Healthcare in Spain for Expats | Complete Guide to Medical Coverage
Healthcare in Spain for Expats: A Comprehensive Overview
Are you an expatriate in Spain or planning to move there? Understanding the healthcare system in Spain for expats is crucial for your well-being. In this article, we’ll delve into the intricacies of healthcare in Spain, covering everything from the structure of the system to how to access medical services as an expat.
Overview of the Spanish Healthcare System
The Spanish healthcare system is renowned globally, recognized for its provision of public, universal, and free medical assistance to all citizens. In 2019, Spain topped the Bloomberg Healthiest Country Index, boasting the highest overall life expectancy at 83.5 years among European Union (EU) member states.
Spain operates both a public and private healthcare system. To access public healthcare, legal residency and contributions to the Spanish government are required as it’s funded through taxes to the Social Security. Alternatively, private healthcare in Spain for expats involves paying a monthly fee to chosen providers for access to medical and hospital care.
Is the Public Healthcare System in Spain Right for Expats?
The National Health System (NHS) is regulated by the General Health Law of 1986. According to this law, it establishes the principles and criteria for its application. Do you want to know what they are?
- Healthcare services are publicly funded, universal, and free.
- The duties and rights of citizens and public authorities are defined.
- The Healthcare is politically decentralized and dependent on the Autonomous Communities.
- The health care provided is comprehensive and of high quality.
- Public services associated with health are integrated into the system.
Despite budget constraints linked to the global financial crisis, the health system remains almost universal, covering 99.1% of the population. It covers medical consultations (excluding ophthalmology and dentistry), hospitalization expenses in public establishments, and medications. The public healthcare services in Spain are divided into two groups: Primary Care and Specialized Care.
Primary Care offers basic services such as consultations, examinations, courses for expectant mothers, and emergency care. Specialized Care directs services to specialty centers and hospitals, both on an outpatient and inpatient basis.
The Spanish National Health System (SNS) functions at both national and regional levels, aligning with the country’s administrative structure. Primary authority for organizing and delivering healthcare services rests with the 17 regional health departments, which often collaborate with specialized entities such as regional Health Technology Assessment (HTA) agencies. Nationwide laws and regulations are planned and regulated by the national Ministry of Health, Consumer Affairs, and Social Welfare. At the top of the coordination hierarchy is the SNS Interterritorial Council, composed of the Spanish Minister of Health and the 17 regional Ministers of Health.
Funding for the SNS comes from general taxation. Tax revenue is highly decentralized, allowing regional governments to allocate their own health budgets. However, a complex system of fund reallocation exists to diminish regional disparities and ensure geographic fairness in essential services such as education, healthcare, and social care.
To access the public healthcare system in Spain, one must be enrolled in the Social Security system. Obtaining a Social Security number is free and fast, and it should be requested before initiating any activity or service. The request can be made by the worker or the employer.
Once registered, individuals must visit the nearest health center to request the Health Card, known as the health insurance card. All duly accredited individuals through their individual health card or other official documentation recognizing their right to healthcare from the Unified Health System, as well as other specific groups, are entitled to public healthcare.
The National Institute of Social Security is the competent authority for determining the right to healthcare funded by public funds from the Unified Health System. Therefore, citizens who are unemployed, retired, or on leave are guaranteed access if registered with Social Security.
Regarding foreigners in Spain, as an entry requirement, the government mandates that all travelers have health insurance or travel insurance with coverage in Spain as part of their visa application. Otherwise, public service is guaranteed only in cases of accidents, serious illnesses, and for pregnant women in labor.
For individuals from European Union and EFTA (European Free Trade Association – Iceland, Liechtenstein, Norway, and Switzerland) member countries, healthcare in the public healthcare system of Spain is accessible with the presentation of the European Health Insurance Card (EHIC).
Undocumented migrants can also access medical care but are required to pay at least 40% of the costs of the medication prescribed to them.
Understanding Healthcare Costs in Spain
In 2022, Spain allocated 1.44% of its budget to healthcare, amounting to €6,606 million in healthcare spending. This marked a 9.88% decrease from 2021 when expenditure was €7,330 million, representing 1.61% of the total budget. However, it showed an increase from 2017, with healthcare spending at €4,093 million, accounting for 1.15% of the total expenditure.
The costs of public healthcare in Spain may vary among autonomous regions. On average, out-of-pocket payments constitute around 24% of the total cost, higher than many European countries.
