Spain has a healthcare system that regularly ranks among the top in the world, providing almost all residents with access to medical care. The system is mainly supported by taxes and social security contributions, meaning most healthcare is free when you need it. Services range from family doctor visits to hospital treatments. The public system, called the Sistema Nacional de Salud (SNS), covers a wide range of needs. Although the public system is strong, private healthcare also exists and many people use it for faster appointments and more options.
The Spanish healthcare system is known for being easy to access and high in quality. This has helped Spain achieve one of the highest life expectancies in Europe. The model mixes national healthcare planning with decisions made by each region, creating a system that is flexible and effective. Still, it has challenges, such as making services work more smoothly and filling gaps in certain areas, like dental and mental health care. Even so, the main goal of making sure everyone gets care and improving the system is always a priority in Spain.
Healthcare system in Spain: structure and key features
Spain’s healthcare uses a national approach for policy but lets regions control day-to-day administration. This setup helps keep rules the same across the country but lets regions adjust services to local needs.
Who manages healthcare in Spain?
At the highest level, the Ministry of Health (Ministerio de Sanidad) sets policies, creates laws, and manages the healthcare budget. They help coordinate healthcare across the country to keep it fair. However, most healthcare delivery is controlled by the 17 autonomous communities. Each one decides how services are run locally, meaning while the overall framework is national, local governments have a lot of say in the details.
What is the Spanish National Health System (SNS)?
The SNS is Spain’s public health network, created in 1986 after the Spanish constitution in 1978 declared health a basic right. The SNS gives nearly all people in Spain public healthcare coverage (over 99%). Care is free at the point of service, and it’s almost all paid for by taxes. You cannot opt out of SNS coverage, showing how central it is to life in Spain.
How is the system decentralized regionally?
Over the past 35 years, regional governments have been given more control of healthcare. Since 2002, each of Spain’s regions has managed and run its own health services. This makes healthcare more responsive to local needs. But it also means that waiting times and the services offered can change depending on where you live. The idea is to make sure everyone gets the same chances for care, but with differences for local populations.
What services are included in the public system?
Spain’s SNS covers most medical needs at no cost at the time of care, including:
- General practitioner and specialist visits (with referral)
- Hospital care and emergency treatment
- Primary care and pharmacy services
Some costs still apply, mainly for prescription drugs and certain medical devices (e.g., prostheses). Dental care isn’t included for adults, except for children under 15 or for surgery, and you often pay extra for glasses and some mental health services. New policies since 2020 aim to keep care universal and fair, focusing on helping those who need it most.
Who can access healthcare in Spain?
Spain’s system is open to many people, with specific rules based on where you are from and your legal status.
Eligibility for Spanish citizens and residents
If you are a Spanish citizen or legal resident, you get public healthcare almost automatically. People working in Spain, whether they are employees or self-employed, pay into social security, which funds the system. Once registered, their spouse and children are also covered. Some groups, like children, pregnant people, and students under 26, can use the system even without direct payments. Others who can access care include divorced or separated people linked to someone with social security, state benefit recipients, and retirees with a pension. Since 2018, eligibility is mainly based on living in Spain, strengthening universal access.
Access for expats, EU citizens, and non-EU visitors
Expats with permanent residence can use the public system. Citizens from the EU/EEA and Switzerland can get treatment with a European Health Insurance Card (EHIC) if they are visiting temporarily. UK pensioners living in Spain keep their coverage post-Brexit. Those moving to Spain who are not yet eligible need private health insurance. Non-EU nationals generally must have private health coverage as part of the visa process to stay in Spain.
Healthcare for immigrants and undocumented residents
Spain provides public healthcare for migrants, including people without legal documents, thanks to both the 1986 health law and changes made in 2018. While undocumented persons can get care, they usually pay at least 40% of prescription costs. Despite this, healthcare costs can be lower for immigrants than for those born in Spain, since immigrants tend to be younger and healthier. This shows Spain’s focus on health for all, no matter a person’s legal status.
Registering for healthcare in Spain
Getting into the Spanish healthcare system is mostly a matter of paperwork. The main steps involve registering with social security and getting a health card.
What documents are needed to register?
