The Spanish Health Care System
UPDATE new ruling from 31st July
Spain’s government has approved legislation restoring universal free health care to all residents, thus reversing a previous law passed by its conservative predecessor that had excluded some sections of society.
Health Minister Carmen Montón has given the green light to a law that will guarantee universal health care to all persons with Spanish nationality as well as foreigners resident in Spain.
Spain’s health care system ranks among the best in the world and is funded by social security payments, meaning the vast majority of the population does not require private insurance for medical treatment.
The cabinet of Socialist Prime Minister Pedro Sánchez thus reversed a law passed by the conservative Popular Party which under then PM Mariano Rajoy had withdrawn health cover from immigrants in an irregular situation, said Isabel Celaá, the government’s spokeswoman and education minister.
According to Celaá, the legislation fulfills one of the main commitments of her government.
Now, immigrants in an irregular situation will have the right to health care under the same conditions as Spaniards without having to justify their residence in Spain if social services confirm that their country of origin cannot pay toward the cover.
At present, based upon Montón’s announcement, rights to healthcare will be based upon residence rather than as being ‘insured’ or ‘beneficiaries’
Non-EU citizens visiting for holidays or more extended periods but not long enough to be considered ‘resident’ should have travel insurance.
Until the situation becomes clearer, tourists in Spain should still take out the usual insurance to avoid unexpected bills for healthcare.
It looks as though that before long it may be possible for Residents of Spain to access healthcare free of charge without the current problem of pre-retirees having to pay private health care etc etc, but this is not published yet.
So what does this actually mean?
There are still some limits on with this new law, but generally, it means that if you’re a resident in Spain, you should now be granted access to healthcare. The exception is if there is another, existing way you can gain healthcare, such as through a bilateral agreement with your home country, through another EU law or any other regulation that may apply to you. Also, this right to healthcare cannot be extended outside of Spain to your home country or anywhere else you might choose to live if leaving Spain.
This is still quite a gray area while much of the information on requirements for the application or renewal of certain types of visas for Spain, such as the non-lucrative visa and the retirement visa, it is best that you still have proof of a private health insurance, under this new change to the law, this isn’t technically the case. This is such a new development, it’s best to err on the side of caution and follow the rules that are presented to you until there’s been time for these changes become fully recognised at all levels in the visa application process.
Please note if you are not subscribing to the Convenio Especial, there is no need to do anything for now, as there is no further news yet on those who are paying private health care etc.
Persons who could be entitled to healthcare from the public funds under the NHS Spain.
Resident early retirees.
Resident paying for private healthcare.
Residing in Spain but irregular (no residency).
Contributing to the Convenio Especial.
In reference to the new Royal Decree on Universal Healthcare for all.
PLEASE DO NOT GIVE UP YOUR EXISTING HEALTHCARE UNLESS THE INSS OR CONVENIO CONTACT YOU.
As soon as we have proper official guide lines on the new rules this web page will be fully updated.
The rules for getting state healthcare in Spain are different from those in the UK. This guide is intended to advise British nationals living, or planning to live, in Spain on the different ways to access healthcare.
If you’re living and working in Spain you’ll likely have access to Spain’s free state healthcare, paid partly by social security payments, which will be deducted from your wage.
The Spanish healthcare service is regularly rated among the world’s best, guaranteeing universal coverage and no upfront expenditure from patients apart from paying a proportion of prescription charges. Spain spends about 10 percent of its GDP on healthcare.
If you are registered to work in Spain and make national insurance contributions then you can get state-run health care on the same basis as a Spanish national. For further information, get in touch with your local TGSS office.
If you registered as a resident in Spain before 24 April 2012, have an annual income of less than €100,000 and are not covered for healthcare though any other means, speak to your local INSS office to register for healthcare in Spain as a resident.
If you are in receipt of a UK old age state pension or long term sickness benefit, obtain an S1 form (previously E121) from the International Pension Centre on +44 191 218 7777. Once issued, register the S1 form with your local INSS office, before you register with your local GP surgery and obtain a medical card.
29th January – Important updates, S1 certificate (formerly known as E106)
An S1 certificate helps you and your dependents access healthcare in the EU/EEA country where you live. If you have an S1 certificate, it will be valid until 29 March 2019.