You’re responsible for the expenses of pharmaceuticals, orthotics, prosthetics, and other health products, contributing between 10 and 60% of the full price based on your income level. Medications are available only at pharmacies, and some require prescriptions.
Public healthcare generally excludes adult dental care except for basic extractions. Dental prostheses and eyeglasses are also not covered.
Despite these costs, public healthcare in Spain is free for all citizens, funded by social security payments from employed and self-employed individuals. Anyone contributing to taxes in Spain is eligible for comprehensive public healthcare, covering most necessities. Spouses and children of the insured person also benefit from coverage.
However, lengthy waiting times for surgeries, procedures, and appointments with specialist doctors are often mentioned as a primary drawback of Spain’s public healthcare system, prompting many to consider private medical insurance.
Who is Eligible for Public Healthcare in Spain?
To access public healthcare in Spain, you’ll require:
- Legal residency status.
- Registration with the Instituto Nacional de la Seguridad Social (INSS), the National Institute of Social Security.
- Possession of a public health card known as TSE or TSI (tarjeta sanitaria individual). This card must be presented during visits to public hospitals, health centers, or pharmacies.
You can obtain a Spanish health card at your local primary healthcare center (centre d’atenció primària – CAP). This card allows registration with an individual doctor or health center within your local healthcare district. However, referrals from your family doctor are necessary to see other specialist doctors.
For individuals who don’t meet the criteria for public healthcare (e.g., not employed in the country), the Spanish Social Security provides a special payment scheme called the Convenio Especial. This scheme allows access to the public healthcare system for a monthly fee. You can apply for the Convenio Especial by submitting the form TA-0040 at the social security office in your place of residence.
An Overview of private healthcare in spain for expats
Private healthcare services coexist with the public system, often within healthcare centers (centros de salud). If you undergo a procedure not covered by state healthcare, you’ll need private expat healthcare in Spain or cover the entire medical costs. Many opt for private expat healthcare Spain to access better and faster treatment.
Expats often prefer private insurance due to a 2013 change in Spanish healthcare laws, limiting access to specific healthcare services. Furthermore, expats require health insurance proof when applying for visas. It’s advisable to have travel health insurance from your home country or, preferably, obtain a private healthcare plan in Spain for expats. Local insurance companies understand the healthcare system and coverage specifics within your plan.
Average Cost of Private healthcare in spain
The cost varies depending on your age, gender, and pre-existing conditions. Health insurance ranges from 100 to 200 EUR (112 to 224 USD) per month on average. Some major insurance companies offer plans as low as 50 EUR (56 USD) per month. Private primary care consultations and specialist visits generally cost between 100 and 150 EUR (112 to 168 USD) per consultation.
Basic, affordable private healthcare for expats in Spain insurance plans in are available for services not covered by public health insurance. These plans include services like dental care and blood tests but exclude surgeries and hospital stays.
Healthcare facilities in Spain for expats
primary care centers in Spain
Basic primary-level services aim to cater to citizens’ general health needs. These services, offered by physicians, are easily accessible to tackle prevalent health concerns.
Specialized health Care Centers and hospitals in Spain
Specific services are available at Specialized Centers and Hospitals throughout the country, whether on an outpatient basis or through patient admission. These services ensure continuity and fairness for all individuals.
Healthcare services are determined by the resources of the national health system, covering preventive, diagnostic, therapeutic, rehabilitative, health promotion, and preservation aspects.
Furthermore, specialized attention is provided for specific at-risk population groups: adolescents, women, the elderly, children, chronic patients, etc., aiming to address their unique needs comprehensively.
To request an ambulance, dial the pan-European emergency number 112. Alternatively, you can directly visit a hospital or emergency room. However, for other hospital treatments, a referral from a primary care physician is necessary.
Ambulance Services in Spain
To request emergency assistance (ambulance, police, fire department) in Spain, simply dial the number 112. The emergency responders consist of trained personnel, including at least one emergency physician, nurse, emergency medical technician, and patient transport assistant. Spain’s emergency medical services operate on a two-tiered response system: Advance Life Support with physicians and nurses, and Basic Support with technicians. Once they evaluate your situation on-site, they will transport you to the nearest hospital.
Emergency care is typically covered by Spain’s public healthcare system. However, if you have private healthcare or are not yet eligible for Spanish healthcare, you might need to personally cover the expenses and then later submit the invoice to your healthcare provider for reimbursement.
