Spain (ES)

Spain is a parliamentary constitutional monarchy of 17 autonomous communities stretching from the sun-scorched Andalusian coast to the Pyrenean peaks, renowned for its passionate flamenco and football culture, world-famous gastronomy from tapas to Michelin-starred restaurants, 300+ days of sunshine on the Costa del Sol and the Balearic Islands, and a relaxed Mediterranean pace of life that consistently ranks it among Europe's most desirable destinations for expats.

Capital: Madrid

Region: Europe

Language: Spanish

Currency: EUR (€)

Cost of living: Affordable (index 55)

Emergency: 112

Healthcare in Spain

Spain has one of the world’s best-performing universal healthcare systems (SNS — Sistema Nacional de Salud), consistently ranked among the top 10 globally for quality and outcomes. Funded through taxation and Seguridad Social contributions, with near-universal coverage. Primary care is strong and heavily used; specialist and surgical waiting lists can be long (3–12 months for non-urgent). Each Comunidad Autónoma manages healthcare directly — services are free at point of use but the system is regionally administered, and moving between regions requires transferring your Tarjeta Sanitaria Individual (TSI).

Ranked 7th in 2000 WHO ranking, consistently top 15 globally. OECD 2023: Spain has highest life expectancy in Europe (83.3 years). Very strong primary care, excellent maternal/infant outcomes. Main weakness: non-urgent specialist and surgical waiting times.

Public healthcare: Sistema Nacional de Salud (SNS)

National Health System

Eligibility:Universal. Covered automatically if you work and pay Seguridad Social, are a pensioner receiving Spanish pension, a beneficiario (dependent family member), or registered unemployed. EU citizens with EHIC covered short-term; long-term EU residents register as residents. Non-EU residents without Seguridad Social can access SNS via "Convenio Especial" (pay-in scheme — €60–157/month depending on age). Since RDL 7/2018, undocumented migrants also have access to primary and emergency care.

Monthly cost:Free at point of use. Funded via taxation and Seguridad Social contributions (4.70% employee + 23.60% employer, no separate health portion). For non-contributors: Convenio Especial €60 under 65 / €157 over 65 per month (buy-in). Private Spanish tax residents pay via general taxation.

What's included:

GP and paediatrician visits at Centro de Salud (no copay)
Specialist consultations via referral (no copay)
Hospital stays and surgery (no copay)
Emergency care 24/7 at hospital Urgencias
Pregnancy, childbirth, postnatal care including matrona (midwife) visits (100% covered)
Vaccinations and preventive care
Mental health via Salud Mental units (long waits)
Physiotherapy with specialist referral
Prescription drugs (with copayment, see below)

Not included (or co-pay required):

Dental care for adults (only extractions and emergencies covered; children get more) — private pay
Glasses and contact lenses (except children’s first pair in some regions)
Cosmetic procedures
Non-emergency dental work — private pay
Psychotherapy — extremely long waits (6–12 months); many pay private
Non-essential vaccines (travel, some flu categories)

Co-payments:Medical visits, hospital and specialist: free at point of use. Prescription drugs have copayment (Real Decreto-ley 16/2012, adjusted 2022–2024): Active workers < €18k/yr: 40% copay; €18k–50k: 50%; €50k–100k: 60%. Pensioners < €18k: 10% (capped at €8.23/month); €18k–50k: 10% (capped at €18.52/month). Low-income, chronic disease patients, Ingreso Mínimo Vital beneficiaries: 0% copay. Children of chronically ill patients: 10% capped at €4.24/month.

How to enrol:1. Empadronamiento at Ayuntamiento (address registration) — required. 2. If working: Alta en Seguridad Social (your employer files within 30 days; autónomos file TA.0521). 3. Go to your assigned Centro de Salud with número de Seguridad Social, empadronamiento, DNI/NIE/TIE. 4. They issue your Tarjeta Sanitaria Individual (TSI) within 1–4 weeks — some regions issue digital TSI immediately via mobile app. 5. You are assigned a médico de familia (GP) and pediatra (for children) based on your address.

Waiting period:None for SNS access itself once registered. Non-urgent specialist appointments typically 3–12 weeks wait. Surgery wait lists: 1–12 months depending on procedure.

