinfo.com/how-to/spain/healthcare/health-system/non-eu-health-coverage