Spanish Health Care System

One of the top issues to consider when moving to another country is the system of health care – it directly impacts your expenses. Besides, having a basic health insurance is mandatory in, perhaps, every country for staying within the country. Luckily, the Spanish health care system can boast affordability and its high quality – Spain’s system of health care is ranked among the best ones in the world. This page will show you how to deal with your health issues, Spanish pharmacies, how to apply for health insurance, and whether applying for an insurance is mandatory at all.
How the Spanish health care system functions
Spain spends over 10% of its GDP on health care, making it the 6th country in Europe by a number of doctors per 1,000 patients. If have arrived in Spain and get to work there, it means that you have access to public health care, which is totally free, though a part of your wage will be deducted for social security (that includes health care). So while a part of health care expenses are financed directly from the workers’ salaries, a large part is still funded by the state.

Spain’s public health care is ranked among the best ones in Europe
The Spanish state allows both public and private healthcare. Moreover, some hospitals in Spain may offer both private and public medical services. There is only one difference in opting between public and private health care for non-emergency treatments: you will get your treatment faster if you have a private health insurance. But the quality of medical services, naturally, does not change, even if you opt to use public medical services.
Public health care in Spain
As it was mentioned above, the Spanish health care system provides free (apart from social security payments, deducted from your salary) public medical services. Though, you may encounter some problems if you are living on one of the Spanish islands – you might be forced to go to the mainland in order to find a state provider of health care.

In order to be entitled to free public health care, you should belong to one of the following categories:

If you are entitled to a temporary stay in Spain or having an EHIC card;
If you are retired;
If you are aged under 26 and you study in Spain;
A child, who is also a resident of Spain;
A pregnant woman, who is also a resident of Spain;
A resident of Spain, who recently divorced from ex-spouse who paid social security contributions;
A resident of Spain, who receives benefits from the state;
A resident of Spain, who works (either employed or self-employed) and pays contributions to social security.

If you do not belong to any of these categories, then you may have a need to purchase a private health insurance. If not, you will be asked to pay for the medical services, received at hospital upon a visit. Also, the government of Spain may offer you a special scheme of state insurance, known as convenio especial, whereas you will be asked to pay for it on the monthly basis.

You must be aware that the Spanish health care system is financed by the contributions to social security, but, considering that the state has a decentralized system of health care, local governments are responsible for the health budgets and quality of medical services. Sometimes, the conditions for using free public medical services may vary across the regions as well.
Getting registered for public health care in Spain
In order to be entitled to public health care in Spain, you need to have a health card and a SIP (Sistema de Information Poblacional) card. You can obtain it by completing the following steps:

Go to one of the social security offices (you can find them here) and receive your social security number. You can receive the SSN only after registering your details at the town hall and providing the following documents in the social security office: residency certificate, ID card (or passport), and filled application form.
After doing so, you will receive your SSN and a certificate which shows your eligibility for public health care. You need to take your foreigner’s identity number (NIE), passport, the certificate and bring it to a local health center.
At the local health center, you need to get registered at a doctor’s office and apply for your personal health card (known as TSI or tarjeta sanitaria individual). At that health center, you will also have to arrange getting a SIP card, which you will have to show each time you take prescription drugs or visit a hospital.
Collect the health card at the health center, unless it was sent to you by mail (you will be told about card delivery at the health center).

How to deal with hospitals and doctors
Once you are registered, you can receive professional medical help at health centers or by visiting a general doctor (known as médico de cabecera). Each health center has around 6-7 doctors, so you may see different doctors upon your visits – though, you can book an appointment with a particular doc (especially if you are undergoing an ongoing treatment).

Many medicines that are hard to get in other European countries without prescriptions (such as antibiotics) can be sold over-the-counter in Spain
Doctors at those health centers may offer both private and state healthcare, so you should be clear with what type of health care you expect to receive from the very beginning. You will also be provided with a leaflet that lists your rights as a patient. If you want to make an appointment with a specialist, you must be referred by your family doctor.

In the case of urgency, you should go directly to an ER (or A&E) hospital (Urgencias). Upon your visit to a hospital, you will be asked to provide either the social security number or your private insurance.

Dental treatments are not provided by the Spanish health care system (public), unless it’s a case of urgency. So you should either pay directly to a dentist or have a private health insurance.
How to deal with Spanish pharmacies
Spanish pharmacies can easily be recognized: each pharmacy has a sign of a green cross. Here you can find closest pharmacies and pharmacies that are available 24/7 (they are not as frequent).

Pharmacies in Spain can easily be recognized thanks to the sign of a green cross
In the Spanish health care system, there are different percentages of non-refundable costs that you should pay for prescription drugs (look here).

You pay 60% of the drug cost if:

You are a state pensioner, who receives more than 100,000 Euro income per year;
You are a worker, whose income exceeds 100,000 Euro per year.

You pay 50% of the medication cost if:

You are a worker, whose annual income ranges between 18,000 and 100,000 Euro.

You pay 40% of the drug cost if:

You are a worker, whose annual income is lower than 18,000 Euro.

You pay 10% of the medication cost if:

You are a state pensioner, who receives less than 100,000 Euro income per year.

Useful sources
Here are some more useful sources regarding the Spanish health care system:

Social Security Office of Spain

Ministry of Health, Social Services and Equality