Private healthcare: Seguro Privado (Private Health Insurance)

Who can use it:Open to anyone. Many expats buy private cover as a complement to SNS (for faster specialist access, dental, physio, English-speaking doctors) or as mandatory insurance for non-lucrative/digital nomad visa holders.

When it makes sense:Highly recommended: (1) visa holders required to carry private insurance (non-lucrative, digital nomad, student); (2) families seeking faster specialist access; (3) expats not yet registered in SNS; (4) those wanting English-language consultation in cities without strong SNS English coverage. Affordable: €40–90/month for under-50s is common.

Monthly cost:€40–70/month (young adults, basic cover), €90–180/month (middle-aged), €200–400+/month (over 60 or with pre-existing conditions). Family plans €180–350/month. Dental-included plans €10–25/month extra.

Major providers:

Sanitas (Bupa Group)Adeslas (SegurCaixa)MAPFREDKVAsisaAxa SaludHM HospitalesCigna Global (international)IMQ (Basque Country)

Accessing care

GP system

Every SNS user is assigned a médico de familia (family doctor) at their local Centro de Salud based on address. Change your assigned doctor via Tarjeta Sanitaria app or in person. Appointments via phone, app (Salud Madrid, La Meva Salut Catalonia, etc.) or in-person. Availability: usually same-day or 1–3 days wait for non-urgent. Consultations 7–15 minutes typical.

Specialist referral

You MUST go through your GP (médico de familia) for a referral (interconsulta) to SNS specialists — no direct access. Waits: 1–4 weeks (cardiology, dermatology) to 3–9 months (traumatology, ophthalmology) depending on region. For urgent cases, GP can mark "preferente" which cuts wait. Private insurance bypasses this: direct specialist booking.

Emergency care

Call 112 for life-threatening emergencies (free, English-speaking operators). For urgent-but-not-life-threatening: go to hospital Urgencias (A&E) directly — triaged with colour system. Wait times 30 min to 6 hours depending on severity. Out-of-hours primary care: Servicios de Atención Continuada / Puntos de Atención Continuada (SAC / PAC) at Centros de Salud (evenings, weekends, holidays). Free at point of use.

Out of hours

061 (medical emergencies) or 112 (all emergencies). Your Centro de Salud has a PAC / SUAP (Servicio de Urgencias de Atención Primaria) for evenings/weekends. Urgencias at any public hospital 24/7.

Prescriptions

Prescriptions (recetas) are issued electronically. Your médico logs the prescription into Receta Electrónica — you collect at any farmacia with your Tarjeta Sanitaria and pay your copayment (0–60% depending on income). Chronic medications renewed automatically on schedule for up to a year.

Dental

SNS covers almost nothing for adults — only extractions, emergencies, oral cancer screening. Children 6–15 (some regions to 17): annual check-up, basic treatment covered under Plan de Salud Bucodental Infantil. Most adults pay private: routine check-up €40–80, cleaning €60–120, filling €60–120, crown €400–900, implant €1,200–2,500. Dental insurance policies (Sanitas Dental, Adeslas Dental) from €10/month cover standard procedures.

Mental health

SNS mental health is available but heavily backlogged. Waiting lists for psicología clínica 3–9 months typical. Psiquiatría generally faster. The 2022 Plan de Acción Salud Mental and the 024 suicide helpline (free, 24/7) reflect national priority but resources are still constrained. Most expats pay private: €50–90/session in-person, or use Spanish/international online platforms (TherapyChat, Mindgram, BetterHelp).

Maternity

Excellent SNS coverage. Pregnancy monitored by médico de familia + matrona (midwife) + obstetra. All consultations, ultrasounds, tests and birth free. Parto natural, cesarean, epidural all fully covered. Hospital stay after birth: 2–4 days typical. Maternity leave: 16 weeks (prestación por nacimiento y cuidado de menor, 100% paid by Seguridad Social). Paternity leave: 16 weeks (equal since Ley 6/2019). Shared parental care strongly supported.

