A Look at Spanish Healthcare

The World Health Organization ranks Spain’s healthcare among the best in the world. Facilities tend to be modern, with state-of-the-art equipment, and Spanish doctors must pass rigorous qualifying exams to get their license to practice. The central government used to be the sole regulator of healthcare, but now each of the country’s 17 Autonomous Communities takes individual responsibility for implementing and executing healthcare.

Spain has both private and public healthcare systems.

Public Healthcare in Spain

Spain’s public healthcare system, known as the seguridad social, covers a range of healthcare services, including general medicine, family practice, pediatrics, and a range of other specialties, nursing, and physical therapy. The seguridad social is paid for out of taxes, and all tax-paying residents in Spain belong to it.

The system has its own doctors (many of whom also have private practices), clinics, and hospitals. Healthcare centers (centros de salud) are all over the country. In cities and towns, a clinic should be within 15 minutes of your residence; even small villages have at least one clinic, although it may not be open every day.

Expats from European Union countries have the right to medical treatment in Spain under European-wide reciprocity agreements.

The situation is different for expats from non-EU countries like the U.S. and Canada. If you are legally working in Spain (either as a self-employed individual or as the employee of a company in Spain) you will automatically have access to public healthcare. That’s because you’ll have a Spanish social security number and will be contributing to the seguridad social. (While the term seguridad social is popularly used to mean the healthcare system, in fact the system also includes pensions and unemployment benefits.)

If you are a non-EU retiree or are otherwise getting only a residence permit for Spain, you don’t automatically get access to the seguridad social. However, you can request access to the system in the autonomous community you live in. Each community will set its own particular requirements—for instance, the annual rate you’ll pay (which likely will vary by age) and how and when you’ll pay (for instance, perhaps a lump-sum annual fee upfront, rather than a monthly fee). As an example, in the autonomous community of Madrid, which is already implementing this system, expats must have had a legal residence permit for at least a year to qualify for the seguridad social.

If you’re in the public healthcare system, you’ll receive a health card that you’ll present for treatment at your local clinic or doctor’s office. You’ll usually be attended by a general practitioner as your primary-care doctor (médico de cabecera). You can choose your own doctor; however, if you use a clinic that has several doctors, you won’t necessarily get the same one every time. Your médico de cabecera will refer you to a specialist as needed. (As with any public healthcare system, you may have to wait for an appointment with a specialist or for non-urgent procedures.)

The seguridad social normally pays most or all the cost of medical treatment and hospitalizations and up to 40% of the cost of prescribed medications. The patient pays the remainder—or buys supplemental insurance to cover the difference. (Note that dental care is not covered under the seguridad social.)

Private Health Insurance in Spain

There are dozens of insurance companies offering private health insurance for Spain. You can choose national plans that cover only Spain, choose Europe-wide plans, or even opt for full international health coverage. It all depends on your personal needs and situation.

As with private insurance anywhere, plans may exclude pre-existing conditions, have a wait time (normally 12 or 24 months) for certain wellness care visits, or have an age limit for accepting new policy-holders, among other things.

To give you an idea of price, plans with Sanitas, a subsidiary of BUPA International and one of Spain’s larger private insurers, run from about €79 ($97) a month to €120 ($148) a month for a person aged in the low 60s. (The low-end plan has a co-pay, and the patient pays part of the cost of hospitalization and surgery. The high-end plan includes dental, plus no co-pay for the first six procedures.)

Pharmacies in Spain

Pharmacies in Spain are often signposted with a large green cross above the door—they’re easy to spot. Pharmacists are well trained and knowledgeable—you can often consult them for minor ailments and avoid a doctor’s visit. Many medicines that would be by prescription only in the U.S. or elsewhere in Europe are available over-the-counter in Spain.

Pharmacies are normally open Mondays to Fridays from 9:30 a.m. to 2 p.m. and then again from 5 p.m. to 9 p.m. or 9:30 p.m. They normally close in the afternoon for siesta, which is still a custom in Spain, and they close for the weekend on Saturdays at about 2 p.m.

For after-hours pharmacy service, each town maintains at least one pharmacy on 24-hour call, known as the farmacia de guardia. The address and phone number of the nearest farmacia de guardia are listed in local newspapers and often posted outside pharmacies.

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