Spain has a high-quality healthcare system that guarantees near-universal coverage for all residents. A little over 99% of the population receives public health care (asistencia sanitaria pública), which is called the National Health System (Sistema Nacional de Salud - SNS).
The health care system is organized at the national and regional levels. The national level is responsible for laws and regulations, while the regional level - divided into 17 autonomous regions - oversees local management of health services. The system is overseen by the Spanish Ministry of Health (Ministerio de Sanidad), which develops policy and controls the national health budget.
More than 70% of the healthcare system is financed by state taxes, which is about 11% of GDP. Residents of Spain usually have private health insurance (seguro de salud privado), which complements the public healthcare system.
Spain tops the list of the world's healthiest countries, according to the Bloomberg Healthiest Country Index 2019. The overall life expectancy is 83.5 years, which is the best among all other European Union (EU) member states.
Who can access the Spanish healthcare system?
Anyone who lives and works in Spain, whether employed or self-employed, can use public healthcare free of charge, as well as children, pregnant women, and students under the age of 26.
Other Spanish residents can access free healthcare when they:
- Recently divorced or separated from a partner registered in the social security system
- Receive certain public benefits
- Retired to a state pension
- Citizens of the EU/EFTA countries (European Free Trade Association - Iceland, Liechtenstein, Norway, and Switzerland) can receive free medical care if they have a European Health Insurance Card (EHIC). Third-country nationals must have travel and health insurance as part of their visa application.
Undocumented migrants can also access medical care, but they must pay at least 40% of the cost of prescribed medications.
How much does healthcare cost in Spain?
The Spanish healthcare system is financed by social security contributions from working citizens. If an employee is registered in the public healthcare system, his/her spouse and dependent children are also covered. Certain other socioeconomic groups, such as students and pensioners, can also use the public healthcare system free of charge, even if they have not paid health insurance contributions.
Most primary healthcare services in Spain are free of charge. Residents have to pay only a portion of the cost of prescriptions, as well as regular payments for public health insurance. However, if they need specialized medical care, they may face additional costs. This is where private health insurance comes in.
How to register in the Spanish healthcare system
Legal residents can access public healthcare with an EHIC card or a Spanish health card (tarjeta sanitaria individual - TSI). Both cards are issued free of charge along with health insurance.
You can apply for a Spanish health card at your local primary care center (center d'atenció primària - CAP). You will receive your TSI card at your home address within two to three weeks. It allows you to make an appointment with a single doctor or a health center in your local health district. However, you must get a referral from your family doctor to see other specialists.
Make sure you always have it with you so that you can show it whenever you use public health services or buy prescription drugs at the pharmacy.
Options for private health care
Private healthcare services are provided alongside the public system, and some health centers (centros de salud) offer both. If you are undergoing a procedure that is not covered by the public healthcare system, you will need to take out private health insurance or pay the full amount of the treatment costs.
Many people also choose private insurance to get better and faster access to treatment. About 25% of the population has some form of private health insurance. Private insurance is also popular among expats.
Private health insurance usually costs between 50 and 200 euros per month, depending on the coverage plan.
Medical centers and clinics
Primary health care (atención primaria), including prescriptions (receta), is provided by family doctors and health centers.
Located in each region, the centers are usually staffed by a multidisciplinary team that includes:
- Family doctors (médico de cabecera)
- pediatricians (pediatras)
- Nurses (enfermeras)
- Gynecologists (ginecólogos)
- Physiotherapists (fisioterapeutas)
Each center usually has about six family doctors. Although you can make an appointment with a specific doctor at some centers, you may not see the same doctor every time you visit.
Spanish pharmacies
Once your doctor has prescribed your medication, you can pick it up at any pharmacy (farmacia) in Spain. They are easily recognized by a large sign with a green cross on the front. Opening hours are usually from 9:30-14:00 and 17:00-21:30 from Monday to Friday. Opening hours differ on weekends, and they are usually closed on Sundays.
In most cities and towns, there are several pharmacies, and each of them takes turns working outside of business hours. Usually, there is a notice on the window or door of the pharmacy with information about the nearest 24-hour pharmacy (farmacia de guardia).
Spain has a co-payment system for prescription drugs. This means that residents have to pay a certain percentage of the cost of medicines, which is non-refundable. How much you pay depends on your personal situation:
- If you are of working age, you pay up to 60% of the cost of the medicine depending on your annual income
- Pensioners pay about 10% of the cost
Hospitals in Spain
If you need an ambulance (ambulancía), you can call the emergency service using the European number (112). You can also go directly to a hospital (hospitales) or ambulance (Urgencias) if it is easier. For any other type of inpatient treatment, you will need a referral from your family doctor.