Spanish pharmacies
Over-the-counter medication in Spain is sold at pharmacies without requiring a prescription. For prescription medication, you’ll need a doctor’s prescription, which you can then use to acquire the medicine from a pharmacy. In most cities and towns, multiple pharmacies operate, taking turns to remain open beyond regular hours. You’ll usually spot a notice on the window or door indicating the nearest 24-hour pharmacy (farmacia de guardia). Additionally, comprehensive lists of pharmacies are available online.
Regarding prescription fees in Spain: children receive medication at no cost, pensioners on state pensions are charged only 10%, whereas employed Spanish citizens face the highest rate, with a fee of 60%.
Specialized healthcare professionals in Spain
Doctors and specialists
As part of Spain’s public healthcare system, you have access to a family doctor who offers free consultations. To access this service, simply register at your local clinic and bring your registration documents. After registration, a family doctor will be assigned to you. These general practitioners can refer you to specialists within the public healthcare system, whether at hospitals or specialized centers. If you visit a specialist without a referral, your insurance may not cover the costs.
Please note that waiting times can be long for frequently requested tests or specific specialist services.
Emergency care is covered within the public healthcare system, including hospital visits for emergencies or necessary surgeries. Both public and private hospitals in Spain are internationally recognized for their quality. However, a downside of public healthcare in Spain is the extended waiting lists for specialists and non-emergency treatments.
Dentists in Spain
One of the most frequent questions posed by users of dental services is: What does the Social Security dentist cover? Although several months ago the government announced it would study the expansion of public health service coverage regarding dental treatments, the truth is that these coverages have not yet been modified. Patients still need to visit a private practice to receive certain services. In Spain, this coverage is divided by age groups and types of treatments.
Treatments for children covered by the Social Security dentist
In Spain, the Social Security dentist covers the following treatments for children:
- Application of topical fluoride.
- Fillings and sealants for permanent teeth fissures.
- Treatment for malformations or trauma in permanent incisors or canines.
- Comprehensive oral check-ups to assess the general condition of the mouth, the presence of cavities, or gum health.
- Root canal treatments for permanent teeth or extraction (if necessary).
- Fillings.
- Dental cleaning in case of detected tartar or discoloration on permanent teeth.
- Information campaigns about oral hygiene habits.
- Special programs conducted by both the Social Security and the Health Departments of the Autonomous Communities.
Dental treatments for adults under Social Security For adults
The Social Security dentist covers treatments such as:
- Infections or inflammations.
- Tooth extractions, including wisdom teeth.
- Dental trauma.
- Lesions on the oral mucosa.
- Minor oral cavity surgeries.
- Biopsies. Acute conditions of the jaw joint.
- Diagnoses.
- Pharmacological treatments for diagnosed pathologies.
- Guidance on hygiene habits.
What dental treatments are not included?
In any case, the dentist within the public health service does not cover treatments categorized under Cosmetic Dentistry. Therefore, if you need veneers, dental implants, teeth whitening, or orthodontics, you must visit a private dental clinic. This is when private healthcare insurance in Spain for expats comes in handy.
The first dentist appointment and dental check-up are often free of charge, but any procedures thereafter are charged. The prices are set by each medical practice. For reference, a filling tends to cost around 60 EUR (67 USD).
Specialized healthcare in Spain
Children’s healthcare
Currently, pediatric primary care is fundamental and essential. However, we face a changing landscape with the decrease or near disappearance of preventable infections due to vaccinations. Yet, other infectious diseases persist or even reappear. Conditions arising during the perinatal period, chronic and degenerative diseases gain greater relevance. Moreover, there is an increase in disabilities among children surviving severe illnesses. Despite this, the pediatric population remains the most vulnerable, especially those with fewer economic and social resources. Additionally, relatively new demographic phenomena in our country, such as immigration and the adoption of children from other countries, must be considered. The inclusion of nursing in pediatric care has significantly contributed to this change.
Mental healthcare
The situation of mental health and well-being among Spanish individuals portrays significant psychological distress in a context of limited public resources. A striking 22.8% of the Spanish population has personal experience with mental health issues. Notably, 18.9% consume psychotropic medications, and 26.2% are currently seeking mental health specialist assistance. Furthermore, 44.9% of the population faces the current situation with concern.
If you require mental health treatment, you can consult your family doctor for a referral. However, better assistance is often available through private healthcare insurance in Spain for expats.