Expat-specific advice

First steps on arrival:

Empadronamiento at Ayuntamiento within 3 months of arrival
Get your NIE/TIE (non-EU) or Certificado de Registro (EU)
Register with Seguridad Social via your employer (or directly as autónomo) to obtain número de la Seguridad Social
At your local Centro de Salud: request your Tarjeta Sanitaria Individual (TSI) with passport/TIE, empadronamiento, número de Seguridad Social
Download your region’s health app: Madrid Salud, La Meva Salut (Catalonia), Mi Salud (Andalucía) — for appointments, prescriptions, test results
Identify your assigned médico de familia and pediatra
Consider supplementary private insurance if you want faster specialist access or dental cover

Finding English-speaking doctors:Hospitals and clinics in Madrid, Barcelona, Valencia, Málaga and the Balearic/Canary islands widely have English-speaking doctors. Major private hospitals (HM Hospitales, Ruber Internacional in Madrid; Hospital Universitari Dexeus, Hospital Clínic in Barcelona; Quirónsalud group nationwide) explicitly market English service. Smaller cities and rural SNS centres have limited English — bring a translator or use Google Translate.

International insurance:Non-lucrative and digital nomad visa holders must hold private insurance with zero copay and full Spain coverage for the duration of the visa — even if subsequently registered in SNS. Popular providers: Sanitas, Adeslas, MAPFRE, DKV (Spanish); Cigna Global, Allianz Care, IMG (international). Typical cost: €600–1,500/year per adult.

Emergency card info:Carry your Tarjeta Sanitaria Individual (TSI) — either physical card or digital version in your region’s app. Memorise 112 (all emergencies). Know your Centro de Salud name and address. For non-EU residents awaiting TSI: carry your NIE/TIE + empadronamiento + passport. A medical ID bracelet or a Centro de Salud’s emergency contact entry in your phone (ICE) is recommended for chronic conditions.

EHIC notes:EU/EEA/Swiss citizens: EHIC (Tarjeta Sanitaria Europea) covers medically necessary care during short visits — NOT a substitute for Spanish resident registration. Once you empadronas and work in Spain, you must register with SNS via your empresa or as autónomo. Non-EU residents do NOT have EHIC.

Pharmacies (Farmacia)

Hours:Typically Mon–Fri 9:30–14:00 + 17:00–20:30; Sat 9:30–14:00. Closed Sundays most locations. Rotating farmacia de guardia (24h duty pharmacy) system ensures 24/7 access in every district — posted outside every farmacia and at farmaciasdeguardia.com.

After-hours / emergency:Farmacia de guardia open 24h on a rotating basis within each district. Look for the green cross lit outside the farmacia or check farmaciasdeguardia.com or the app of your Colegio de Farmacéuticos. Night surcharge typically €1.50–3.

Prescription rules:Medicamentos con receta médica: require prescription, scanned via Tarjeta Sanitaria from the Receta Electrónica system. Over-the-counter (medicamentos sin receta, EFP) include paracetamol, ibuprofen (≤400mg), simple antihistamines. Farmacéutico consultation is free and encouraged. Antibiotics require a prescription.

Available over-the-counter:

Analgesics: paracetamol, ibuprofen 400mg
Cold & flu: Frenadol, Couldina, Termalgin, Nolotil (only with prescription since 2023 regulatory change)
Allergy: Cetirizina, Loratadina
Digestive: Almax, Gaviscon, Omeprazol (low dose)
Throat: Strepsils, Mebucaina
First aid: Betadine, apositos, suero fisiológico
Suplementos: multivitáminas, hierro, vitamin D3
Basics: paracetamol for children (Apiretal, Dalsy)

Typical costs

GP visit (with insurance)	€0 (SNS) or €0 direct-bill (most private insurance)
GP visit (private pay)	€50–90 (private consultation without insurance)
Specialist visit	€0 (SNS with referral) / €70–150 (private without insurance)
Emergency visit	€0 (SNS) / €150–400 (private ER)
MRI scan	€0 (SNS with referral) / €200–400 (private)
Prescription average	€1–12 (copay for common drugs, depends on income bracket)
Dental check-up	€40–80 (private, not covered for adults in SNS)
Baby delivery	€0 (SNS) / €3,000–7,000 (private)

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