There are a large number of public and private hospitals in Spain, but only public hospitals provide free treatment. Since some hospitals offer both private and public health care, be sure to let the staff know which service you want to receive by showing your insurance card.
Medical visa to Spain
Medicine in Spain has earned a good reputation thanks to experienced, qualified specialists, high-tech clinics located in the resort areas of the country. All medical institutions have been certified and are under the close supervision of the Spanish Ministry of Health.
Features of a medical visa in Spain
If you need to go for treatment, you need a medical visa to Spain. The visa differs from the usual one in that instead of providing documents for booking a hotel, you need to invite the clinic that receives the patient.
A medical visa for treatment in Spain can be:
- Category C, if the period of stay in the country is less than 3 months;
- Category D, which is called national, allows you to stay in the country for more than 90 days.
A person traveling for treatment may need to be accompanied, and the accompanying person must have an appropriate package of documents, the main of which confirms the relationship with the patient.
A medical visa to Spain is not required to rest at balneological resorts, thermal and mineral springs, for which the island is famous.
Requirements for documents
A medical visa to Spain is usually issued without any difficulties. The process of applying for a medical visa to Spain begins with an invitation letter from a clinic that is ready to accept a patient. It is necessary to discuss the diagnosis and expected prognosis for recovery, to discuss the conditions for the accompanying person and the means of transportation of the patient, and, if necessary, to pay part of the bill for the upcoming treatment.
A medical visa for treatment in Spain is issued upon submission of the following documents:
- A doctor of the accepted clinic confirms in writing that all payment issues have been resolved.
- 2 color high-quality photographs taken relatively recently and in accordance with certain requirements. One photo must be pasted on the form submitted by the applicant.
- An invitation letter from the clinic. It indicates the length of stay for treatment.
- An international passport. It must have at least two blank pages, be issued no more than 10 years ago, and be valid for another 3 months after returning home.
- The applicant must sign the application for a permit in person.
- General civilian passport.
- Medical insurance.
- A document confirming that round-trip airline tickets are booked. In severe cases, with unknown prognoses, one-way booking is possible with the permission of the receiving clinic.
- Bank receipts confirming that the client's account has the amount of money to cover his/her expenses.
- Certificates from a local medical institution confirming the diagnosis and the need for treatment.
- Guarantees of returning to the country (papers for real estate, property, etc.).
For an accompanying person:
- Passports - domestic and foreign.
- A certificate from the receiving institution confirming that the patient needs to be accompanied.
- Insurance.
- Documents confirming the booking of accommodation for the required period.
- Copies of round-trip airline tickets.
The embassy may change the list of documents and request additional papers at its discretion. A medical visa to Spain is always issued urgently within 3 days, in case of a patient's critical condition - within 1 day.
Medical visa to Spain for minors
Persons under the age of 18 may also need a medical visa to Spain.
The following documents must be attached to the standard package of documents:
- A document confirming the parents' consent to the child's departure (if the child is traveling unaccompanied or with relatives);
- A person under 14 years of age presents a birth certificate;
- A copy of the foreign passport of one of the parents;
- If the child is accompanied by one of the parents, the other parent must have a written permission certified by a notary.
Numbers:
- Emergency Medical Services (Servicio de Urgencias Médicas - SUMMA): 112
- Ambulance: 061
- Police: 091
- Red Cross (cruz roja): 902 222 292
- Help with domestic violence or abuse: 016
- Suicide, crisis and support line: 717 003 717
- Support for drug addicts: 900 161 515
- Poison and drug helpline (Servicio de Información Toxicológica - SIT): 915 620 420
- Support for the elderly: 900 222 223
- Emergency dental care: 900 906 210
When deciding to give birth in Spain, it is important to remember that public health care provided by the National Health System must ALWAYS be provided to all pregnant foreign women, regardless of their administrative status, circumstances, length of residence in Spain or country of origin. It must be available to them without any additional conditions.
Spanish law stipulates that pregnant foreign women temporarily or permanently residing in Spain are entitled to health care during pregnancy, childbirth and the postpartum period.
Among the services provided are those included in the list of national medical services.
Childbirth in Spain: Primary care for pregnant women
- Early detection of pregnancy and potential risks.
- Monitoring of the normal course of pregnancy in a coordinated and documented manner, with the provision of specialized care in accordance with the recommendations of health services.
