In Spain there is both paid and free healthcare. In the first case, we are talking about serving citizens in private medical institutions on the basis of health insurance policies issued by private insurance companies; in the second case – about providing services to citizens in public medical institutions that are part of the social insurance system.
Unlike some European countries (for example, Germany), where public and private insurance are incompatible and you always have to choose one, in Spain you can combine paid and free healthcare. However, it must be remembered that a number of foreign citizens do not have access to public healthcare: this is enshrined in law and concerns, first of all, owners of residences without the right to work, who are required to have private medical insurance with full coverage.
All other Spanish citizens and resident foreigners who contribute to social security on their own or who are members of the family of a social security payer (natural or adopted dependent children under 26 years of age, as well as spouses and registered partners) can benefit from free healthcare and at the same time – voluntarily for personal reasons – pay for private health insurance at their own expense, which gives access to private specialists.
Public medicine in Spain
Public healthcare in Spain is financed from the Social Insurance Fund – Seguridad Social. Pensions, subsidies, benefits and other social benefits are paid from the same fund. The fund is replenished by deductions from wages of employees, social quotas of entrepreneurs, contributions from cooperative employees, etc.
The provision of public health care in Spain is regulated by domestic laws, general European legislation and bilateral agreements signed by Spain with a number of countries.
Who has the right to count on free healthcare in Spain?
The following have access to free public healthcare in Spain:
- Citizens of Spain residing permanently in the country;
- Persons who do not reside permanently in Spain, but are entitled to free healthcare in the light of bilateral agreements;
- Foreign resident citizens legally and permanently residing in Spain, who are not required by current legislation to have private health insurance;
- Citizens working in Spain as employees or as individual entrepreneurs, registered in the social insurance system, as well as members of their families mentioned above;
- Pensioners receiving a pension from social insurance, as well as recipients of other payments, benefits or subsidies;
- Unemployed citizens who have already received benefits or assistance due to them, but are still looking for work and do not have private insurance.
- Persons with disabilities (degree of disability from 65% and above) regardless of residence.
In addition, minor children, victims of violence and pregnant women in an illegal status have the right to free healthcare in Spain.
Access to free medicine for other categories of illegal foreigners directly depends on the decisions of regional authorities. In some autonomies, it will not be difficult for an illegal citizen to obtain a SIP sanitary card; in others, it will be a long and difficult struggle with the bureaucratic machine.
Public medicine in Spain for money
A special case of public medicine in Spain is the voluntary payment of social quotas for services in public medical institutions. Those. there is access without any restrictions to public medicine, but subject to self-payment of social quotas.
A clear example when a similar situation may arise: in the absence of the right to free medicine and at the same time in the impossibility of obtaining private health insurance (for example, due to the refusal of insurance companies to work with a client with chronic diseases).
You can apply for a state sanitary SIP card for money if the following conditions are met:
- It is possible to confirm a year of continuous residence in Spain;
- Available registration in Spain (document of registration at the place of residence);
- There is no right to access free healthcare in Spain.
Public health insurance in the Valencian Community costs:
- 60 € – for persons under 65 years of age;
- 157 € – for persons over 65 years of age.
The Alegria company provides assistance in obtaining medical insurance necessary to obtain a residence permit in Spain. Read more about the service here.
Private medicine in Spain
Private (paid) medicine in Spain is the only one available to a number of categories of foreign citizens – we will list them below. For all other residents of Spain, paid medicine is complementary or alternative: someone can get by with the state one for the rest of their lives, while others, in order to avoid queues for appointments with specialists, decide to pay for private insurance at their own expense.
Those citizens who are required by law to have private health insurance must choose insurance companies authorized to operate throughout Spain. The policy must provide full coverage without any additional payments, include hospitalization and repatriation.
All other citizens who voluntarily choose private medicine are not bound by any restrictions: their policies may include co-payments, have coverage restrictions, etc.
You must have full private health insurance in Spain in the following cases:
- When applying for a study visa (student residence) and its extension;
- Upon registration residence permit without the right to work (residencia no lucrativa), obtaining an entry visa D and subsequent extensions of a residence permit in Spain;
- When applying for an EU citizen certificate, if there is no employment contract;
- When registering a residence for family members of European citizens, if there is no employment contract.
Advantages of paid medicine in Spain
Paid medicine in Spain offers a wide choice of specialists, private medical offices and large treatment centers. The main advantage of paid medicine is the speed of service, the absence of huge queues to see specialists, and the opportunity to get to these specialists without going through a family doctor.
The choice of insurance companies and insurance programs is quite wide: you can choose the degree of coverage, the system of co-payments, and enter into an agreement with the company that covers the largest number of specialists in the nearest private hospital. Each doctor and private center works simultaneously with different insurance companies: both small regional and large national and international.
Insurance companies offer their clients a flexible system of discounts for each additional insured family member and for additional services (for example, dental insurance). As a rule, you can choose a payment system that is convenient for you: monthly, quarterly or once a year.
When taking out a private medical policy, it is necessary to keep in mind that all insurance companies provide for a “tiempo de carencia” – a period during which a new client cannot count on coverage for a number of services (usually from 6 to 12 months). Most often, time restrictions apply to complex studies, surgical operations, pregnancy and childbirth.
Paid healthcare in Spain: how much does it cost?
Each insurance company has its own pricing policy. The price of private insurance is calculated based on many parameters: the client’s age, the presence or absence of chronic diseases, a tendency to certain diseases due to lifestyle or individual indicators (excess weight, smoking, alcohol consumption, etc.), insurance coverage, additional options (service abroad, independent choice of a specialist, partial compensation for the costs of medicines and much more).
The average price of private health insurance for a person aged around 40 with no chronic diseases, with full coverage without co-payments, will be between 50 and 70 euros per month. For a person aged 65 years or older, it will be difficult to find insurance for less than 200 euros per month, and the number of private insurance companies working with elderly clients is small.
Level of medicine in Spain
The level of medicine in Spain and the equipment of medical centers are very high. This applies to both free and paid medicine. At the same time, prices for paid medicine continue to remain affordable, especially when compared with prices in other European countries.
The level of medicine is assessed by many indicators, including life expectancy, infant mortality, timely diagnosis of diseases in the early stages, reduction in the incidence of some chronic diseases, heart attacks, etc. In the world rankings, Spain is in 8th place, and the Spaniards themselves assess the work of their native healthcare system as quite good.
It is also worth noting that Spain occupies a leading position in the world in the number of transplantations and blood donations.