Sexual and reproductive health in Spain
The sexual and reproductive health services in the Spanish public healthcare system are usually comprehensive and accessible to the population. These services include:
Family planning: Access to contraceptives, counseling on contraceptive methods, and, in some cases, free placement of intrauterine devices (IUDs) or prescription of hormonal contraceptives.
Prenatal care: Pregnant women receive complete prenatal care, including ultrasounds, laboratory tests, medical consultations, and pregnancy monitoring.
Obstetric care: Services are offered for childbirth in public hospitals, including medical care during labor and postpartum care.
Gynecological care: Gynecological check-ups, Pap smears, diagnosis, and treatment of gynecological diseases.
Prevention and treatment of sexually transmitted diseases (STDs): Free and confidential testing, diagnosis, and treatment of STDs are provided.
The services may vary slightly by region and might require a referral from a primary care physician to access some specialized treatments. However, overall, quality services covering a wide range of sexual and reproductive health needs are offered.
Women’s healthcare in Spain
In the public healthcare system in Spain, comprehensive care for women’s health is provided, including a variety of specific services:
Gynecological Health: Routine gynecological exams, Pap smears, diagnosis, and treatment of gynecological diseases, including monitoring of menstrual cycles, menopause, and other specific issues.
Family Planning: Access to contraceptive methods, guidance on family planning, and in some cases, free placement of intrauterine devices (IUDs) or prescription of hormonal contraceptives.
Prenatal and Obstetric Care: Pregnancy monitoring, ultrasounds, laboratory tests, assistance during childbirth, and postpartum care.
Early Detection and Treatment of Breast Cancer: Screening mammograms and follow-up programs for breast cancer, as well as diagnosis and treatment in case of early detection.
Comprehensive Sexual Health Care: Assessment and treatment of sexual health issues, prevention and treatment of sexually transmitted infections (STIs).
These services are available in primary care centers and public hospitals. Coverage may slightly vary by region, but overall, high-quality care tailored to women’s specific health needs is provided.
Abortion is legal in Spain. The procedure can be carried out within the first 14 weeks of pregnancy. In cases where there’s a serious health risk for either the individual or the child, termination can be done up to 22 weeks. After 22 weeks, termination is permitted only when the fetus is not viable or when a severe, incurable disease is detected.
As of 2022, Spanish law permits individuals aged 16 and 17 to undergo abortions without parental consent. Additionally, the government provides state-funded paid leave for women experiencing severe menstrual pain.
Access to gynecologists and midwives is available through public or private healthcare options. While most births occur in hospitals, there’s a growing trend of home births. However, public healthcare doesn’t cover home births.
The Spanish Ministry of Health offers extensive resources for women facing domestic abuse or sexual violence, including support for victims of human trafficking. In case of these issues, emergency services can be reached by calling 112.
Healthcare for seniors
Healthcare for the elderly in Spain is designed to address their specific health and wellness needs. Some key aspects include:
- Integral Medical Care: Primary care centers offer general medical services, allowing seniors to access regular consultations with family doctors and nurses for chronic disease management, treatment follow-ups, and vaccination.
Specialized Care Programs: Public hospitals provide hospital care for acute illnesses or specialized treatments. There are specialized geriatric units focusing on the specific health needs of older adults.
Long-Term Care: There are long-term care centers and nursing homes for seniors requiring ongoing assistance. These facilities offer personal care, medical attention, and recreational activities.
Health Prevention and Promotion: Prevention and health promotion programs, such as vaccination campaigns, regular health check-ups, and tailored exercise programs for the needs of older adults, are conducted.
Social and Psychological Support: Emotional and psychological support is provided through social assistance services, offering guidance on available resources, retirement adjustment, among others.
Overall, the healthcare system in Spain strives to provide comprehensive and quality care to ensure the well-being of older adults.
If you possess a residence permit, you’ll have access to public healthcare in Spain. However, if you are retiring to Spain and haven’t contributed to social security payments, you might need to complete an S1 form (available in Spanish) or enroll in the special agreement (convenio especial) offered in your local community. Healthcare for retired expats in Spain can vary depending on your contribution history, so it’s essential to explore all your options to ensure you’re adequately covered during your retirement.
Conclusion
Navigating Spain healthcare for expats may seem complex initially, but with the right information and preparation, you can access quality medical services. Whether you opt for the public system, private insurance, or a combination of both, understanding your options will contribute to a healthier and happier expat experience in Spain.
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