Registration starts at your local TGSS (social security office). You will need:
- Proof of legal residence
- Your passport
- Your foreigner’s identification number (NIE)
- Proof of relationship for dependents (family book or similar)
- Local address registration (empadronamiento) from your local town hall
Once registered and confirmed by the INSS (National Institute of Social Security), you move to the next step.
How to get a health card (Tarjeta Sanitaria Individual)
After you have your social security number and medical certificate, go to your area’s health center (Centro de Salud or CAP) to apply for your health card (TSI). Requirements can vary but usually involve presenting your certificate, social security number, passport, and NIE. The card typically arrives by mail in 2-3 weeks and must be shown at public healthcare visits and pharmacies.
Public versus private healthcare options
Spain offers both public and private healthcare. Many people use both together, depending on their needs.
What are the differences between public and private care?
| Feature | Public Healthcare (SNS) | Private Healthcare |
|---|---|---|
| Funding | Paid by taxes/social security | Paid out-of-pocket or via insurance |
| Cost at time of care | Usually free (except some medicines) | Depends on insurance plan; some costs likely |
| Waiting times | Can be longer for non-urgent care | Shorter for appointments and procedures |
| Choice of doctor | Limited | Usually free choice |
| Languages spoken | Mainly Spanish/regional | Often English and other languages |
Private care is popular for faster access, choice of doctor, and comfort. It’s also preferred by many foreigners since staff often speak English.
Private health insurance: what does it cover?
Private health insurance usually costs between €50-€200 per month, based on age and coverage. Basic plans cover doctor visits and diagnostics, while broader policies include hospital care, surgeries, dental work, vision care, and more. These plans often cover things not included in the public system. Non-EU citizens living in Spain may need private insurance for residence permits. Main insurance providers include Allianz Care, APRIL International, Cigna Global, and Sanitas (Bupa Group).
Voluntary health insurance (Convenio Especial)
If you do not qualify for the public system, the Convenio Especial lets you join the public system for a fee: about €60 monthly, or €157 for those over 65. The program is run by regional authorities and can help bridge the coverage gap for many people.
Healthcare costs and funding in Spain
The healthcare system is mainly paid for by taxes and social security. This keeps care mostly free at the point of use for those who qualify.
How is the Spanish healthcare system funded?
Money comes mostly from taxes and required payments from those working in Spain. In 2021, public funding made up 71.7% of health spending. After the COVID-19 pandemic, spending on health grew, and Spain now spends around €99.3 billion yearly on public healthcare. This averages out to about €2,079 per person.
What healthcare services require out-of-pocket payments?
- Prescription drugs (with co-payments, higher for adults than for seniors or children)
- Adult dental care (except for extractions/children under 15)
- Eyeglasses and vision care
- Some mental health services and dental prostheses
On average, people in Spain pay about 24% of total health costs themselves, mostly for items not fully covered by public insurance.
Prescription costs and pharmaceutical expenditure
| Income Level | Patient Pays |
|---|---|
| €18,000 or less | 40% |
| Over €100,000 | 60% |
| Seniors (€18,000 or less) | 10% (with monthly limit) |
This setup helps keep medicines affordable for everyone, especially seniors. In 2023, €14.132 billion was spent on prescriptions. Efforts like price cuts for generics and changes to co-payments have helped keep medicine costs under control.
Spanish healthcare facilities and professionals
Spain’s healthcare includes many modern facilities and well-trained professionals, helping the system run smoothly and earn high ratings from patients.
Primary care centers and clinics
Most people see a general practitioner at a local health center (Centro de Salud or CAP). These centers, found everywhere in Spain, are staffed by a team of doctors, pediatricians, nurses, and other professionals. Most visits require an appointment, with average waits of around two weeks. Once registered, you pick a general practitioner, who refers you to specialists if needed.
Hospitals in Spain: types and specialties
- Public hospitals: Free for SNS users; referral needed for non-emergencies
- Private hospitals: Paid for by private insurance or directly
- Some hospitals offer both types of care
Spain is a leader worldwide in organ transplants and is known for cancer and reproductive treatment. Many hospitals are recognized internationally for their quality. Emergency rooms usually have short waits compared to other countries.