- Maternal education, including breastfeeding promotion, urinary incontinence prevention, and preparation for childbirth.
- During the first month of the postpartum period, a postpartum visit to assess the health of the woman and the newborn. the health of the woman and the newborn.
Childcare services
- Assessment of the child's nutritional status, physical and psychomotor development.
- Prevention of sudden infant death.
- General advice on child development, bad habits and healthy lifestyle.
- Medical education and prevention of childhood injuries.
- Preliminary recommendations for the prevention and detection of sleep problems and sleep and sphincter problems.
- Identification and monitoring of children with physical and mental disabilities.
- Identification and monitoring of children with chronic pathologies.
Specialized care
- Pregnancy monitoring, coordinated and documented with primary care, in accordance with the recommendations of health services.
- Obstetric care for normal inpatient deliveries (including epidurals in accordance with medical protocols) and other medical care required during pregnancy, labor, mid-labor, labor and delivery, and expulsion of the afterbirth.
- Procedures for diagnosis, medical and surgical treatment of complications of pregnancy, childbirth and the postpartum period.
- Prescribing and conducting diagnostic tests and procedures, including newborn screening.
- Attention to congenital anomalies and diseases of newborns arising in the congenital anomalies and diseases of newborns arising in the perinatal period. Intensive care, including newborn nursing.
To receive free medical care, a pregnant woman who is not a resident of Spain must go to the nearest Health Center and submit an application. The Health Center will issue her all the necessary documents for monitoring pregnancy and childbirth with the appropriate doctors.
It should also be remembered that a child born in Spain does not automatically acquire Spanish citizenship, but under certain circumstances, it can be requested.
Citizenship by presumption: being a Spaniard directly as a child of a foreigner
The first case concerns those children who (almost) automatically become Spanish because they were born in Spain.
The main requirement for this type of citizenship is that the parents must belong to a country whose legislation does not provide for the direct granting of citizenship to a child born abroad.
There are few countries where this is the case:
Argentina, Colombia, Costa Rica, Chile, Ecuador (if the children were born before 2008), Guinea-Bissau, Peru, Sahara, Switzerland, São Tomé and Príncipe, and Venezuela.
If you, as a foreigner, are from one of these countries (and both parents must be from them) and your child is born in Spain, then, since your country of origin will not grant him/her your nationality because he/she was born outside the national territory, he/she will become Spanish by simple presumption (since Spain does not allow a child to remain stateless).
But, in addition, there are two other cases in which the child will also acquire citizenship directly, even if his or her parents are not citizens of any of these countries:
- If the mother comes from Morocco and is unmarried, and the father (to whom she is not currently married) comes from one of the above countries
- If the parents come from certain regions of Palestine, although here we also find a number of additional requirements
How will the process work in this case?
It is very important to note that in order for the child to acquire Spanish nationality directly, you cannot register the child at birth through the consulate in your country of origin.
In this case, he or she will receive your nationality and therefore will not be able to obtain Spanish nationality directly.
The first thing you should do is go to the Civil Registry Office (in Spain), where you will be allowed to apply for Spanish citizenship for the child if you provide the appropriate documents:
- An Empadronamiento certificate confirming that the newborn is living with the parents at the same address
- The child's birth certificate
- Birth certificates of the father and mother, translated and legalized (this document is issued by the registry office of the country of origin)
- Foreign passport of both parents, original and copy
- Confirmation of marriage (and a copy)
- Certificate from the consulate stating that the country of origin does not recognize the child's citizenship
The family arraigo procedure allows you to apply for a one-year residence and work permit in exceptional circumstances due to the fact that you are the parents of a Spanish child under the age of 18.
The only requirement that must be demonstrated is that the child is currently living with his/her parents (the residence permit applicants).
Citizenship after a year of residence in Spain
On the other hand, we encounter the opposite case: the parents are not citizens of any of the above countries, so the law of the country of origin forces the child to automatically assume their nationality at birth, regardless of the country in which he or she was born.
In this case, it is necessary to apply for citizenship by residence after one year of legal residence in Spain.
It will work as follows:
- First of all, it is important that the parents are legal residents of Spain, as this is what will allow their child to apply for a residence permit later
- After the birth of the child, the parents must register him/her in the civil registry so that he/she can receive a passport (with the nationality of the parents)
- After completing this procedure, they must apply for residence (residence as a minor child of legal residents)
- One year after obtaining residency, the child will be able to apply for Spanish citizenship, with the advantage of not having to take any exams, as he or she is under 18 years old.
Spain