Healthcare is one of the most important issues to sort out when you move abroad. It’s often also one of the most confusing. Spain offers excellent public healthcare for those who qualify, and for those who prefer to opt for private or who don’t qualify for public healthcare, there are many affordable options.
The public healthcare system in Spain has a very good reputation and is generally considered to be as good as or better than any other European country. The country has the sixth highest rate of doctors per inhabitant in the world (4.95 for every 1,000 people) according to the World Health Organisation. Forty percent of the country’s hospitals are publicly owned and the rest are private.
The Spanish public health service functions on a contributions basis, meaning that in order for you and your dependents to access it you must be paying into the social security system. Each autonomous region manages its local healthcare system—the local health authority in Catalunya is called CatSalut.
Do you qualify for public healthcare?
To qualify for public healthcare you must
- *Be a resident in Spain.
- Pay social security contributions, either through employment or as a freelancer (autónomo). Exceptions to this include children, pensioners, pregnant women and receivers of certain state benefits.
*Pregnant women who are not legally resident in Spain are also entitled to free public healthcare.
Non-residents do not qualify for universal healthcare. However, there is a pay-in scheme, called the Convenio Especial, for people who otherwise don’t have access to healthcare. To qualify for this you must be ‘empadronado’ with your local town hall and pay a monthly fee.
For full details of who qualifies for public healthcare see the CatSalut website.
How to register
To enjoy free access to all public healthcare you need a Targeta Sanitaria Individual or TSI (Individual Healthcare Card). This card is personal and non-transferable and you will expected to show it whenever you are using healthcare, buying prescription drugs at the chemist etc.
To get the card, you need to fill out form TA1 and take it to your nearest Social Security office (Tesorería General de la Seguridad Social - TGSS), along with your passport, NIE and padrón certificate from your local town hall. You will also need proof of your employment status in order to receive a certificate that you are entitled to free public healthcare.
Take your social security number and the certificate along with your passport and NIE to your nearest public health centre (Centre d'Atenció Primaria - CAP). At the CAP your healthcare card will be processed for you to pick up or sent it in the post.
Centre d'Atenció Primaria - CAP
CAPs are for all non-emergency visits. You will be provided with the name, timetable, and phone number of your doctor and paediatrician (if you have children) as well as a phone number for after-hours care. Once you have been assigned a doctor, this is the person you will then see for any health reason. If you require medical attention outside of the CAP's opening hours you should go to your nearest Centre d'Atenció Continua or CAC (Continual Attention Centre). These centres are open 24 hours a day. If you are unable to reach a centre, the telephone to call in an emergency is 061.
Spanish pharmacists are highly trained and helpful. Many drugs that need a prescription in other countries, such as the contraceptive pill and some antibiotics, are available over the counter in Spanish chemists. If you have a social security card, you will get prescription drugs at a 60 percent discount. Pensioners get them for free.
European Health Insurance Card (EHIC)
The EHIC (European Health Insurance Card) entitles EU residents to free public healthcare for the first three months of their stay in Spain. This only covers emergency treatment and is not valid for Spanish residents.
About 25 percent of people living in Spain have private health insurance and it is generally considered cheaper than many other EU countries. Although the level of public care is high here, there are many advantages to private insurance. These include:
- immediate access to specialists
- the possibility to choose specialists
- lower waiting times for appointments, operations and treatment
- the possibility to choose English-speaking specialists
- more comfortable facilities
Some things to bear in mind when choosing your healthcare insurer are:
- does it also cover you in your country of origin?
- does it cover you in countries that you travel to frequently?
- does it have a good dental plan?
The amount you pay each month will depend on your age, sex and whether you have any pre-existing health issues.
Companies offer different packages according to needs, ranging from low-cost simple options to comprehensive coverage. Many have a basic plan for people who have access to public healthcare but want to cover extras, such as dental care, outpatient visits and blood tests. These plans are cheaper as they don’t cover surgery or hospitalisation.
*If you are expecting to get pregnant and would like to have private healthcare, make sure that you sign up before the pregnancy as all insurance companies have an exemption period.
See here for a list of private insurance companies in Spain