Pharmacies and prescription medication access
Pharmacies (farmacia) are marked by a green cross and are the only place to get medicines. Some open 24/7. Prescriptions from a doctor are required for many medicines, and you cannot get scripts from hospital doctors directly-you’ll need to use your medical report at the pharmacy.
Doctors, specialists, dentists, and other practitioners
Doctors in Spain get thorough training, and there are more doctors per person than the EU average. However, there is a shortage in some specialties and rural areas. Specialist visits in the public system require a family doctor’s referral, with average waits of 57 days. Dental care for adults is private and usually paid upfront, with an average filling costing about €60. Children get basic dental care free under the SNS.
Specialized healthcare services
Some services, especially outside basic healthcare, vary in availability and coverage between the public and private sectors.
Children’s healthcare and immunizations
Children are covered by their parent’s insurance. Free dental and pediatric care is included until age 15. Vaccinations are free and cover diseases like Hepatitis B, Polio, Tetanus, MMR, and Diphtheria. Children also have access to child psychologists and psychiatrists if needed.
Women’s and reproductive health
- Pregnant individuals can see gynecologists and midwives, mostly in hospitals.
- Home births are growing in popularity but are not covered by the public system.
- Most contraception methods are widely available; some require a prescription.
- Emergency contraception can be bought without a prescription.
- Cancer screenings (breast, cervical) are provided by local areas.
- Abortion is legal up to 14 weeks, and up to 22 weeks with health risks or some extreme cases.
- People aged 16 and 17 can get abortions without parental consent.
- State-funded paid leave for painful periods is being introduced.
- Fertility treatments are available, with costs for IVF starting around €2,500.
Mental health support and services
Mental healthcare is available, but public services are limited, especially for talk therapy. People usually need a doctor’s referral to see a specialist in the public system. Private insurance is often used for wider or faster access. Efforts are ongoing to improve mental health services across regions.
Emergency medical services in Spain
Spain has well-organized emergency care for both residents and visitors.
What to do in a medical emergency?
- Call 112 for emergency help (ambulance, police, fire) – English-speaking operators available
- Go directly to a hospital emergency room (Urgencias)
Emergency care is covered for SNS users. Emergency rooms are well staffed and have shorter wait times than many other countries.
Emergency access for tourists and non-residents
- Tourists with an EHIC receive emergency care at the same cost as locals
- Private travel insurance is highly recommended for visitors
- If uninsured, emergency services must be paid for, and reimbursement can be sought from your insurer later
Comparing Spanish healthcare internationally
Spain’s healthcare is highly ranked around the world for its quality, access, and efficiency.
How does Spain rank for quality of care?
- WHO ranked Spain 7th in the world for efficiency (2000, 2009)
- In 2020, Spain was named the most efficient health system in Europe (World Economic Forum, Bloomberg)
- Ranked 2nd in Europe and 6th worldwide in the 2023 Health Care Index
- Highest life expectancy in the EU (2.7 years above average)
Most people report few problems getting care, which suggests the system works well across income levels.
Strengths and challenges of the Spanish model
Strengths:
- Open to all – nearly everyone has health coverage
- Modern facilities and advanced technology
- Highly skilled medical staff
- World-leading in organ donation and transplantation
- Costs at point of service kept low for most
Challenges:
- Shortages of doctors in some specialties and rural areas
- Limited dental, vision, and mental health services under public care
- Pressure to fund rising costs as the population ages
- Some complaints about management and efficiency
Public opinion and satisfaction in Spain
People in Spain generally think the healthcare system is good and trust it to meet their needs. Most want the government to keep managing healthcare. The biggest complaint is long waits to see specialists, which people think could be fixed by hiring more doctors.
Frequently asked questions about the healthcare system in Spain
- The Spanish constitution requires the government to provide basic and preventive care for everyone. This keeps the focus on access and quality for all.
- Spain ranks high for healthcare efficiency internationally, due to careful use of resources and attention to public health. Private insurance is common and often used to supplement the public system for faster service or extra care.
- Debate about how to keep the system sustainable and efficient continues, but Spain’s healthcare remains a source of national pride and sets an example for many other countries.
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