After this date, the certificate may not be valid, depending on decisions by member states. You should go to the NHS website for the latest information on each country.
You can continue to apply for an S1 certificate until 29 March.
You may be eligible for an S1 certificate, if you:
- have worked and paid contributions in the UK
- receive some UK benefits such as pensions
Apply through the Business Services Authority for an S1 certificate on 0044 (0)191 218 1999.
As from the 1st July 2014, early retirees are no longer able to apply for a residual S1 form based on national insurance contributions. The NHS Choices website has more information about this change.
If you are a worker seconded to Spain, or the family member of a someone making UK national insurance contributions, contact HMRC to see if you have entitlement to an S1 form (previously an E106 or E109). Once issued, register the S1 form with your localINSS office, before you register with your local GP surgery.
If you are coming to study or are currently studying in Spain as part of a UK-recognised course, you may be entitled to healthcare paid for by the UK.
In Spain access to healthcare by children and pregnant women is protected by law. Please see the social worker at your local health centre for more details.
IMPORTANT: If you are covered by the UK for healthcare and you are going on holiday or temporary stay to another EEA country, you will be covered by your UK EHIC. To apply for an EHIC, you can do so by calling on (+44) 191 279 0575
As an expat, you are entitled to free state healthcare if you are:
- resident in Spain and work in employment or self-employment and pay social security contributions,
- resident in Spain and receiving certain state benefits,
- 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 resident in Spain,
- under 26 and studying in Spain,
- a state pensioner, or
- staying temporarily in Spain and have an EHIC card (see below).
The state system is funded by social security contributions, with each region of Spain taking individual responsibility for a health budget allocated by central government.
As the healthcare system is decentralised, you will need to check the conditions in your own area for using healthcare services. There’s a directory of the regional health authorities within the different regions of Spain on the Spanish health ministry’s website (mainly in Spanish). Click on your region on the map for contact details of your local health authority and links to specific information about the health services it provides.
Private healthcare in Spain
If you are not paying social security contributions, then you can choose to take out private health insurance or pay the full amount of any medical costs.
If you are not covered for state-run healthcare through any other means, the Spanish regional health authorities offer a special pay-in scheme (convenio especial). This is a public health insurance scheme available nation-wide where you pay a monthly fee to access state-run healthcare. The scheme is managed by each autonomous region.
NEW RULES from July 31st 2018
It is recommend that all those who currently pay the convenio especial or voluntary payment should make an appointment with the local INSS (Social Security) as soon as possible for clarification.
If there is a contact number on the contract signed when joining the convenio, you could try to call that to verify as well.
Policy holders pay on an individual basis for access to public healthcare, regardless of pre-existing conditions, anywhere in Spain. Children do not have to join the Convenio Especial as they are protected under Spanish law and can access state healthcare for free.
The basic monthly fee is 60€ for the under 65s and 157€ for those aged 65 and above. However, prescriptions are not subsidised at this rate so you would pay 100% of prescription costs. This form of cover doesn’t give holders the right to an EHIC at this time.
How to register for Spain’s public health care
First of all, you must register with social security (Dirección General de la Tesorería General de la Seguridad Social or TGSS), which has offices throughout Spain, to get a social security number. You’ll need to show your passport or ID card, residency certificate and a completed application form. You’ll also need to have registered your details (address etc.) at your town hall. (see our separate webpage on how to get this)
Once you have registered with the TGSS you’ll be given a social security number and a certificate stating that you’re entitled to medical help. You then take the certificate, passport and NIE number (foreigner’s identity number) along to your local health centre. You can then register with a doctor and apply for a health card (tarjeta sanitaria individual or TSI). This will be sent to you in the post, or you will be asked to pick it up personally. You’ll need to show it every time you visit a clinic, hospital or collect a prescription from a pharmacy.
Going to the doctor in Spain
In Spain, you get primary heath care through a health centre (centro de salud or centro de asistencia primaria or CAP), or a general doctor (médico de cabecera). Before you can see a doctor, you’ll need to register (see above).
Click on this map to find your local health centre. The health centre will probably have around six doctors and you may not see the same one each time you visit, although in some centres you can book to see the same doctor, particuarly if you are in ongoing treatment. Find a doctor with his or her own practice through the phone book or by personal recommendation.
Doctors may offer both private and state healthcare; make sure you are clear which type of healthcare you want. There may be separate surgery times for private and state patients. You should be given a leaflet called Carta de Derechos y Deberes (Charter of Rights and Obligations) that sets out your rights as a patient. You usually make an appointment to see a doctor at a health centre although doctors with individual practice may offer a first-come-first-served basis. You have the right to be accompanied by a friend or relative during consultations. You can change doctors easily, just by re-registering.
Going to see a specialist
If you want to be seen by a medical specialist in Spain you’ll need to be referred by a family doctor. If you have private health insurance, you’ll be able to see a specialist much faster than going through the public system.
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’ll need a referral from a doctor. There are public and private hospitals. 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 hospital you’ll need to show your social security card or proof of private insurance.
If you are discharged from a hospital and need medication, you have to take the hospital medical report to a pharmacy for the prescription to be fulfilled, as hospital doctors don’t issue prescriptions.
Pharmacies in Spain
You can take a prescription to any pharmacy (farmacia). Look for a shop with a large green cross sign outside.
Pharmacy opening hours
Pharmacies are usually open Monday to Friday from 9.30am to 2pm and 5pm to 9.30pm, and Saturdays 9.30am to 2pm. There’s 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.
Prescription charges in Spain
You have to pay a percentage of the cost of prescription medicines, and the cost is non-refundable. How much you pay depends on your income and whether you are of working age or a state pensioner. For example, if you are of working age and your annual income is less than EUR 18,000 you have to pay 40 percent of the cost of the medication. If your income is between EUR 18,000 and 100,000 you pay 50 percent, and if it’s over EUR 100,000 then you pay 60 percent. State pensioners pay 10 percent unless their income is over EUR 100,000, in which case they also pay 60 percent. You can find out more about this co-payment system, in Spanish, here.
Registered pharmacists can also provide health consultations and guidance on health matters.
Visiting the dentist in Spain
Dental treatment is not covered by the state healthcare system unless in an emergency. You must either pay for dental treatment unless you have private health insurance. Find a dentist by looking in the phone book or by personal recommendation. Just call up and make an appointment.
Pregnancy and birth in Spain
The standard of care for pregnant women in Spain is highly regarded in both the private and public sectors. The degree of medical contact is reasonably high, with an initial appointment with a doctor or midwife (comadrona/llevadora) to confirm the pregnancy, antenatal appointments and hospital scans. Most births take place in a hospital although home births are becoming increasingly popular. A word of warning: if you wish to give birth at a private clinic, it’s advisable to take out medical insurance well ahead of getting pregnant otherwise it might be hard to find an insurer.
In an emergency
In a serious, life-threatening emergency, call the pan-European number 112 free of charge from any mobile/cell phone or landline. The Spanish word for A&E or ER is urgencias.
Other emergency numbers include:
- 060 for an ambulance (ambulancia)
- 961 496 199 – emergency dentists
- 963 600 313 – on duty pharmacy
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
European Health Insurance Card (EHIC)
If you have an EHIC card issued by an EU-member state and you are in Spain on a holiday or other temporary visit – that is, you are not yet a resident in Spain – you can use your EHIC to access state healthcare in Spain. You can also use it if you are studying in Spain as part of a course based in your home country.
You can use the EHIC to get any medically necessary treatment (as determined by the doctor you see) through the state system either at a reduced cost or free. This could be routine or specialist treatment – for a new or an ongoing condition – which cannot wait until you return home. It does not give access to private healthcare.
You cannot use the EHIC if you are coming to Spain specifically to get medical treatment or to give birth. If this is the case, you should seek advice from the health authorities in your home country before coming to Spain.
It is advisable not to totally rely on the EHIC and to take out medical insurance. There have been cases where an EHIC has been refused in some parts of Spain. This is being investigated by the European Commission but if it happens to you, try to get proof that you presented it at the time as it may persuade an insurer to waive their excess. See our separate page which explains exactly what is covered by your EHIC card